Pain at the back of your heel most often comes from irritation of the Achilles tendon where it attaches to the heel bone, or from inflammation of the small fluid-filled sac (bursa) sitting just behind it. These two causes account for the majority of cases, but several other conditions can produce pain in the same spot, and telling them apart matters for choosing the right approach.
Achilles Tendon Problems
The Achilles tendon connects your calf muscles to your heel bone, and the point where it anchors into the bone is the most common source of posterior heel pain. Insertional tendinitis is inflammation right at that attachment site. You’ll feel tenderness if you press directly on the back of the heel bone, and over time, calcium deposits or a small bone spur can form just above the insertion point, making the area visibly swollen or bumpy.
This tends to develop from overuse. Increasing your running mileage too quickly, spending long hours on your feet, or ramping up any repetitive activity that loads the calf and heel can trigger it. The tendon doesn’t always recover between bouts of stress, and what starts as mild stiffness in the morning can progress to pain that lingers throughout the day.
A more serious possibility is a partial or complete Achilles tendon tear. This usually happens suddenly during a burst of activity: pushing off to sprint, jumping, or changing direction quickly. People often describe hearing a pop or feeling like they were kicked in the back of the leg. If you can’t push your foot downward with normal strength, or if you can feel a gap in the tendon when you run your fingers along it, those are strong signs of a tear that needs prompt medical evaluation.
Bursitis Behind the Heel
Tucked between the Achilles tendon and the heel bone sits a small cushioning sac called the retrocalcaneal bursa. Its job is to reduce friction when the tendon moves over bone, but repetitive loading or pressure from tight shoes can inflame it. When this bursa swells, you’ll notice pain slightly deeper than with tendinitis, felt more in the space between the tendon and the bone rather than on the surface.
The back of your heel may look puffy, feel warm, and turn slightly red. Pressing along the sides of the tendon, just where it meets the heel bone, typically reproduces the pain. Bursitis and insertional tendinitis frequently show up together, which can make self-diagnosis tricky. The key difference is location: bursitis pain is in front of (deeper to) the tendon, while tendinitis pain is right at or just below where the tendon meets the bone.
Haglund’s Deformity (Pump Bump)
Some people develop a bony enlargement on the heel bone right where the Achilles tendon attaches. This growth, called Haglund’s deformity, creates a visible bump you can see and feel through the skin. It earned the nickname “pump bump” because rigid-backed shoes like pumps or high heels press directly against it, making it especially painful.
The bump itself isn’t dangerous, but it creates a cycle of irritation. The bony prominence rubs against footwear, which inflames the overlying soft tissue and the nearby bursa, which causes swelling, which increases the friction. The single most effective thing you can do is switch to shoes with a soft or open back that don’t press on the bump. Backless shoes, soft heel counters, or cushioned pads placed inside the shoe can all reduce the mechanical irritation that keeps the pain going.
Sever’s Disease in Children
If the person with heel pain is between 8 and 14 years old, the most likely diagnosis is Sever’s disease, an inflammation of the growth plate in the heel bone. Children’s bones are still developing, and the ends where growth happens are made of cartilage that’s softer and more vulnerable to stress than mature bone. A tight Achilles tendon pulls on this growth plate during activity, especially during growth spurts when the bone is lengthening faster than the tendon can keep up.
Sever’s disease is extremely common in active kids and is not a sign of permanent damage. The pain typically resolves once the growth plate hardens into solid bone, though managing activity levels and stretching the calf in the meantime helps keep it comfortable.
Inflammatory Conditions Worth Knowing About
Sometimes posterior heel pain isn’t caused by overuse at all. Inflammatory forms of arthritis, particularly psoriatic arthritis and ankylosing spondylitis, can attack the exact spot where tendons and ligaments attach to bone. This type of inflammation is called enthesitis, and the Achilles insertion is one of its favorite targets.
The clue that your heel pain might be part of something systemic is what else is going on. If you also have stiffness in your lower back that’s worse in the morning, skin patches consistent with psoriasis, or pain at other tendon attachment points (like the bottom of the foot or around the knee), it’s worth mentioning all of these symptoms together. Blood tests can help identify underlying inflammatory conditions driving the problem.
How to Tell These Causes Apart
Where exactly the pain is and what triggers it narrows things down more than you might expect:
- Tenderness right where the tendon meets the heel bone: insertional Achilles tendinitis, possibly with bone spur formation.
- Pain deeper, between the tendon and bone, with visible swelling: retrocalcaneal bursitis.
- A hard bump on the back of the heel that hurts in stiff shoes: Haglund’s deformity.
- Sudden onset during activity with a pop or loss of push-off strength: Achilles tendon tear.
- Back-of-heel pain in an active child aged 8 to 14: Sever’s disease.
- Heel pain plus morning back stiffness or skin changes: possible inflammatory arthritis.
One useful physical check: if you’re on your stomach and someone squeezes your calf muscle, your foot should point downward. If it doesn’t, that suggests the Achilles tendon has torn and needs medical attention quickly.
What Helps Posterior Heel Pain
For most non-traumatic causes, the first step is reducing the mechanical load. That means temporarily pulling back on whatever activity triggered the pain, whether that’s running, walking long distances, or wearing rigid-backed shoes. Ice applied to the back of the heel for 15 to 20 minutes after activity can reduce inflammation in the early stages.
Eccentric calf exercises are one of the most well-studied treatments for Achilles tendon problems. These involve slowly lowering your heel below the level of a step, which loads the tendon in a controlled way that stimulates repair. A typical program starts with 3 sets of 10 raises on flat ground during the first two weeks, progresses to 3 sets of 15 off the edge of a stair through week five, then adds weight from weeks three through twelve. Both straight-knee and bent-knee versions target different parts of the calf. The exercises are performed daily, and the full program runs about 12 weeks.
For bursitis and Haglund’s deformity, footwear changes carry most of the weight. Open-backed shoes eliminate direct pressure on the bump. Heel lifts placed inside your shoe can reduce the angle at which the tendon pulls on the heel, decreasing irritation of both the tendon and the bursa. Stretching the calf gently helps in nearly every posterior heel condition by reducing the tension the Achilles places on the heel bone.
If the pain doesn’t improve after several weeks of consistent home management, imaging can clarify what’s going on structurally. X-rays reveal bone spurs or Haglund’s deformity. Ultrasound or MRI can show tendon thickening, bursal swelling, or partial tears that might change the treatment plan.