“The back of my heel hurts when I walk” describes a location, not a diagnosis. Pain there may involve the Achilles tendon or its attachment, pressure from a shoe, irritation of nearby soft tissues, or an injury. Pain under the heel points to a different group of possibilities. Mayo Clinic Achilles tendinitis guidance Mayo Clinic heel-pain guidance
The spot, timing, and way the problem began can help a clinician narrow the possibilities. This article offers general education for readers in West Haven, New Haven County, and Connecticut. It cannot determine the cause of one person's heel pain.
Where Exactly Is Behind the Heel?
Behind the heel means the area where the Achilles tendon approaches and attaches to the heel bone. That is different from pain under the heel, pain in the arch, or pain several inches higher in the calf. The Achilles region is used whenever you walk, run, jump, climb, or rise onto your toes. Mayo Clinic Achilles tendinitis guidance
Point with one finger to the most painful spot: at the shoe collar, tendon attachment, higher along the tendon, or under the foot. This makes an evaluation more focused.
Pain under the heel, especially with the first steps after rest, may fit a plantar fascia pattern more than an Achilles pattern. The practice's heel pain page explains why several conditions can cause heel symptoms.
What May Cause Pain Behind the Heel?
Several structures sit close together at the back of the heel, so symptoms can overlap. Achilles tendon irritation, pressure or rubbing from footwear, inflammation of a nearby bursa, and sudden strain or trauma are common categories a clinician may consider. Mayo Clinic Achilles tendinitis guidance Mayo Clinic heel-pain guidance American College of Foot and Ankle Surgeons
Achilles Tendon Irritation
The Achilles tendon connects the calf muscles to the heel bone. Pain can occur along the middle portion of the tendon or where it attaches to the heel, and it may come with stiffness, tenderness, swelling, or weakness. Mayo Clinic Achilles tendinitis guidance
The Achilles tendonitis treatment page covers that condition and its evaluation based treatment options. Not every sore back of heel is Achilles tendonitis.
Pressure From a Shoe
A stiff or poorly fitting shoe collar can rub the back of the heel with each step. Footwear can also aggravate a bony prominence at the back of the heel and irritate nearby soft tissue. The American College of Foot and Ankle Surgeons describes this pattern with Haglund's deformity and associated bursitis. American College of Foot and Ankle Surgeons
Notice whether the skin is rubbed, a bump is present, or one pair reliably triggers pain. Persistent findings deserve examination.
Irritation Around a Bursa or Nearby Soft Tissue
A bursa is a small fluid filled sac that helps reduce friction between tissues. One near the back of the heel can become irritated, sometimes alongside Achilles symptoms or pressure from footwear. Mayo Clinic heel-pain guidance American College of Foot and Ankle Surgeons
A clinician can compare tenderness, swelling, movement, and shoe contact to identify the involved area.
A Sudden Strain or Injury
Pain that began during a forceful push, jump, fall, or sudden change of direction needs a different level of caution than a gradual ache. An Achilles rupture may cause a pop, sharp pain, and difficulty pushing off or walking normally. Mayo Clinic Achilles tendon rupture guidance
A prompt examination is the safer next step when strength changes suddenly.
Less Common Causes
Nerve irritation, stress injury, arthritis, infection, and other conditions can also produce heel pain. A symptom location can narrow the possibilities, but it cannot rule out a less common cause. The history and examination determine whether testing or referral is needed.
Why Does Walking or Running Make It Worse?
Walking and running repeatedly load the Achilles region as the calf controls the ankle and the foot pushes away from the ground. Symptoms may increase when the tendon or nearby tissue is asked to handle more force than it currently tolerates. Mayo Clinic Achilles tendinitis guidance Achilles tendinopathy clinical practice guideline
An abrupt increase in walking distance, running mileage, speed, hills, or a new sport can raise demand on the area. Worn shoes, a rigid shoe back, different terrain, or less recovery time can also contribute. Mayo Clinic Achilles tendinitis guidance American College of Foot and Ankle Surgeons Achilles tendinopathy clinical practice guideline
Pain may appear during activity, afterward, or with the first steps after rest. Record that timing for the evaluation.
What Questions Should You Ask Yourself?
The answers will not diagnose the problem, but they can help you describe it accurately.
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Did the pain begin suddenly or gradually?
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Was there a pop, snap, fall, or immediate loss of strength?
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Can you push off the foot and walk without a new limp?
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Is the area swollen, warm, red, bruised, or visibly changed?
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Is pain worst during activity, afterward, or after rest?
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Did you recently change shoes, walking distance, mileage, hills, work duties, or sport?
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Is the pain directly behind the heel, under it, or higher in the lower leg?
What Can You Try Initially?
For a gradual, mild problem without warning signs, reduce the activity that clearly makes symptoms worse and review the shoe that contacts the painful area. Avoid repeatedly testing the heel with long walks, hills, running, or jumping if each attempt increases pain. Mayo Clinic Achilles tendinitis guidance
Do not begin aggressive stretching when a significant injury is possible. A sudden pop, marked weakness, major swelling, or inability to push off needs assessment before a home exercise plan. Mayo Clinic Achilles tendon rupture guidance
There is no universal recovery timeline. The cause, severity, health history, and treatment plan all affect recovery.
Which Warning Signs Should Not Wait?
Seek prompt medical assessment after a sudden pop, an immediate loss of push off strength, inability to bear weight, visible deformity, rapidly increasing swelling, major bruising, numbness, a color change, an open wound, or significant trauma. Sudden severe pain that prevents movement may indicate an Achilles tear. Mayo Clinic Achilles tendinitis guidance Mayo Clinic Achilles tendon rupture guidance
Rapidly spreading redness, drainage, fever with a foot wound, or a foot that becomes unusually cold or discolored also needs urgent attention. Call 911 or go to the nearest emergency department for a life threatening emergency.
West Haven Foot & Ankle Center offers appointment based urgent foot and ankle care on selected days, subject to availability. Call before traveling because the service is not an emergency department and does not accept walk ins.
What Happens During a Heel Pain Evaluation?
An evaluation reviews location, onset, triggers, and injury history. The clinician may examine skin and footwear, feel the heel and tendon, check movement and strength, and watch you walk.
Imaging is not automatically required for every sore heel. It may be considered when the examination suggests a tear, bone injury, unusual cause, or another question that imaging can answer. Mayo Clinic Achilles tendinitis guidance Mayo Clinic Achilles tendon rupture guidance
How Is Pain Behind the Heel Treated?
Treatment depends on the tissue involved and the reason it is irritated. A plan may include changing aggravating activity, modifying footwear, rehabilitation, supportive devices, or another clinician selected option. Advanced treatments should be discussed only after the diagnosis, risks, alternatives, and goals are reviewed.
The practice confirms conservative options for selected Achilles and heel problems, but no treatment works for every cause. This triage article routes readers to the condition pages.
Arrange a West Haven Heel Pain Evaluation
Persistent pain behind the heel, repeated flares, or a new limp deserves an accurate location based assessment. The aim is to identify which structure is involved and choose a plan that matches the examination.
Call West Haven Foot & Ankle Center at (475) 238-7400 or use the contact page to arrange an evaluation with Dr. Sean Lazarus, DPM.
Frequently Asked Questions
Why does the back of my heel hurt when I walk?
Possible reasons include Achilles tendon irritation, shoe pressure, irritation of a nearby bursa, or an injury. The exact location, timing, strength, swelling, and way symptoms began help a clinician narrow the cause. Mayo Clinic Achilles tendinitis guidance Mayo Clinic heel-pain guidance American College of Foot and Ankle Surgeons
Is pain behind the heel the same as plantar fasciitis?
Not usually. Plantar fasciitis most often causes pain under or toward the inner heel, while Achilles problems often cause pain at the back of the heel or higher along the tendon. More than one problem can exist, so location alone is not a diagnosis. Mayo Clinic Achilles tendinitis guidance Mayo Clinic heel-pain guidance
Should I stretch a sore Achilles?
Do not stretch aggressively when there was a sudden injury, pop, marked weakness, or major swelling. Mild, gradual symptoms may eventually benefit from a clinician guided plan, but the first step is to rule out a significant injury. Mayo Clinic Achilles tendon rupture guidance Achilles tendinopathy clinical practice guideline
When should pain behind the heel be evaluated?
Arrange an evaluation when pain persists, keeps returning, causes a limp, limits normal walking, or is not improving after reducing clear triggers. Sudden severe pain, a pop, loss of push off strength, or inability to bear weight needs prompt assessment. Mayo Clinic Achilles tendinitis guidance Mayo Clinic Achilles tendon rupture guidance
Will I need imaging for back of heel pain?
Not every patient needs imaging. A clinician may consider it when the history and examination suggest a tear, bone injury, unusual cause, or another finding that needs clarification. Mayo Clinic Achilles tendinitis guidance Mayo Clinic Achilles tendon rupture guidance