Pain in the back of your heel most commonly comes from problems with the Achilles tendon or the surrounding structures where the tendon meets the heel bone. The specific cause depends on where exactly the pain sits, how it started, and your age and activity level. Several conditions target this area, ranging from overuse injuries that build gradually to acute ruptures that happen in an instant.
Achilles Tendonitis
The Achilles tendon connects your calf muscles to your heel bone, and it bears enormous force every time you walk, run, or push off the ground. When this tendon becomes irritated or begins to break down, pain develops at the back of the heel. There are two distinct types, and the difference matters because they behave differently.
Insertional Achilles tendonitis affects the lower portion of the tendon, right where it attaches to the heel bone. This is the type most likely to cause pain at the very back of the heel. It can strike at any age and activity level, though runners are still most prone. Tight calf muscles are a frequent contributor because they place extra stress on the attachment point. Bone spurs often develop on the back of the heel alongside this condition, which can make the area feel bumpy or tender when pressed.
Noninsertional Achilles tendonitis hits higher up, in the middle portion of the tendon above the heel. This type tends to affect younger, active people. The pain sits a few inches above the heel rather than right at the bone. Both types typically start as mild stiffness or soreness that worsens with activity, and both can become chronic if ignored.
Haglund’s Deformity
Sometimes called a “pump bump,” Haglund’s deformity is a bony enlargement on the back of the heel bone. The bump itself isn’t always painful, but it creates problems by pressing against shoes and irritating the soft tissues around it. Rigid-backed shoes, including pumps and high heels, tend to make it worse. Over time, the pressure and friction from the bony growth can trigger both Achilles tendonitis and bursitis in the heel, creating overlapping sources of pain in the same area.
Retrocalcaneal Bursitis
A small fluid-filled sac called a bursa sits between the Achilles tendon and the heel bone, cushioning the two structures so they don’t grind against each other. When this bursa becomes inflamed, it swells and produces a deep, aching pain at the back of the heel. The area may feel warm and look slightly puffy on both sides of the tendon. Bursitis often develops alongside Achilles tendonitis or Haglund’s deformity, which can make it hard to tell one condition from another without a professional exam.
Achilles Tendon Rupture
A rupture is a partial or complete tear of the Achilles tendon, and it feels nothing like the gradual onset of tendonitis. The hallmark signs are a sudden pop or snap at the back of the ankle (often during intense physical activity like sprinting or jumping), followed by sharp pain and difficulty walking. Some people describe it as feeling like they were kicked in the heel.
If you suspect a rupture, a clinician can perform a simple bedside check: you lie face down with your feet hanging off the edge of a table while they squeeze your calf muscle. In a healthy tendon, the foot will move. If the foot stays still, the tendon is likely torn. This needs prompt medical attention because the treatment approach and timeline change significantly depending on how quickly you’re evaluated.
Calcaneal Stress Fracture
The heel bone itself can develop tiny cracks from repetitive impact, particularly in runners, military recruits, or anyone who ramps up activity too quickly. The pain from a stress fracture tends to feel different from tendon problems. Rather than being localized to the back of the heel where the tendon attaches, it often hurts when the heel is squeezed from both sides. A positive “squeeze test,” where pressing inward on the sides of the heel reproduces pain, points toward a stress fracture rather than a soft tissue problem. Imaging with an MRI is usually needed to confirm it, since stress fractures don’t always show up on standard X-rays early on.
Sever’s Disease in Children
If your child complains of heel pain, the most likely culprit is Sever’s disease, a growth plate irritation that’s extremely common between ages 8 and 14. During growth spurts, the heel bone grows faster than the surrounding muscles and tendons, which pulls on the growth plate and causes pain. It’s not actually a disease, and it doesn’t cause lasting damage, but it can sideline an active kid for weeks.
Doctors diagnose it with a physical exam, applying gentle pressure to the heel and watching how the child walks, runs, or jumps. Imaging may be ordered to rule out a stress fracture, but X-rays aren’t needed in most cases. Rest, stretching, and cushioned heel inserts typically resolve symptoms as growth evens out.
Nerve Entrapment
Less commonly, pain around the heel can come from a pinched nerve rather than a tendon or bone problem. One well-known culprit is entrapment of a small nerve that branches off near the inside of the ankle and runs close to the heel bone. When this nerve gets compressed, it produces a sharp, radiating pain that’s often worse at night and after walking. You might also notice tingling or an unusual sensation spreading across the inner heel. This type of pain doesn’t always respond to the standard stretching and icing that helps tendon problems, which is part of what makes it tricky to identify.
How Posterior Heel Pain Is Treated
Most causes of back-of-heel pain respond to conservative treatment, but the timeline is longer than many people expect. For Achilles tendonitis, the cornerstone of rehabilitation is a specific type of exercise called eccentric loading, where you slowly lower your heel off the edge of a step. The original protocol calls for 180 repetitions per day over 12 weeks, which is a serious commitment. Some people notice improvement within a few weeks, while others need to work at it for months before the tendon adapts.
For insertional Achilles tendonitis specifically, most people experience gradual improvement and recover within 12 months or less with consistent exercise. That number surprises many people who expect to feel better in a few weeks, but tendon tissue remodels slowly. Continuing exercises for at least three to four months is generally the minimum recommendation before expecting meaningful change.
Other supportive measures include temporarily reducing the activities that aggravate the pain, wearing shoes with a slight heel lift to reduce tension on the tendon, and icing the area after activity. For Haglund’s deformity, switching to open-backed shoes or using padding to reduce pressure on the bump helps. Bursitis may respond to rest and anti-inflammatory strategies, though persistent cases sometimes need a cortisone injection or, rarely, surgery.
How to Tell Which Condition You Have
Location is your best initial clue. Pain right where the tendon meets the bone, especially with a visible bump, suggests insertional tendonitis or Haglund’s deformity. Pain a couple of inches above the heel points to noninsertional tendonitis. Deep pain that worsens when you squeeze the sides of the heel raises concern for a stress fracture. A sudden pop during activity followed by difficulty walking is a red flag for a rupture. And burning or tingling that radiates outward, particularly at night, hints at a nerve issue.
Many of these conditions overlap or occur together. Haglund’s deformity can cause bursitis, which can irritate the Achilles tendon, creating a chain of problems in the same small area. If your pain has lasted more than a couple of weeks without improvement, or if it started suddenly during exercise, getting an accurate diagnosis matters because the right treatment depends entirely on which structure is involved.