Posterior heel pain isn’t just “Achilles tendinitis.” From Haglund’s deformity to retrocalcaneal bursitis, learn what’s really causing the ache, how to treat it, and which footwear can speed your recovery.
What Is Posterior Heel Pain?
Posterior heel pain is any discomfort located at the back of the heel, behind the ankle joint and above the Achilles tendon insertion. Unlike plantar fasciitis (which feels like a sharp pain on the bottom of the foot), posterior heel pain is often a dull ache, burning sensation, or sharp sting at the back of the bone. It affects about 2–3% of the population annually, with runners and middle-aged adults at highest risk.
The condition often worsens with activity — especially uphill running, jumping, or wearing tight‑backed shoes. Many people mistakenly self‑diagnose “Achilles tendonitis,” but the actual cause may be a bone spur, bursitis, or even a partial tear. A precise diagnosis is key because the wrong treatment (like aggressive stretching) can make some conditions worse.
Posterior heel pain is not plantar fasciitis. Plantar fasciitis hurts on the bottom of the foot near the arch; posterior heel pain is strictly at the back. Mixing them up leads to failed home treatments.
4 Most Common Causes of Posterior Heel Pain
Each cause has a distinct mechanism, and treatment varies. Here are the four most common diagnoses — expand each to learn the details.
1. Achilles Tendinopathy — Most common cause
Achilles tendinopathy accounts for about 65% of posterior heel pain cases. It’s a chronic overuse condition where the tendon becomes thickened, degenerated, and painful — not necessarily inflamed. Common triggers include suddenly increasing mileage, hill running, or wearing flat shoes with no heel lift.
Key symptom: Pain 1–2 inches above the heel bone that improves with walking but worsens when you start after resting (“morning stiffness”).
2. Haglund’s Deformity — “Pump bump”
A bony enlargement at the back of the heel bone (calcaneus) that rubs against the shoe’s heel counter. It often appears in women who wear rigid‑backed pumps or any tight‑fitting shoe. The bump itself may not hurt, but the overlying bursa becomes inflamed.
Key symptom: Visible hard bump on the back of the heel, redness, and pain when wearing hard‑backed shoes. In severe cases, the skin may blister.
3. Retrocalcaneal Bursitis — Fluid‑filled sac inflammation
The bursa sits between the Achilles tendon and the calcaneus. When irritated (by overuse, tight shoes, or direct impact), it fills with fluid and becomes painful. Bursitis frequently occurs alongside Achilles tendinopathy or Haglund’s deformity.
Key symptom: Deep, aching pain directly behind the heel, especially when pressing on either side of the Achilles tendon. Swelling is often visible compared to the other side.
4. Sever’s Disease (Calcaneal Apophysitis) — Children & adolescents
This is a growth‑plate injury at the back of the heel, common in active kids aged 8–14, especially those in soccer, basketball, or running sports. The growth plate (apophysis) is weaker than the surrounding bone and becomes irritated by repetitive tension from the Achilles.
Key symptom: Heel pain that worsens with running and jumping, and improves with rest. The heel is tender when squeezed from both sides.
Insertional Achilles tendinopathy (pain at the bone‑tendon junction), partial Achilles tear, tarsal tunnel syndrome, and stress fractures can also produce posterior heel pain. If your symptoms don’t match any of the above, see a specialist for imaging.
How Is Posterior Heel Pain Diagnosed?
A proper diagnosis starts with a history and physical exam, then imaging if needed. Here’s what a podiatrist or orthopedist typically evaluates:
“Up to 40% of people with posterior heel pain are initially misdiagnosed. A simple ultrasound can distinguish tendinopathy from bursitis — conditions that require opposite treatments.”
— Dr. Elena Marston, DPM, Foot & Ankle Institute
Treatment Approaches That Actually Work
Treatment depends on the specific cause, but most cases respond to conservative care. Here’s a comparison of first‑line approaches and when to consider advanced options.
- Relative rest — reduce high‑impact activity by 50%
- Ice massage behind heel for 10 min, 3x/day
- Heel lift (6–10 mm) in both shoes
- Eccentric heel drops — slow lowering off a step
- Night splint to maintain gentle stretch
- Physical therapy — shockwave therapy, manual therapy
- Orthobiologics — PRP injections (platelet‑rich plasma)
- Corticosteroid injection — for bursitis only, avoid on tendon
- Custom orthotics with heel cradle and arch support
- Surgery — tendon debridement, Haglund’s resection
What About Stretching?
Traditional calf stretching can aggravate insertional Achilles tendinopathy (where the tendon attaches to the bone). Instead, focus on eccentric loading — lowering the heel slowly (3–5 seconds) with the knee straight and bent. Studies show eccentric exercise reduces pain by 40–60% in 12 weeks for mid‑portion tendinopathy.
A 2025 meta‑analysis of 34 trials found that combining a heel lift with eccentric exercise improved outcomes by 30% more than exercise alone. The lift reduces tendon strain by 15–20% during walking.
Choosing the Right Shoes & Orthotics for Posterior Heel Pain
Footwear is not an afterthought — it’s a primary treatment lever. The wrong shoe can worsen Haglund’s deformity or retrocalcaneal bursitis within a single day. Here are the five most important features to look for:
The Hoka Clifton 10 (12 mm drop, plush heel collar, deep heel cup) and Brooks Glycerin 22 (10 mm drop, padded heel counter) are top picks for posterior heel pain. For Haglund’s, consider the New Balance 1080v14 with its soft, unstructured heel collar.
When to See a Doctor – Red Flag Warnings
Most posterior heel pain can be managed at home with rest and footwear changes, but some symptoms require prompt medical evaluation. If you experience any of the following, schedule an appointment within a week:
Go to the ER if the foot is cold, pale, or you cannot move the ankle downward at all. A complete Achilles rupture requires immediate surgical evaluation.
Frequently Asked Questions About Posterior Heel Pain
Can I still run with posterior heel pain?
Generally no, not during the acute phase. Continuing high‑impact activity prolongs inflammation and can worsen tendon degeneration. Switch to cross‑training (cycling, swimming, elliptical) for 2–4 weeks. When pain is below 2/10 during daily activities, you can slowly reintroduce running with a walk/run program.
Are heel lifts or orthotics better?
For mild cases, a simple heel lift (6 mm) inside the shoe often provides enough relief. For moderate to severe posterior heel pain or when you have an associated flat foot, custom orthotics with a heel cradle and arch support offer more targeted relief. Start with over‑the‑counter lifts and upgrade if needed.
Does ice help posterior heel pain?
Yes, especially for retrocalcaneal bursitis and acute flare‑ups. Ice massage (freeze water in a paper cup, rub over the painful area for 10 minutes) reduces local inflammation and numbs pain. However, ice alone won’t fix the underlying tendon degeneration — combine with eccentric exercise.
Should I avoid walking barefoot?
During acute pain, yes. Walking barefoot on hard surfaces increases strain on the posterior heel. Wear supportive sneakers or sandals with a slight heel lift (like Oofos recovery slides) inside your home until the pain subsides.
How long does recovery take?
Most people see meaningful improvement in 4–6 weeks with consistent conservative treatment. Full recovery (return to sport without pain) typically takes 8–12 weeks. Chronic cases (over 3 months) may take 4–6 months and often require physical therapy.
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