Today I'd like to talk to you about back of the heel pain. Three conditions that affect the back of the heel are, Achilles tendonitis, stress fractures, and Sever's disease in children.

What Causes Achilles Tendonitis?

Achilles tendonitis is one of the most common conditions that occur in the back of the heel. This is where there is inflammation and pain along the achilles tendon, usually above the heel bone.

This can be caused by a lot of factors. We're in January, and what happens? All the New Year's resolutions come into play, and people who haven't been exercising are getting out there again. You may just do a little too much too suddenly. Or you may have been working indoors, days are getting slightly longer and emperatures are warming a little, and you suddenly move out onto hard surfaces like concrete and asphalt. And three is you may have been more sedentary, and you may not have been stretching enough before you got back into your activities, all of which can lead to inflammation of the Achilles tendon.

Two Problems Associated With the Achilles Tendon

Two problems associated with the Achilles tendon that are more concerning are Achilles tendinosis and Achilles tendon rupture.

Achilles tendoninosis

With Achilles tendoninosis you may notice a lump on the back of your heel. Your tendon isn't just inflamed and a little bit swollen, but there's actually more of a firm lump in that Achilles tendon. This can be the development of degeneration within the tendon called tendinosis rather than tendonitis, but it might look the same to most of you, and it might feel the same. This is more worrisome because besides rest and elevation an MRI exam can determine whether there's true degeneration of the tendon going on, and a greater degree of rest, immobilization, and additional treatments may be necessary to resolve this problem.  

Achilles tendon rupture

With an Achilles tendon rupture you likely won't be able to push off your foot. The pain will be increased. You'll know something else has gone on here, and this needs immediate immobilization and rest and certainly evaluation by your physician.

Symptoms of a Stress Fracture

Stress fracture is a lot less common.  If you've got signs such as swelling, increased temperature, increased sensitivity if you're trying to stretch, which are all good for so many other conditions, and even pain along the whole back of the heel bone or when you squeeze it from side to side, you may well have developed a stress fracture. X-rays may show this, but an MRI may be necessary to evaluate it. And the most important thing about it, if it's diagnosed, drop off the word stress and keep the word fracture. And when there's a fracture it needs immobilization and may take up to 12 weeks before you can get back out to your exercise program.

What Is Sever's Disease?

Lastly, let's address the children. After this great holiday and into our new year, the kids will be getting into baseball, soccer and already basketball, and a lot of impact goes on and with it irritation to the heel. They're in a growing phase, and in the back of the heel they develop a condition called Sever's disease. Simply put it's an inflammation of the growth plate in the back of the heel. It's often alleviated by a simple use of a heel lift. If the child is not responding to the simple measures you take with rest and a little bit of elevation, have them evaluated and be sure that's all you're dealing with. So if you have pain in the back of the heel, let's get to the bottom of this.

Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.