Posterior heel pain can be hard to diagnose. This article discusses the differences between Achilles tendinitis, insertional Achilles tendinitis and Haglund's deformity. Treatment options are also described.
Achilles tendinitis, Haglund's deformity and insertional Achilles tendinitis - what's the difference?
Achilles pain - the location of pain makes a difference.
The Achilles tendon is the single largest, strongest tendon in the human body. There are a number of different problems specific to the tendon, particularly at the insertion of the tendon into the heel bone (calcaneus). Those problems include Achilles tendinitis, insertional Achilles tendinitis and Haglund's deformity. Let's take a look at each of these problems in a bit of detail so that you can differentiate one from another.
Achilles tendinitis typically occurs 2-4 cm proximal to the insertion of the tendon into the heel bone. This area is called the tidal zone of the tendon. The tidal zone is an area where there is a decrease in the vascular in-flow to the tendon. This area of hypo-vascularity makes the tendon more susceptible to injury. Findings associated with Achilles tendinitis include:
- Pain at the onset of an activity such as rising from bed in the morning or at the start of a run.
- Stiffness of the tendon that decreases with activity.
- Pain is 2-4cm above the heel in the body of the tendon.
- Pain increased by going barefoot or in low heeled shoes.
- Swelling of the tendon is rare and if present represents a partial tear of the tendon.
- No swelling at the back of the heel.
Insertional Achilles tendinitis occurs at the level of the insertion of the Achilles tendon into the heel bone. Symptoms include:
- Pain at the onset of activity.
- Pain increased by going barefoot or wearing low heeled shoes.
- Stiffness that decreased with activity only to get worse at the conclusion of activity.
- Pain at the back of the heel.
- Firm swelling of the back of the heel that is circumferential, encompassing all sides of the back of the heel.
Haglund's deformity, also called a pump bump, is found on the lateral side (outside) of the heel. Symptoms of Haglund's deformity include:
- No pain at the onset of activity.
- Pain not influenced by heel height.
- Pain is increased by wearing enclosed shoes.
- Swelling of the heel specific to the posterior lateral heel only.
Treatment of posterior heel pain
A heel lift can have a significant impact on all three conditions, but for different reasons. A heel lift will decrease the pull of the Achilles tendon which will have a positive impact on both Achilles tendinitis and insertional Achilles tendinitis. With a Haglund's deformity, the heel lift is used to raise the bump higher. In many cases, this is enough of a solution to decrease direct pressure to the bump.
Night splints will have a positive impact on both Achilles tendinitis and on insertional Achilles tendonitis, but will have no effect at all on Haglund's deformity. A stretching block will provide the same effect - great for Achilles tendinitis and insertional Achilles tendinitis while providing no change for Haglund's disease.
An Achilles Heel Pad provides gel cushion and can be used in conjunction with a heel lift. The Achilles Heel Pad can have a positive effect on all three types of heel pain described.
Which product is right for you? We call it Medically Guided Shopping - you need to find the right diagnosis before you can purchase the right product. Be sure to consult our knowledge base articles on the conditions before making a purchase.