What Is the Back of the Foot Called?

Most people call the back of the foot the heel, and in everyday speech that is correct. Doctors and scan reports usually reach for a broader word, the hindfoot, which covers the whole rear part of the foot and not just the rounded part you stand on.¹ The names matter most when the back of your foot hurts, since they point to which structure is involved.

Heel, Hindfoot and Calcaneus

Anatomists divide the foot into three regions: the hindfoot at the back, the midfoot, and the forefoot near the toes.² The hindfoot starts at the ankle joint and ends at a joint partway along the foot where it meets the midfoot.³⁴

Only two bones make up the hindfoot: the talus and the calcaneus.⁵ The talus, or ankle bone, sits on top and forms the lower half of the ankle joint.⁶ The calcaneus is the largest bone in the foot and is what people mean by the heel bone.⁷ On a report, “calcaneal” simply means “of the heel bone.”

These words turn up in different places. An X-ray or MRI report may say hindfoot, calcaneus or calcaneal tuberosity instead of heel. The calcaneal tuberosity is the rounded back-and-bottom part of the heel bone that you can feel. Rearfoot is another word for hindfoot, used often in shoe and running writing.

A few mix-ups are common. The ankle is the joint above the heel, not the heel itself. The Achilles is a tendon attached to the heel bone, not a bone or a region. The bony bumps on each side of the ankle belong to the leg bones, not the hindfoot.

The Heel Bone and Its Cushion

Inside the heel bone, tiny bony struts mostly run front to back along its length, lining up with the forces of walking.⁸ The outer shell is thickest at the bottom of the back of the heel, the part that hits the ground.⁹ The human heel bone is also relatively wide at the back, which helps spread landing forces and lowers the risk of cracking.¹⁰ In runners, the inner struts tend to be thicker in people who run more miles a week and have run for more years,¹¹ so the bone adapts to the load you put on it.

Under the heel bone sits a fat pad that absorbs shock, protects against concentrated pressure, and lowers pressure on the sole.¹² The tissue behaves partly like a spring and partly like a slow-moving gel, stiffening as it is squeezed faster.¹³ Its thickness and firmness differ between athletes in different sports, which suggests it adapts to how the heel is loaded.¹⁴ But the pad tends to thin with age.¹⁵

The pad is made of fat chambers held in place by fibrous walls, a honeycomb that lets it squash and then spring back after each step. On a hard floor it has to do nearly all the cushioning, because the surface gives nothing back, so the same step loads it more than on carpet or grass. Cushioned shoes share the work, which is why walking barefoot on tile is often what first makes a tired or thin pad noticeable.

What Attaches to the Heel Bone

The Achilles tendon forms where the two main calf muscles join, and it attaches to the upper back part of the heel bone.¹⁶ Its fibers spread across the back of the bone, with different calf muscles anchoring to slightly different areas.¹⁷ When your calf contracts, it pulls the heel up and lets you push off and rise onto your toes.

The plantar fascia is a strong band of tissue that starts broadly from the inner underside of the heel bone.¹⁸ It runs forward along the sole and splits into five strands, one for each toe.¹⁹ It acts like a tie rod that helps hold up the arch.

Small heel nerves and arteries branch off near the inner ankle, and their number and route vary between people.²⁰ Small blood vessels also feed the spots where tendons attach to the heel.²¹

Where tendon meets bone is a high-stress spot that can get sore. The Achilles and the plantar fascia both pull on the same bone from different sides, and tight calves can increase tension on both at once. A limited ankle bend is one practical sign: if it is hard to pull your toes toward your shin with the knee straight, the calf may be short or tight.

Touch can help tell the structures apart. Pain above the heel at the back usually involves the Achilles. Pain under the heel toward the inner side usually involves the plantar fascia. Pain in the center of the heel pad points toward the fat pad.

Common Causes of Back and Bottom Heel Pain

Heel spurs usually form from repeated strain and small tears where the plantar fascia pulls on the heel bone.²² Runners and jumpers, older adults, and people with flat feet or high arches are at higher risk.²³ Heavier body weight, being female, arthritis and foot position are also linked to spurs under the heel.²⁴ A spur is often a sign of long-term strain rather than the main source of pain.

Many people have spurs without any pain, so finding one does not prove it is behind your symptoms. It records where tissue has pulled on bone over time, and treatment usually targets the strained tissue around it, not the spur itself.

A thinning heel fat pad can cause pain in the middle of the heel.²⁵ People with this problem had fat pads of about 7 millimeters compared with about 10 in people without heel pain,²⁶ and a pad less than about 9 millimeters thick was often linked with heel pain.²⁷

At the back of the heel, Haglund’s deformity is a bony bump on the upper back of the heel bone where the Achilles attaches.²⁸ It often leads to swelling of a small fluid sac there and irritation of the tendon, causing pain at the back of the heel.²⁹ Stiff, prominent shoe backs, especially in high heels, press on the bump and cause pain and swelling.³⁰ A high arch with the heel tilted inward can make this worse.³¹ Where the Achilles attaches, the tendon can also wear down and sometimes form calcium deposits, with genetics affecting who is at risk.³²

The pain pattern gives hints. Sharp pain under the heel with the first steps in the morning, or after long sitting, easing as you move, is the classic sign of plantar fasciitis, though it can return after long walks. Deep, bruise-like pain in the center of the heel that worsens on hard floors or barefoot fits a thin fat pad better. A visible bump that hurts where a shoe rubs, with the area perhaps red or swollen, suggests Haglund’s bump. Pain and stiffness at the back of or just above the heel after activity points toward the Achilles tendon rather than the bone.

Easing and Treating Heel Pain

Because stiff shoe backs press on a Haglund’s bump, shoes with softer or lower heel backs can ease the pain.³³ But a rigid shoe back does not stop the heel from slipping and rolling inside the shoe,³⁴ so fit around the heel matters as much as how stiff the shoe is. Cushioned insoles and heel cups can help make up for a thin fat pad.

For the first few weeks at home, stretch the calf and the sole of the foot several times a day, for example by leaning toward a wall with the back knee straight, since tension in both is a common contributor. Cut back on running and jumping while the pain settles, rather than stopping all movement, so the tissue gets a chance to calm down. Avoid walking barefoot on hard floors, and wear a supportive, cushioned shoe even around the house. Ice the sore area for a short time after activity to take the edge off.

See a doctor for pain after a fall or jump onto your heels, which needs an X-ray. Pain that lasts more than a few weeks despite rest also deserves a check, rather than pushing on. Numbness or tingling in the heel also deserves a check, since it may point to an irritated nerve.

For stubborn heel pain with a spur, removing the spur reduced pain and disability scores to a fraction of their starting levels.³⁵ Adding a release of the plantar fascia gave no better results than removing the spur alone.³⁶ Surgery for Haglund’s syndrome can include shaving down the bump and cleaning out the inflamed tissue.³⁷

Heel Fractures From Falls

In a heavy landing, the ankle bone slams into the heel bone and stress builds in specific parts of it.³⁸ The faster the impact, the more and differently the stress spreads, which shapes how the bone breaks.³⁹ A straight-down impact at about 5 meters per second, roughly a fall from a little over a meter, can begin to damage the spongy inner bone of both hindfoot bones.⁴⁰

A heel fracture usually follows a fall from a height or a car crash, when the foot takes sudden force straight through the heel. The heel swells quickly, bruises, and is too painful to put weight on. It can look wider or flatter than the other side. This is not a sprain to walk off, so it needs prompt imaging to see how the bone has broken, and treatment depends on how badly it has shifted.

Why the Human Heel Is Built This Way

Flat-footed animals like humans and bears keep the heel on the ground, while dogs and cats walk on their toes and horses on toe tips.⁴¹ In a dog or horse, the backward-pointing joint high on the leg is actually the ankle, with the heel bone forming its point. Over mammal history, foot postures shifted from flat-footed to toe-walking to hooved.⁴²

A larger back part of the heel bone evolved in the common ancestor of African apes and humans.⁴³ Early human relatives over 3 million years old already had heel and ankle bones much like ours.⁴⁴ Some later relatives had a slimmer, more apelike heel bone, so not every species walked quite the same way.⁴⁵

Heel striking has a cost. Landing hard on the heel produces a bigger jolt through the body than normal walking.⁴⁶ In running, an obvious heel strike gives a larger impact than a subtle heel strike or landing on the front of the foot.⁴⁷

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