Shoes hurt your Achilles tendon when the back of the shoe repeatedly presses against, rubs, or pulls on the tendon where it connects to your heel bone. This is one of the most common causes of heel pain, and it usually comes down to a few fixable problems: a stiff heel counter, poor fit, or footwear that changes how much load the tendon absorbs with each step.
How the Back of Your Shoe Creates the Problem
The Achilles tendon runs down the back of your lower leg and attaches to your heel bone (calcaneus). It sits just beneath the skin, with very little padding protecting it. The rigid back portion of a shoe, called the heel counter, wraps right around this area. When that material is stiff, too tight, or poorly positioned, it presses directly into the tendon or the tissue surrounding it with every step.
This constant compression does two things. First, it irritates the tendon itself, which can lead to Achilles tendinitis, an inflammation of the tendon fibers. Second, it can inflame the small fluid-filled sac (bursa) that sits between the tendon and the heel bone, a condition called retrocalcaneal bursitis. Both problems produce pain and tenderness at the back of the heel, and they frequently occur together. The telltale sign of bursitis is skin at the back of the heel that feels warm and looks red, with pain that gets worse when you stand on your tiptoes or push off while walking.
Shoes That Slip Cause Just as Much Damage
It’s not only tight shoes that cause trouble. Shoes that are too loose let your heel slide up and down with each stride, dragging the heel counter across the tendon over and over again. This repetitive micro-friction is especially damaging during longer walks or runs because the irritation accumulates. You might not feel it during a short errand, but after 30 minutes of walking, the back of your heel is raw and inflamed.
A heel lock lacing technique can help if you’re wearing lace-up shoes. This method uses the top two eyelets to create a loop on each side, then crosses the laces through those loops before tying. It anchors the heel snugly against the back of the shoe, reducing slippage while keeping the front of the shoe comfortable. It’s a simple fix that podiatrists regularly recommend for heel pain.
Heel Drop and Tendon Load
Every shoe has a “heel drop,” the height difference between the heel and the forefoot, usually measured in millimeters. Most traditional running shoes have a drop of 10 to 12 mm, meaning the heel sits noticeably higher than the toes. This elevated heel shortens the distance your Achilles tendon has to stretch with each step, reducing the load on it.
Flat shoes, zero-drop shoes, and minimalist footwear remove that elevation. Your Achilles tendon then absorbs significantly more force because your ankle moves through a greater range of motion. Research on runners transitioning to minimalist shoes found that Achilles tendons do adapt to this increased loading over time, but the transition period is where injuries happen. If you’ve recently switched to flatter shoes and your Achilles hurts, the shoe isn’t necessarily wrong for you long-term, but your tendon hasn’t caught up yet. Gradually increasing wear time over several weeks gives the tendon a chance to remodel and strengthen.
On the other end of the spectrum, high heels and shoes with very steep drops keep the tendon in a shortened position for hours. When you then switch to flat shoes or go barefoot, the sudden stretch on a tendon that’s been held short all day can trigger pain at the insertion point.
Haglund’s Deformity: A Bony Bump That Makes It Worse
Some people have a bony enlargement on the back of the heel bone that sticks out right where the shoe presses. This is called Haglund’s deformity, sometimes nicknamed a “pump bump” because it’s notoriously painful in pumps and other shoes with tight, rigid backs. The bump creates extra friction between the bone and the heel counter, irritating both the tendon and the bursa.
If you can see or feel a hard, bony prominence at the back of your heel, this may be contributing to your pain. The most effective way to manage it is straightforward: avoid shoes with stiff backs that press against the bump. Open-back shoes, soft-counter sneakers, or shoes with notched heel collars all reduce contact with the area.
Training Errors and Worn-Out Shoes
Footwear is only part of the equation. Clinical evidence links Achilles tendinopathy to training-load errors, including sudden increases in walking or running distance, jumping back into full activity after a break, ramping up intensity too quickly, or not allowing enough recovery time between sessions. The tendon can handle a lot of force, but it needs gradual, consistent loading to stay healthy. Abrupt changes overwhelm its ability to repair.
Worn-out shoes compound the problem. As the midsole breaks down, the cushioning and heel support that once limited tendon strain deteriorate. The shoe looks fine on the outside, but the internal structure is no longer doing its job. Most running shoes lose meaningful cushioning after 300 to 500 miles of use. If you walk or run regularly, tracking your mileage gives you a clearer replacement timeline than waiting for visible wear.
What Helps When Your Achilles Already Hurts
A small heel lift placed inside your shoe can provide immediate relief. A lift of about half an inch to one inch reduces how far your ankle bends backward (dorsiflexion) with each step, which decreases the compressive force between the tendon and the heel bone. This is particularly helpful for insertional Achilles tendinopathy, where the pain is right at the attachment point on the heel. You can buy adhesive heel lifts at most pharmacies and slip them into your existing shoes.
Switching to shoes with a padded, flexible heel collar instead of a rigid counter also makes a noticeable difference. Many athletic shoe brands now design the collar with a cutout or softer material right at the Achilles level for this reason. When shopping, press on the back of the shoe with your thumb. If it barely gives, it’s likely to aggravate an already irritated tendon.
Orthotics, whether custom-made or generic over-the-counter insoles, may reduce strain on the Achilles, though clinical evidence shows they don’t significantly reduce pain on their own. They work best as one piece of a larger approach that includes appropriate footwear, gradual loading, and heel lifts when needed.
Tendinitis vs. Bursitis: How to Tell the Difference
Both conditions cause pain at the back of the heel, but they feel slightly different. Achilles tendinitis typically produces a stiff, achy sensation along the tendon itself, often worst in the morning or after sitting for a while, then loosening up with gentle movement. Bursitis tends to cause a more localized, sharp pain right at the heel bone, with visible swelling, warmth, and redness on the skin. Pain from bursitis often intensifies when you stand on your toes or wear shoes that push into the area.
These two conditions frequently overlap. When bursitis develops alongside Achilles tendinitis, recovery can take longer and may require immobilizing the ankle for several weeks to let both structures heal. If your pain persists after switching shoes and reducing activity, or if the area is noticeably swollen and warm, imaging like an X-ray or MRI can clarify what’s going on and rule out structural issues like a Haglund’s deformity or a partial tendon tear.