Pain at the back of your heel most commonly comes from one of three conditions: Achilles tendinitis, retrocalcaneal bursitis, or a bony growth called Haglund’s deformity. In many cases, two or all three of these develop together, a combination that orthopedic specialists refer to as the “terrible triad” of posterior heel pain. Understanding which one is driving your symptoms helps you manage it effectively and avoid making it worse.
Achilles Tendinitis
The Achilles tendon connects your calf muscle to your heel bone. It’s the longest and strongest tendon in your body, and it routinely handles forces two to four times your body weight with every step. Over time, those repetitive loads cause degenerative wear and tear, particularly where the tendon attaches to the heel bone. That degeneration triggers inflammation and pain right at the back of your heel.
There are two types. Insertional Achilles tendinitis affects the lower portion of the tendon where it meets the heel bone, and this is the type most likely to cause pain at the back of the heel specifically. Non-insertional tendinitis affects the middle portion of the tendon, higher up the leg. Runners and basketball players are especially prone, but anyone who suddenly increases their activity level or spends long hours on their feet can develop it.
The hallmark symptoms include stiffness and tenderness in the tendon, swelling around the heel, and leg weakness. You’ll typically notice more discomfort after activity (or the day after exercising), when climbing stairs or walking uphill, and first thing in the morning, with gradual improvement as you move around. In severe or long-standing cases, the inflamed tendon can calcify, forming bone-like fragments within the tendon itself.
Retrocalcaneal Bursitis
A bursa is a thin, fluid-filled sac that helps tendons glide smoothly over bone. One sits right between your Achilles tendon and the back of your heel bone. When this bursa gets irritated, it thickens and swells, producing a tender, bruise-like feeling at the back of your heel. The area may feel warm to the touch, and pressing on either side of the Achilles tendon just above where it meets the heel bone will reproduce the pain.
Bursitis typically develops after prolonged time on your feet, but it often appears alongside other posterior heel problems. When the heel bone becomes enlarged (as in Haglund’s deformity), it pinches and irritates the bursa, setting off a cycle of inflammation that can be difficult to break without addressing the underlying cause.
Haglund’s Deformity
Haglund’s deformity is a bony growth on the back of your heel bone, right where the Achilles tendon attaches. It forms gradually over years and creates a visible, palpable bump. The exact cause isn’t fully understood. It may be genetically inherited, or it can develop from chronic irritation, overuse (especially in runners), high-arched feet, tight Achilles tendons, or gait abnormalities. Sometimes it appears with no identifiable trigger at all.
This condition is often called a “pump bump” because shoes with rigid, tight-fitting backs, like pumps or dress shoes, press directly against the growth and make the pain significantly worse. If you’ve noticed that certain pairs of shoes cause more heel pain than others, the shape of the shoe’s heel counter is a likely factor. Shoes that flare out sharply at the back force your foot through a longer arc of motion during each step, increasing stress on the heel. Footwear with a more rounded, beveled heel tends to match the natural shape of the heel bone and reduce irritation.
When All Three Overlap
These three conditions frequently coexist. An enlarged heel bone irritates the bursa sitting next to it, which in turn inflames the Achilles tendon at its attachment point. This is why posterior heel pain can feel like one diffuse ache rather than three distinct problems. The pain concentrates at the back and bottom of the heel, worsens with activity and tight shoes, and may be accompanied by visible swelling or a noticeable bump.
Sever’s Disease in Children
If your child is complaining about pain at the back of their heel, the most likely explanation is Sever’s disease. This condition occurs when the growth plate in the heel becomes injured and inflamed during a growth spurt. Girls typically experience it between ages 8 and 10, and boys between ages 10 and 12. Because the heel is one of the first body parts to reach full size during early puberty, the muscles and tendons can’t keep up with bone growth. The resulting tightness puts excessive stress on the heel.
A classic sign is pain when you squeeze the back of your child’s heel from both sides. Sever’s disease resolves on its own once the growth plate closes and the bone matures, but rest and activity modification help manage the discomfort in the meantime.
What Helps Posterior Heel Pain
Conservative treatment works for most people. The cornerstone is progressive exercise therapy, typically a structured program of stretching and strengthening exercises performed daily at home. For insertional Achilles tendinopathy, a key principle is reducing compression on the tendon at its attachment point. This means avoiding stretches that push the ankle into extreme positions, which can pinch the tendon against the heel bone and make things worse.
Pain and function tend to improve the most during the first 12 weeks of consistent exercise. After that, improvement often plateaus as people return to sports and daily activities, suggesting that extended rehabilitation or additional recovery time may be needed for complete pain resolution. The minimum timeframe to return to sport in structured rehab programs is around 8 weeks, but many people need longer.
Night splints can help reduce morning pain and stiffness by keeping the Achilles tendon gently stretched while you sleep. Clinical trials show noticeable improvements in mobility and pain relief with consistent use over several weeks, though wearing them inconsistently tends to limit their effectiveness.
Footwear changes make a meaningful difference. Avoiding shoes with rigid, tight heel counters reduces direct pressure on the bump and bursa. Open-backed shoes or those with soft, flexible heel collars give the area room to breathe. Heel lifts placed inside your shoes can reduce the angle of pull on the Achilles tendon, taking some strain off the attachment point.
Signs of a Serious Injury
Most posterior heel pain is a gradual, overuse problem. But a sudden, sharp event is different. If you hear or feel a pop in your heel, especially during physical activity, this could indicate an Achilles tendon rupture. The classic description is the sensation of being kicked in the calf, followed by severe pain and swelling near the heel, inability to push off the injured leg when walking, and inability to stand on your toes on that side. A rupture requires immediate medical attention.