Causes, Symptoms and Podiatry Treatment

Pain behind the heel can make walking, exercising, climbing stairs and even wearing shoes uncomfortable. One common cause is retrocalcaneal bursitis, an inflammation of a small cushioning sac (bursa) located between the Achilles tendon and the heel bone.

At POD11, our podiatrists assess the entire lower limb to identify why the irritation has developed and provide a treatment plan aimed at reducing pain and improving function.

What is Retrocalcaneal Bursitis?

Retrocalcaneal bursitis occurs when the small fluid-filled sac between the Achilles tendon and the heel bone becomes inflamed.

The bursa normally reduces friction during walking and running. When it becomes irritated, swelling and pain develop behind the heel.

The condition often occurs together with:

• Achilles tendinopathy

• Haglund's deformity (heel bump)

• Tight calf muscles

• Poor foot mechanics

Common Symptoms

Patients commonly describe:

• Pain behind the heel

• Pain when walking uphill

• Pain after running

• Pain when first getting up in the morning

• Swelling behind the heel

• Tenderness when squeezing the sides of the heel

• Difficulty wearing shoes with a firm heel counter

• Pain when standing on tiptoes

Many people notice that the pain gradually becomes worse over weeks or months.

What Causes Retrocalcaneal Bursitis?

Several factors may contribute:

Tight calf muscles

Limited ankle flexibility increases pressure on the Achilles tendon.

Poor foot biomechanics

Excessive pronation or altered foot mechanics may increase stress around the heel.

Overuse

Running, hiking and jumping sports commonly overload the area.

Footwear

Shoes with a rigid heel counter may repeatedly compress the bursa.

Haglund's deformity

A prominent heel bone can rub against footwear and irritate the bursa.

Sudden increase in activity

Increasing walking or exercise too quickly may overload the tissues.

How is it Diagnosed?

A podiatrist will usually diagnose retrocalcaneal bursitis through:

• Detailed medical history

• Assessment of symptoms

• Foot posture assessment

• Walking and gait analysis

• Achilles tendon examination

• Range of motion testing

• Calf muscle flexibility assessment

Sometimes imaging such as ultrasound or MRI may be recommended if another condition is suspected.

Conditions That Can Feel Similar

Several problems may produce pain behind the heel, including:

• Achilles tendinopathy

• Haglund's syndrome

• Insertional Achilles tendinopathy

• Partial Achilles tendon tear

• Calcaneal stress fracture

• Posterior ankle impingement

An accurate assessment helps determine the correct treatment.

Podiatry Management

Treatment focuses on reducing irritation while addressing the underlying cause.

Footwear Advice

Supportive footwear with a softer heel counter may reduce pressure on the inflamed bursa.

Activity Modification

Reducing activities that aggravate symptoms allows the tissue to recover.

Stretching Program

Gentle calf stretching may improve ankle flexibility when appropriate. In some cases of insertional Achilles problems, stretching is modified to avoid excessive compression.

Orthotics

Custom or prefabricated orthoses may improve foot mechanics and reduce excessive loading.

Heel Lifts

Temporary heel lifts may reduce tension on the Achilles tendon.

Exercise Rehabilitation

Progressive strengthening exercises help restore tendon function once pain settles.

Neuromodulation (Where Appropriate)

For patients with persistent pain, neuromodulation techniques such as Stimpod® therapy may be considered as part of an overall management plan. This treatment aims to help reduce pain and improve function but is not a cure for the underlying condition.

Referral

If symptoms persist despite conservative treatment, referral for imaging or specialist review may be recommended.

Tips to Help Recovery

• Wear supportive footwear.

• Avoid shoes that rub the back of the heel.

• Reduce high-impact activities temporarily.

• Ice the area after activity if recommended.

• Follow your prescribed rehabilitation program.

• Avoid returning to sport too quickly.
  
  

When Should You See a Podiatrist?

You should arrange an assessment if:

• Heel pain lasts longer than two weeks.

• Walking becomes painful.

• There is persistent swelling.

• Pain keeps returning.

• You cannot participate in normal activities.

• The pain is becoming progressively worse.

Early treatment often leads to a faster recovery and reduces the risk of long-term problems.

Some other names for this condition:
pain behind heel
back of heel pain
retrocalcaneal bursitis
heel bursitis
Achilles bursitis
Achilles heel pain
heel pain when walking
pain at back of heel
Haglund's deformity
podiatrist for heel pain
heel pain treatment
heel pain Chermside
heel pain Brisbane North

Frequently Asked Questions

Is retrocalcaneal bursitis the same as Achilles tendinitis?

No. Although they commonly occur together, retrocalcaneal bursitis affects the bursa beneath the Achilles tendon, while Achilles tendinopathy involves the tendon itself.

Can I still walk with retrocalcaneal bursitis?

Many people can continue walking, but excessive walking may worsen symptoms. A podiatrist can advise how much activity is appropriate during recovery.

How long does recovery take?

Recovery varies depending on the severity and underlying cause. Mild cases may improve within several weeks, while more persistent cases can take several months with appropriate treatment.

Do I need surgery?

Most patients improve with conservative management. Surgery is usually considered only when symptoms persist despite appropriate treatment and after specialist assessment.

Why Choose POD11?

At POD11, we don't just treat the painful heel—we identify why it has become painful. Our assessment includes foot biomechanics, gait analysis, footwear review, muscle flexibility, and lower-limb function to create an individualized treatment plan aimed at reducing pain and helping you return to your normal activities safely.

Book an Appointment

If you're experiencing pain behind your heel, our podiatrists can provide a comprehensive assessment and discuss the most appropriate treatment options for your condition.