Have you ever felt that sharp, nagging pain behind your heel that just doesn’t go away?
If you’ve recently noticed pain in the back of your heel, especially after running or exercising, you’re not alone. Heel pain is common, but understanding exactly why it’s happening can be tricky. More often than not, the pain could be a sign of Achilles tendonitis or retrocalcaneal bursitis. Let’s look at how you can tell the difference, and more importantly, what you can do about it.
What’s Causing the Pain Behind Your Heel?
Pain at the back of your heel generally comes from two main sources—the Achilles tendon itself or the small fluid-filled sacs behind it, known as bursae. Knowing which one is causing your discomfort can make all the difference in recovery.
Achilles Tendonitis
Achilles tendonitis usually develops due to repetitive stress or overuse. I often see it among runners, hikers, and athletes in Melbourne who regularly push themselves, especially those training on uneven terrain or increasing their training intensity too quickly. The tendon becomes inflamed, causing pain that can get progressively worse over time.
If your pain worsens during activities or first thing in the morning, it could be tendonitis. Our guide on Achilles tendon injuries might offer more clarity.
Retrocalcaneal Bursitis
On the other hand, retrocalcaneal bursitis affects the fluid-filled sacs behind your heel bone. It often develops because of friction from footwear—especially shoes with rigid or tight heel counters—or repetitive motion that irritates these sacs. If the pain feels sharp and is worse when pressing the back of your heel, it might be bursitis. For a clearer picture, check out this helpful resource from Cleveland Clinic.
Why Stretching Might Not Always Help
Now, here’s something surprising that most people don’t know: stretching might actually worsen your pain if you’ve got insertional Achilles tendonitis. Often, clients come to me after trying extensive stretching routines, only to find their symptoms getting worse. Soft-tissue work like massage sticks, foam rolling, or even heel lifts (around ¼ inch) usually works better in these cases.
If you’re unsure, our running assessment service can help pinpoint exactly what’s going wrong with your foot mechanics and find a better approach.
Footwear Matters More Than You Think
I’ve noticed a clear link between the type of footwear my patients use and their heel pain. Shoes with rigid heel counters can irritate the bursae or aggravate Achilles tendonitis. Switching to more accommodating footwear or using customised orthotics can often bring significant relief.
If you need expert advice, we specialise in creating custom orthotics for runners that address your specific foot structure and activity needs.
Shockwave Therapy: A Popular Option for Heel Pain
One treatment method that’s gained popularity in recent years is radial shockwave therapy. It’s non-invasive, quick, and can significantly reduce pain in conditions like Achilles tendonitis or chronic heel bursitis. I regularly recommend shockwave therapy to my clients who’ve tried other treatments without much success.
Strengthening Is Often Better Than Resting
Rest is important, but prolonged inactivity rarely solves the underlying problem. Instead, progressive strengthening exercises—especially single-leg calf raises—can lead to better long-term outcomes. This strengthens the tendon and reduces future injury risk.
Not sure how to start? We provide functional testing to identify exactly where your strength deficits are, making your recovery faster and more precise.
Could It Be Something Else?
Occasionally, what seems like tendonitis or bursitis could actually be something like a stress fracture, peroneal tendinopathy, or even plantar fasciitis. It’s crucial to get a proper diagnosis. We’ve seen plenty of cases where the initial self-diagnosis turned out to be something completely different. If you’re not seeing improvement, definitely book an appointment to get it checked out professionally.
How Long Does Recovery Take?
Honestly, recovery timelines vary. Mild tendonitis or bursitis might ease up within a few weeks with proper care. Severe cases or chronic conditions, though, can linger for months if not treated correctly. The key is early intervention, the right diagnosis, and personalised treatment plans.
When Should You See a Podiatrist?
If you’ve been experiencing pain behind your heel that’s lasted more than a couple of weeks—or if it’s affecting your daily life or favourite activities—it’s time to see a professional. Early diagnosis and the right approach can save you months of discomfort.
At Up & Running Podiatry, we offer comprehensive care tailored specifically for active individuals in Melbourne. Feel free to reach out through our contact page, and let’s get you back on your feet—pain-free.