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Posterior Heel Pain


Posterior heel pain can be caused by many things. It can occur behind the heel where the Achilles Tendon attaches to the heel bone.  Haglund’s deformity is a relatively common condition affecting young and old men and women. It is often a hereditary problem that can be aggravated by shoes.  A bony enlargement on the back of the heel causes the severe pain characteristic of the deformity.  In addition, shoe irritation can lead to the formation of a bursitis, in which case the area becomes quite red and inflamed.  Bursae’s are fluid filled sacks that absorb pressure. Often times, excessive pronation or excessive movement while walking causes the heel to rub against the back of the shoe.  This prolonged irritation causes the formation of an enlarged bump and overlying skin irritation.  Sometimes, the bump can be caused by a bone spur growing within the Achilles Tendon.  This is more problematic than Haglund’s Deformity because it can damage the Achilles Tendon as well as cause pain and trouble with shoe gear.  Young children with posterior heel pain can have a problem with irritation of a growth plate in the back of the heel.

Conservative care includes the wearing of a soft cushion on the back of the heel, heel lifts, orthotics or shoe gear changes.  At our Institute, we recommend felt heel lifts to lift the back of the heel up in the shoe to decrease the pressure the shoe puts on the foot and the pull of the Achilles Tendon.  A custom orthotic device can be used in most instances to help with the pain.  A special device called a night splint can hold the foot in the correct position while you sleep to decrease pain in the back of the heel.  Sometimes a air filled sock called an Air Heel can be used to help as well. A local injection of cortisone will help relieve a painful heel when placed away from the Achilles Tendon.

Surgery is usually performed only if all of the conservative treatment doesn’t work.  Usually people get better without surgery.  If you have surgery, most of the time you can walk the same day and, be awake or asleep for the procedure.  Depending on what is done, sometimes you will need to be off your foot for 4-6 weeks.  This time off is necessary in situations when part of the Achilles Tendon needs to be detached from the heel bone to perform the surgery.  It has to be reattached and this process takes time to heal.   If your tendon needs to be reattached then this will require walking in a walking boot and crutches for 4-6 weeks.  If the tendon doesn’t have to be removed then immediate walking in a cam walker is allowed.

Your condition as always will be treated accurately and depending on the situation, your time off will vary.  You are encouraged to ask questions and find out all the details of your specific complaint or problem.

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