What could cause the back of my heel to hurt?
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The back side of my heel hurts throuhout the day. The tenderness is located just above the heel bone where the Achilles tendon is. It is different from the pain that occurs on the bottom of the foot, and it often feels worse when I flex my foot or try to push off during walking. I also notice some stiffness in the area, and sometimes it feels irritated by the back of my shoe. I am trying to figure out if this is related to tendon strain, inflammation, or a bone spur. I am not too active so I do not know if it could be Achilles Tendonitis, but I read that is usually from being active and over using that tendon. Is there anything else that this pain could be?
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Dr. William Naughton, DPM AdminChief Medical OfficerOfficial Account of Dr. William Naughton, DPM. As Chief Medical Officer, Dr. Naughton reviews discussions for medical safety and provides expert biomechanical insights based on 20+ years of surgical experience.Yes - pain at the back of the heel where the Achilles tendon attaches is commonly caused by irritation of the tendon or surrounding tissues, even in people who are not highly active.
Posterior heel pain at the Achilles tendon insertion is not limited to athletes or overuse injuries. While Achilles tendinitis is often associated with repetitive strain, many cases develop from non-sport-related factors such as tight calf muscles, poor footwear, abnormal foot mechanics, or cumulative stress from daily activities. Because the Achilles tendon experiences significant force with every step, even routine walking can aggravate already stressed tissues.
Common symptoms include stiffness after rest, tenderness when flexing the foot upward, localized swelling, and irritation caused by shoe contact at the back of the heel. These signs often indicate insertional Achilles irritation, where both traction and compression forces act on the tendon at its attachment to the heel bone. Over time, this stress can also inflame the retrocalcaneal bursa, contribute to Haglund’s deformity, or stimulate the formation of a heel spur at the tendon insertion.
Systemic factors can further influence symptoms. Individuals with diabetes, vascular compromise, or altered nerve sensitivity may experience Achilles and heel discomfort due to changes in circulation, tissue resilience, or pain perception. In these cases, symptoms may appear with less activity and take longer to resolve, making early recognition and proper support especially important.
Initial treatment focuses on reducing mechanical stress and inflammation. However, if the underlying biomechanical contributors are not addressed, symptoms may persist or gradually worsen.
- Posterior heel pain can occur even without athletic overuse
- Tight calves, poor footwear, and foot structure issues are common contributors
- Stiffness, tenderness, swelling, and shoe irritation are typical symptoms
- Conditions such as Haglund’s deformity, bursitis, and heel spurs may coexist
- Diabetes and circulatory changes can increase susceptibility to tendon irritation
- Supportive shoes with softer heel counters, icing, gentle calf stretching, heel lifts, and custom orthotics can reduce strain
- Ongoing or worsening pain warrants professional evaluation
