What Causes Pain at the Back of the Foot?

Image via WikipediaThe Achilles tendon is the largest and toughest tendon in the body. It is an important structure that help us balance. It is important in running and walking. This tendon can store energy when running, it works very much like a spring, and this springing action can increase running speeds without using much energy.

Tendons and ligaments are very similar in structure and function, the only difference is their attachment. Tendons attach muscle to bone and ligaments, ligaments attach bone to bone.

From above, the Achilles tendon attaches to the calf muscles: soleus and gastrocnemius muscles. And from below, the tendon attaches to the middle portion of the calcaneus, also called heel bone. Directly above the attachment on heel bone, there is a fluid-filled, pillow-like structure called the Retrocalcaneal Bursa. This serves a cushion between the Achilles tendon and heel bone, preventing these structures from being "rubbed together".

Heel pain is one of the most common foot complaints in adults of all ages. There are many causes of pain involving this area and pain affecting the posterior or back of the heel involves all structures discussed above. The following are the pathologic conditions involving each structure:

Retrocalcaneal bursitis is a swelling or inflammation of the retrocalcaneal bursa. Too much use of the ankle sometimes irritates this bursa and cause painful inflammation. This condition is often triggered by aggressive exercise or a sudden increase in activity without initial stretching and conditioning.

Calcaneal Spur. Normally, there is a bony prominence that is palpable at the heel bone. This is actually the insertion of the Achilles tendon to the calcaneal bone. Over time, this bony prominence can enlarge irritating the Achilles tendon. This bony growth is called Haglund's Deformity (pump bump).

Achilles tendinitis is an inflammation of the Achilles tendon. The cause can be due to the conditions above, tear during strenuous activities, or the natural "wear and tear" degeneration because of aging causing foot pain.