Rear Heel Pain: The Complete Guide to Diagnosing and Treating Posterior Heel Pain in 2026From Achilles tendinopathy to pump bumps — understanding causes, finding the right treatment, and choosing footwear that heals

Insertional Achilles tendinopathy is the most common cause of rear heel pain, especially in active adults over 40. Unlike mid-portion tendinopathy (which occurs 2–6 cm above the heel), insertional Achilles tendinopathy involves the very point where the tendon attaches to the calcaneus. Bone spurs often form at this site, though they are usually a consequence of the condition, not the primary cause of pain.

Symptoms include a dull ache at the back of the heel that worsens with activity and feels stiff after rest. You may notice a visible bump or thickening at the insertion point. Squeezing the sides of the heel often reproduces pain. This condition is strongly associated with tight calf muscles, overpronation, and wearing shoes with rigid heel counters.

Treatment focuses on eccentric loading exercises performed with the foot in dorsiflexion, shockwave therapy, and heel lifts in shoes to reduce tendon strain. Surgery is reserved for cases that fail 6–12 months of conservative treatment.

The retrocalcaneal bursa sits between the Achilles tendon and the heel bone. When this bursa becomes inflamed — often from repetitive friction or direct pressure — it produces a sharp, localized pain just above the heel bone. The area may feel warm and swollen, and pressing on the space just in front of the Achilles tendon reproduces pain.

Retrocalcaneal bursitis is common in runners who increase mileage too quickly, and in people who wear shoes with a rigid, high heel counter that digs into the back of the heel. It can also occur alongside insertional Achilles tendinopathy, making diagnosis more complex.

Initial treatment includes activity modification, ice massage (use a frozen water bottle on the back of the heel for 10 minutes), and anti-inflammatory medications. Heel lifts and open-back shoes or sandals can provide immediate relief by removing pressure from the bursa. In persistent cases, a corticosteroid injection may be considered, but this carries a risk of Achilles tendon rupture if not performed with ultrasound guidance.

Haglund’s deformity is a bony enlargement on the back of the heel bone (calcaneus) that rubs against the Achilles tendon and adjacent bursa. It earned the nickname “pump bump” because it is common in women who wear high-heeled pumps with rigid backs that press against this area. However, it can affect anyone who wears shoes with a firm heel counter.

The hallmark sign is a visible, hard bony prominence on the back of the heel. Unlike insertional tendinopathy, the pain is often more superficial and related to shoe pressure. The overlying skin may become red, thickened, or develop a callus. Haglund’s deformity is often genetic — some people are simply born with a more prominent calcaneus — but it can also develop over time due to chronic irritation.

Conservative care includes open-back shoes, padding over the bump, and heel lifts. Ice and anti-inflammatory medications help during flare-ups. Extracorporeal shockwave therapy can reduce pain in some cases. Surgery to shave down the bony prominence is effective but requires a prolonged recovery (6–8 weeks non-weight-bearing).

A complete or partial rupture of the Achilles tendon is a medical emergency. It typically occurs during a sudden explosive movement — pushing off with the foot while the knee is extending, as in sprinting, jumping, or stepping into a hole. Many people describe a “pop” or “snap” sensation, often thinking they were kicked or struck from behind.

Signs include severe pain at the back of the heel, inability to stand on tiptoes on the affected side, and a palpable gap in the tendon. The Thompson test (squeezing the calf while the patient lies face-down — if the foot doesn’t plantarflex, the tendon is likely ruptured) is a reliable clinical indicator.

Treatment can be surgical or non-surgical depending on age, activity level, and the degree of rupture. Non-surgical treatment involves immobilization in a cast or boot in a plantarflexed position for 6–8 weeks, followed by progressive rehabilitation. Surgical repair offers a slightly lower re-rupture rate but carries risks of infection and nerve damage. Either way, rehabilitation takes 4–6 months and should be guided by a physiotherapist.

Sever’s disease is the most common cause of rear heel pain in children aged 8–14 years, particularly in physically active kids who play sports that involve running and jumping. It is not a true “disease” but rather a traction apophysitis — inflammation of the growth plate at the back of the heel where the Achilles tendon attaches.

Pain is typically bilateral and worsens with activity, especially during running, jumping, or even walking. The child may limp or walk on their toes. Squeezing the sides of the heel reproduces pain. Sever’s disease is self-limiting — it resolves once the growth plate fuses, usually by age 14–16. But active management is important to keep children moving and pain-free.

Treatment includes relative rest, ice, calf stretching, and heel lifts (10–15 mm) in shoes. In most cases, over-the-counter heel cups or silicone heel pads are enough. Custom orthotics are rarely needed. The key is education: parents and coaches should understand that pushing through the pain can prolong recovery.

No. Plantar fasciitis causes pain on the bottom of the heel, not the back. Rear heel pain involves the posterior structures — the Achilles tendon, retrocalcaneal bursa, and the back of the calcaneus. The two conditions can coexist, especially in people with flat feet, but they require different treatment strategies.

Recovery time depends on the cause. With consistent conservative treatment: insertional Achilles tendinopathy typically improves within 8–12 weeks; retrocalcaneal bursitis often resolves in 4–6 weeks; Haglund’s deformity may take 12–16 weeks to settle. Complete healing of the tendon structure can take 6–12 months, though pain usually resolves much earlier. Patience is essential — rushing back to activity is the number one cause of relapse.

Yes, but you must modify your activities. Avoid running, jumping, and hill walking. Low-impact alternatives include swimming (using a pull buoy to minimize kicking), cycling with a moderate gear, and upper-body strength training. The key is to avoid activities that load the Achilles tendon under tension. Once your pain-free walking is established, slowly reintroduce exercise over 4–8 weeks.

Most people with Haglund’s deformity never need surgery. Conservative care — including open-back shoes, heel lifts, and physical therapy — resolves symptoms in 70–80% of cases. Surgery is considered only when pain significantly limits daily activities after 6+ months of non-surgical treatment. The procedure involves removing the bony prominence and reattaching the Achilles tendon, with a recovery period of 6–8 weeks non-weight-bearing and 3–4 months before returning to sports.

Extremely flat shoes (zero-drop, minimal soles) increase tension on the Achilles tendon and aggravate most forms of posterior heel pain. A small heel lift (8–15 mm) is almost always beneficial during the acute phase. This does not mean you need high heels — just shoes with a moderate heel-to-toe drop. Over time, as pain resolves, you can gradually transition to lower-drop shoes if you prefer them.