Understanding the Anatomy and Common Causes
Pain at the back of the foot when walking often involves structures around the ankle and heel. The Achilles tendon, a strong band of tissue connecting calf muscles to the heel bone, is frequently implicated. Directly behind the heel bone, or calcaneus, lies the retrocalcaneal bursa, a small, fluid-filled sac that reduces friction between the Achilles tendon and the bone. The plantar fascia, a thick ligament on the sole of the foot, also attaches to the bottom of the heel bone, and its inflammation can sometimes cause pain that radiates towards the back of the heel.
Several conditions commonly lead to discomfort in this area. Achilles tendinopathy refers to the degeneration or inflammation of the Achilles tendon, often resulting from repetitive stress or sudden increases in activity. This condition can cause pain and stiffness, particularly in the morning or after periods of rest. Another common cause is plantar fasciitis, characterized by inflammation of the plantar fascia, with pain typically felt at its attachment point on the heel bone, which can extend to the rear of the foot.
Retrocalcaneal bursitis occurs when the bursa between the Achilles tendon and heel bone becomes inflamed, causing pain. This inflammation can result from overuse, poorly fitting footwear, or trauma. Haglund’s deformity, sometimes called “pump bump,” is a bony enlargement on the back of the heel bone that irritates the Achilles tendon and retrocalcaneal bursa. In growing children and adolescents, Sever’s disease (calcaneal apophysitis) is a common cause of heel pain, involving inflammation of the growth plate from repetitive stress.
Identifying Symptoms
Pain at the back of the foot can manifest in various ways, ranging from a dull ache to a sharp, stabbing sensation. The discomfort may be constant or appear only during specific activities like walking, running, or standing for extended periods. Individuals often describe the pain as worse during the first steps in the morning or after prolonged rest.
The pain can intensify with activity and may be accompanied by a feeling of stiffness in the heel or ankle. Swelling, warmth, or redness around the back of the heel might also be present. Tenderness to the touch along the Achilles tendon or at the heel bone is another common symptom, which can make wearing certain shoes uncomfortable.
Initial Steps for Relief
Resting the affected foot by reducing aggravating activities is key. Applying ice to the painful area for 15-20 minutes several times daily can reduce inflammation and discomfort. Elevating the foot minimizes swelling.
Gentle stretching exercises for the calf muscles and Achilles tendon can improve flexibility and alleviate tension. It is important to perform these stretches slowly and without bouncing to avoid further injury. Choosing appropriate footwear with good arch support and cushioning, while avoiding flat shoes or high heels, can also help distribute pressure more evenly across the foot. Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be used to manage pain and inflammation, following dosage instructions carefully.
When to Seek Medical Attention
Seek attention if the pain is severe and prevents walking or bearing weight. A sudden onset of pain, especially after an injury or trauma, warrants assessment to rule out more serious conditions.
Consult a healthcare provider if the pain does not improve after a few days or weeks of home remedies. Increased swelling, redness, warmth around the heel, or numbness or tingling in the foot are concerning symptoms. Signs of infection, such as fever or pus, or inability to move the foot or ankle normally, require immediate medical attention.
Medical Treatments and Management
Medical professionals begin with a thorough physical examination of the foot and ankle to assess range of motion, tenderness, and swelling. Imaging studies, such as X-rays, magnetic resonance imaging (MRI), or ultrasound, may be ordered to visualize bones, tendons, and soft tissues to confirm diagnosis and rule out other conditions.
Physical therapy is a common and effective treatment, focusing on specific exercises to strengthen the foot and ankle muscles and improve flexibility. Therapists may also use modalities like ultrasound or dry needling to promote healing and reduce pain. Custom orthotics or shoe inserts can provide additional support, correct biomechanical imbalances, and reduce stress on the affected structures. In some cases, casting or bracing may be used to immobilize the foot and allow for healing, particularly for more severe conditions or injuries.
Injections, such as corticosteroid injections, may be considered to reduce inflammation and pain in specific areas, though their use near the Achilles tendon is often approached with caution due to potential side effects. Platelet-rich plasma (PRP) injections are another option, aiming to stimulate tissue repair and regeneration. Prescription-strength anti-inflammatory medications may be prescribed for more severe pain or inflammation. Surgical options are generally reserved for severe, persistent cases that have not responded to extensive conservative treatments, such as repairing a torn Achilles tendon or removing bony spurs associated with Haglund’s deformity.