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Posterior Heel Pain - how to differentiate the symptoms of heel pain

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?x-ray foot, lateral view

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 allnight splint 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.

The Achilles Tendon Support and The AirHeel are unique products that provide compression.  both can be used in conjunction with a heel lift.

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.


Dr. Jeffrey Oster
Jeffrey A. Oster, DPM

Medical Advisor

Updated 3/18/2021

Leave your comment
11/28/2018 12:47 PM
I had an extra navicular bone which was removed surgically and also achilles tendon lenghening at the same time.  I now have tingling around my surgical scar.  Do you have any products that would help me?
11/29/2018 8:40 PM
Hopefully, your surgery was performed fairly recently.  If so, there's a good chance the nerve can still heal.  Nerves can be damaged in so many ways during surgery, and in many cases, the injury is very benign but results in what you describe as tingling.  Retraction of the nerve, perhaps an injury during suturing and even just exposure to air are some of the ways nerve can become damaged.  Most will come back in time but the tingling may last for up to a year post surgery.<br>
Jump on YouTube and see if you can find techniques for 'cross fiber massage'. Cross fiber massage can be used to help break up scar tissue adjacent to the nerve.<br>
We don't carry any products specific to your condition but I'd check you local pharmacy for something called Zostrix.  Zostrix is derived from capsaicin, the heat in hot peppers.  With repeated use of Zostrix, you can decrease that tingling.<br>
<a href="/jeffrey_a_oster_dpm_cv">Jeffrey A. Oster, DPM</a><br>
Medical Director<br>