A burning sensation in the back of the heel, particularly when stretching, is a common and often uncomfortable experience. This discomfort can signal various underlying issues. Understanding its origins and how to address it can help manage symptoms and prevent further irritation. This article explores common causes and provides actionable steps for management and prevention.
Understanding the Heel’s Anatomy
The heel (calcaneus) is the largest bone in the foot. The Achilles tendon connects the calf muscles to the heel bone, enabling movements like walking, running, and jumping. A small, fluid-filled sac, the retrocalcaneal bursa, sits between the Achilles tendon and the heel bone. This bursa acts as a cushion, reducing friction and helping the Achilles tendon glide smoothly.
Common Causes of Burning Sensation
A burning sensation in the back of the heel, especially during stretching, often points to irritation or damage in the Achilles tendon or retrocalcaneal bursa. Several conditions can lead to this pain.
Achilles Tendinitis
Achilles tendinitis, or tendinopathy, involves inflammation or degeneration of the Achilles tendon. It commonly results from repetitive stress or overuse, often seen in activities like running or jumping. Pain can range from a mild ache to a more severe burning sensation, especially after prolonged activity or stair climbing. Stretching an inflamed Achilles tendon can exacerbate this pain due to increased tension on the compromised fibers.
Retrocalcaneal Bursitis
Retrocalcaneal bursitis is inflammation of the retrocalcaneal bursa, the fluid-filled sac behind the Achilles tendon and above the heel bone. Overuse, such as from running uphill or a sudden increase in physical activity, can irritate this bursa. Symptoms include pain, swelling, tenderness, and sometimes redness at the back of the heel, with discomfort often worsening with pressure or foot flexion. Stretching can compress the inflamed bursa, intensifying the burning feeling.
Haglund’s Deformity
Haglund’s deformity is a bony enlargement on the back of the heel bone. This prominence can irritate the retrocalcaneal bursa and Achilles tendon, leading to pain and inflammation. Sometimes called “pump bump,” it can be worsened by wearing shoes with rigid backs that press against the bump. Stretching may increase mechanical friction between the bony growth and soft tissues, amplifying the burning sensation.
Nerve Entrapment
Nerve entrapment, such as of the sural nerve, can also cause burning pain in the heel. The sural nerve provides sensation to the outer side of the foot and ankle, traveling down the back of the leg near the Achilles tendon. Compression or irritation of this nerve, possibly due to scar tissue or external pressure from footwear, can result in tingling, numbness, or a burning sensation. While less common with stretching, nerve compression can be aggravated by movements that put tension on the nerve pathway.
Why Stretching Can Intensify the Sensation
While stretching promotes flexibility, it can paradoxically worsen a burning sensation when tissues like tendons or bursae are already inflamed, injured, or degenerated. This occurs because stretching applies mechanical stress to these compromised structures. Stretching can increase friction, compression, or micro-trauma to damaged tissue fibers. For example, pulling on an inflamed Achilles tendon or compressing a swollen bursa during a stretch can heighten irritation and pain. When tissues are highly sensitive due to injury, even beneficial movements can trigger discomfort.
Managing and Preventing Heel Discomfort
Managing heel discomfort involves a multi-faceted approach aimed at reducing irritation and promoting healing.
Initial Management
Initially, adhering to the RICE principle—Rest, Ice, Compression, and Elevation—can help alleviate acute pain and swelling. Resting the affected heel by avoiding activities that cause pain is important for healing. Applying ice packs for 15-20 minutes several times a day can reduce inflammation. Compression with a bandage and elevating the foot can further help manage swelling.
Stretching and Activity
Proper stretching techniques are important but should be approached cautiously. Gentle, controlled stretches for the calf muscles and Achilles tendon can improve flexibility, but any stretch that intensifies the burning pain should be avoided. Warm-up exercises before physical activity can prepare muscles and tendons, reducing the risk of injury. Gradually increasing activity levels instead of sudden bursts can prevent overuse injuries. Strengthening exercises for the calf muscles, performed without pain, can enhance the ability of the Achilles tendon to handle stress.
Footwear and Support
Appropriate footwear with good cushioning and arch support can significantly reduce stress on the heel. Orthotic inserts can provide additional support and pressure relief.
When to Seek Medical Advice
While many instances of heel discomfort can improve with home care, certain signs and symptoms warrant professional medical evaluation. It is advisable to consult a healthcare provider if heel pain persists for more than a few weeks despite home treatments. Worsening pain, especially if it interferes with daily activities or makes walking difficult, is another indicator to seek help.
Immediate medical attention is recommended for severe heel pain that occurs right after an injury or is accompanied by significant swelling, inflammation, or stiffness. The inability to bear weight on the affected foot, difficulty bending the foot downward, or rising on the toes are also concerning symptoms. Additionally, any signs of infection, such as fever, or neurological symptoms like numbness or tingling in the heel, should prompt a medical visit. Early diagnosis and treatment can prevent acute conditions from becoming chronic.