Pain at the back of your foot most commonly comes from the Achilles tendon, the heel bone, or the small fluid-filled sacs (bursae) that cushion the area where they meet. The specific location of your pain, whether it’s right at the back of the heel, just above it, or deeper inside, points to different causes. Most of these conditions develop gradually from overuse, though some appear suddenly after a specific injury.
Where Exactly the Pain Is Matters
The back of the foot is a compact area, but a few centimeters can make a real difference in diagnosis. The heel bone (calcaneus) is the largest bone in your foot and sits at the very base. The Achilles tendon, the thick cord running down from your calf, attaches to the back of this bone. Between the tendon and the bone sits a small bursa that reduces friction. Pain can originate from any of these structures, and they sometimes irritate each other.
If your pain is centered a few inches above where your heel meets the ground, the Achilles tendon is the most likely source. If it’s right at the back of the heel where the tendon meets bone, you could be dealing with insertional tendon problems or bursitis. Pain underneath the heel, felt when you step down, usually points to plantar fasciitis or a bruised fat pad rather than a true “back of foot” problem.
Achilles Tendon Problems
The Achilles tendon is the most common culprit when the back of your foot hurts, especially if you’re active. In its early stage, called tendonitis, the tendon becomes inflamed and painful. This is a short-term inflammatory response, and the tendon cells themselves are irritated but not yet damaged. Pain typically shows up during or after activity and may feel stiff first thing in the morning.
If that inflammation isn’t addressed, it can progress to tendinosis, a chronic condition where the inflammatory cells are replaced by degenerative ones. The tendon thickens, becomes weaker, and the pain becomes more persistent. This distinction matters because the two stages respond to different treatments. Early inflammation often improves with rest and ice, while the chronic degenerative stage requires a more structured rehabilitation approach.
One of the most effective rehab methods for Achilles tendon pain is a specific heel-drop exercise. You stand on the edge of a step, rise up on your toes using both legs, then slowly lower down on just the affected leg. The standard protocol calls for 3 sets of 15 repetitions, twice daily, seven days a week for 12 weeks. You do this both with your knee straight and with it bent at about 45 degrees to target different parts of the tendon. It’s a significant commitment, but it works by stimulating the tendon to rebuild stronger tissue.
Achilles Tendon Rupture
A complete or partial tear of the Achilles tendon is the most serious cause of sudden pain at the back of the foot. People often describe hearing a pop or feeling like they were kicked in the calf. Walking becomes difficult immediately, and the calf may swell and bruise. With a complete tear, you can sometimes feel a gap or soft spot in the tendon, typically an inch or two above where it attaches to the heel.
This isn’t something that gradually worsens. It happens during a sudden push-off, pivot, or jump. If you felt a distinct moment of injury and can’t push off your toes normally, you need to get it evaluated quickly. A simple clinical test, where a provider squeezes your calf while you lie face down to see if your foot moves, is over 95% accurate for confirming the diagnosis.
Retrocalcaneal Bursitis
Between the Achilles tendon and the heel bone sits a small bursa, a fluid-filled cushion that prevents friction. When this bursa becomes inflamed, you feel pain and swelling right at the back of the heel, sometimes with warmth and skin discoloration. The pain gets noticeably worse when you stand on your toes, which compresses the inflamed bursa between tendon and bone.
This condition often develops from running too much or from shoes that press into the back of the heel. It can exist alongside Achilles tendon problems, since the two structures sit right next to each other and irritation of one frequently affects the other.
Haglund’s Deformity (Pump Bump)
If you can see and feel a hard, bony bump on the back of your heel, you may have Haglund’s deformity. It earned the nickname “pump bump” because rigid-backed shoes like high heels press directly against it, making the pain worse. The bump itself is an enlargement of the heel bone, and the skin around it often becomes swollen or discolored.
Several factors increase your risk: high foot arches, tight Achilles tendons, certain walking patterns, and shoes with stiff heel counters. Runners are particularly prone to it because of the repetitive pressure on the heel. The bump won’t go away on its own, but the pain it causes can be managed by switching to shoes with softer or open backs, using heel pads, and stretching the Achilles tendon to reduce tension on the area.
Heel Bone Stress Fracture
Repetitive high-impact activity, like running or jumping, can gradually wear down the heel bone until it develops a stress fracture. Unlike a sudden fracture from a fall or accident, a stress fracture builds up over weeks. The pain worsens with activity and improves with rest but doesn’t go away completely. You may notice the pain is more diffuse, spreading across the heel rather than pinpointing one spot.
This is more common in runners who have recently increased their mileage or intensity. It’s also more likely in people with lower bone density. A stress fracture won’t show up on an X-ray in its early stages, so imaging with an MRI is sometimes needed to confirm it. Recovery requires several weeks off from impact activities.
Back-of-Heel Pain in Children
If your child complains of pain at the back of the heel, the most likely cause is Sever’s disease, one of the most common sources of heel pain in growing kids. It’s not actually a disease but an inflammation of the growth plate in the heel bone. During growth spurts, bones lengthen faster than muscles and tendons can keep up, putting extra stress on the heel where the Achilles tendon attaches.
Children and adolescents who run and jump in sports are at the highest risk. The pain typically comes on during or after activity and may cause limping. It resolves on its own once the growth plate fully hardens, but in the meantime, reducing activity, stretching the calf, and using supportive shoes or heel cups can help manage the discomfort.
How to Narrow Down Your Cause
A few quick self-checks can help you figure out what’s going on before you see anyone:
- Squeeze test: Gently squeeze the sides of your heel bone. If this reproduces the pain, a stress fracture or bursitis is more likely than a tendon problem.
- Toe raise: Stand on your toes. Pain that sharpens at the back of the heel suggests bursitis or insertional tendon issues. Pain higher up in the tendon points to mid-tendon problems.
- Morning stiffness: Achilles tendon issues typically cause stiffness and pain with your first steps that loosens up after a few minutes. Plantar fasciitis does the same but at the bottom of the heel.
- Visible bump: A hard lump you can see and feel at the back of the heel is characteristic of Haglund’s deformity.
What Recovery Looks Like
Most causes of back-of-heel pain improve with conservative treatment, but timelines vary considerably. Mild Achilles tendon irritation may settle down in a few weeks with rest, while the structured eccentric exercise protocol for chronic tendon problems runs 12 weeks. Plantar fasciitis, which can overlap with heel pain, generally improves after a few months of consistent stretching. If symptoms haven’t budged after two months of effort, further intervention like injections or imaging may be needed.
Across all these conditions, the same factors tend to speed recovery: reducing the activity that triggered the pain, wearing shoes that don’t press on or irritate the heel, stretching the calf and Achilles tendon daily, and gradually returning to activity rather than jumping back in. The longer you’ve had the pain before addressing it, the longer recovery tends to take.