Treatment for Posterior Heel Pain

Posterior heel pain, or pain in the rear of the heel, has a number of potential causes, including Achilles tendonitis, retroachilles bursitis, retrocalcaneal bursitis, bone contusions and fracture of the talus or calcaneus bones. While anyone can suffer this kind of pain, it is particularly prominent among athletes and other physically active adults. Depending on the type of injury present, treatment for posterior heel pain ranges from conservative use of rest and painkillers to surgery.

Understanding the Causes of Posterior Heel Pain

• While some posterior heel injuries result from single traumatic events, pain is more commonly the result of repetitive actions such as running, jumping, rapidly shifting foot positions and making quick lateral movements ("cutting"). Your injury may be the result of these actions themselves, or a combination of repetitive motion with ill-fitting or improper footwear. In some cases, improper footwear may cause heel pain in everyday nonathletic activity. Obesity may also be a factor.

Treating Achilles Tendonitis

• Achilles tendonitis is an inflammation of the Achilles tendon at the point where it attaches to the calcaneus, or heel bone. Your doctor will begin treatment for this injury by recommending rest, ice packs and the suspension of any activities that cause pain. He may also suggest use of a non-steroidal anti-inflammatory (NSAID) medication. Higher levels of pain may require use of a prescription oral corticosteroid such as prednisone. Injected corticosteroids can directly injure the Achilles tendon, and should never be used. Proper adjustment of footwear is an essential part of most heel pain treatments, and your doctor may direct you to wear shoes with a heel notch to decrease friction on your tendon. A physical therapist can recommend exercises to stretch and strengthen your tendon after your pain is controlled.

Treating Bursitis

• Retroachilles bursitis is an inflammation of the protective sac (bursa) that lies in back of the Achilles tendon. Retrocalcaneal bursitis is an inflammation of the bursa that lies between the calcaneus and the Achilles tendon. In their minor forms, both of these injuries are treated in the same manner as Achilles tendonitis. If you suffer from persistent heel bursitis, your doctor may recommend surgical removal of whichever bursa is causing your pain.

Treating Bone Contusions and Fractures

• Bone contusions are impact injuries of the bone surface and underlying layers. If you have a heel contusion, your doctor will treat you with an appropriate painkiller and fit you with some form of walking cast to cushion your heel during everyday activity. It may take a number of weeks for these injuries to heal fully.

  Bone fractures of the posterior heel are typically stress fractures. If you are diagnosed with a stress fracture, your treatment will be the same as for a bone contusion.

Surgical Options

• Surgery is reserved for heel pain that does not respond to other forms of treatment. In addition to bursa removal, procedures include removal of calcaneus bone spurs and removal of calcium deposits in the Achilles tendon. In order to provide easier travel of the Achilles tendon, doctors may also lengthen that portion of the tendon connected to the gastrocnemius calf muscle. If you have persistent unresolved posterior heel pain, consult your doctor about appropriate surgical options.