Back of Heel Pain | South Texas foot specialist

Pain in the back of the heel can have several causes. The Achilles tendon attaches to the back of the heel and that area can become painful.

The most important cause is a "defective" attachment of the achilles tendon to the back of the heel. Basically there is too much side to side motion between the heel bone and the attachment of the Achilles and that sets up an area of inflammation. The body tries to stabilize the area and lays down extra bone but the excess bone often causes one to feel a lump and is termed Achilles Insertional Calcific Enthesopathy or AICT. Initially the area of enlargement is composed of scar tissue, later calcification and finally ossification (bone formation). Bone formation on the back of the heel is often referred to as a “spur” due to the way the bone looks on x-ray.

Treatment may include physical therapy to calm down the inflammation and stretch any tightness out of the Achilles. An orthotic (shoe insert) with a deep heel cup may be used as it serves to decrease the side to side motion and protect the area. Excessive inward motion of the heel is termed “overpronation” and excessive outward motion is term “oversupination.”



A newer treatment involves the use of pressure waves or sonic shockwaves to break down the scarred tendon or calcium deposits. That treatment is known as ESWT or extracorporeal shockwave therapy. ESWT is performed in the office under local anesthesia and patients can usually return to work the next day.  If the condition has been untreated for a long time, the calcification can turn to bone which then requires surgical treatment.


Unlike pain on the bottom of the heel, surgical treatment may be needed more often for this problem and is easier and more successful. The Achilles is pulled back and any excess bone cleaned off the back of the heel bone and then the Achilles re-attached. Sounds like a big deal, but modern technology has provided us with some great tools such as bone anchors which make the re-attachment of the Achilles strong, easy - the goal is to have an Achilles that moves less against the heel bone once healed.

There is a major advantage to treat this early so that non-surgical treatments can be utilized.


For more information on Back of Heel Pain in the San Antonio, TX area, call Ed Davis, DPM, FACFAS. at (210) 490-3668 today!