Understanding Posterior Heel Pain and How to Treat It

Introduction: An often neglected, but disabling pain

Posterior heel pain is a symptom that seems benign at first, but can profoundly affect a person’s quality of life. Every step becomes an ordeal, every stair climb a fear. Yet, this pain often remains underestimated, both by patients and some healthcare professionals. It is sometimes dismissed as simple “tension” or “temporary inflammation,” when it can indicate a deeper functional imbalance, involving the musculoskeletal system as a whole. From this perspective, osteopathy offers a complementary and valuable approach, aiming to understand the overall origin of the pain rather than masking its manifestations.

The heel, an essential support point in the human body, is subjected to significant mechanical stress every day. When standing, walking, or running, it acts as a shock absorber, stabilizer, and propellant. It is therefore not surprising that it is prone to functional disorders, particularly in its posterior region, where essential structures such as the Achilles tendon, bursae, and calf muscles are inserted. If pain persists there, it can gradually lead to changes in posture, locomotor adaptation, and even a limitation of physical activity.

In the field of conventional medicine, heel pain is often approached from the perspective of local pathology: tendonitis, bursitis, bone growth, etc. These diagnoses are useful and necessary, but they do not always take into account the underlying functional causes: distant joint stiffness, posterior muscle chain disorder, pelvic compensation or plantar imbalance. This is where osteopathy can intervene in a relevant way, by exploring the links between the different parts of the body and restoring mobility to restricted structures.

The public affected by this type of pain is wide: amateur or professional athletes, workers in prolonged standing positions, the elderly, growing children. The mechanisms at the origin of the symptom vary: tendon overuse, repeated trauma, unsuitable shoes, dysfunctional posture, excess weight, etc. In all cases, a comprehensive, individualized and manual approach like that of an osteopath can provide significant relief, while promoting a better understanding of the body by the patient.

This article aims to shed light on the multiple facets of posterior heel pain, combining anatomical, clinical, and osteopathic data. It is aimed at patients curious to better understand their pain, but also at therapists wishing to enrich their clinical perspective. We will explore the most common causes, the signs to look for, diagnostic strategies, and, above all, the treatment options offered by osteopathy. Clinical cases will illustrate this approach, and practical advice will be offered to prevent recurrences.

It is essential to remember that pain, in osteopathy, is not an enemy to be silenced, but a warning signal to be listened to. It tells us of an imbalance, a loss of mobility, sometimes of an excess or a lack. It can reflect an old conflict, recent overwork, or a latent dysfunction that is expressed through the body. From this perspective, the posterior region of the heel becomes a true crossroads for body reading: it reveals what the rest of the body is silently compensating for. The osteopath, by placing his hands attentively, can then highlight what the pain is trying to express.

In a world where physical performance is often valued at the expense of listening to the body, taking the time to understand heel pain may seem trivial. And yet, it is often through these pains, considered minor, that general fatigue and an overall imbalance are expressed. By neglecting them, we risk allowing chronic problems to set in, or even compromising other joints. This is why osteopathy, in its preventive and comprehensive approach, finds its relevance in this type of clinical picture.

Finally, beyond physical relief, well-conducted osteopathic treatment can also strengthen the feeling of bodily coherence, help the patient reclaim their body image, and prevent future injuries. It’s not just about “getting rid of the pain,” but about supporting a process of functional, postural, and sometimes emotional adjustment. Because the heel, in its symbolism as well as its function, is what connects us to the earth: pain in this area can also call into question our way of walking in the world.

Heel Anatomy: Dive into the Posterior Region

Understanding the anatomy of the heel, particularly its posterior portion, is fundamental to understanding the mechanisms of pain that can occur there. This area, both dense and complex, acts as an anchor and transmission point for many structures essential to locomotion. It combines bone, tendon, muscle, vascular, and nervous elements, each of which can cause functional disorders. For the osteopath, a detailed knowledge of this architecture is essential to guide palpatory diagnosis and refine therapeutic procedures.

The calcaneus: bony pillar of the heel

The calcaneus is the main bone of the heel, the largest in the foot. It constitutes the posterior support point of the foot when standing and walking. It articulates above with the talus (forming the subtalar joint), and anteriorly with the cuboid bone. The posterosuperior surface of the calcaneus has a projection, the calcaneal tuberosity, on which the Achilles tendon is inserted. This region is the frequent site of pain, particularly in tendinopathies or mechanical conflicts such as Haglund’s syndrome.

The calcaneus plays a role in transmitting vertical (body weight) and horizontal (propulsion) forces, making it a high-stress area. It is also involved in inversion/eversion movements and helps the foot adapt to uneven ground.

The Achilles tendon: link between the triceps surae and the heel

The calcaneal tendon, better known as the Achilles tendon , is one of the most powerful tendons in the human body. It is formed by the joining of the tendons of the gastrocnemius (gastrocnemius) and soleus muscles, which together make up the triceps surae. This tendon inserts on the posterior surface of the calcaneal tuberosity.

When walking or running, the Achilles tendon transmits the force of the calf muscle contraction to the foot, enabling forward thrust. This structure is constantly stressed, making it vulnerable to microtrauma, especially in cases of postural imbalances or mechanical overload. Its relatively low vascularity in the insertion area also contributes to its susceptibility to tendinopathies and degenerative lesions.

Bursae: protective tampons

The posterior region of the heel has two important bursae :

• The retrocalcaneal bursa , located between the Achilles tendon and the calcaneal bone;
• The retrotendinous bursa , located between the Achilles tendon and the skin.

These bursae reduce friction between moving structures. Inflammation can cause bursitis, which is often painful and sometimes confused with tendinopathy. Excessive tension in the triceps surae, stiff shoes, or foot malposition can all contribute to irritation of these bursae.

Soft tissues: skin, fascia and fat pad

The posterior skin of the heel is thick, often horny, and contains a layer of specialized fatty tissue that acts as a shock absorber. Beneath the skin is the plantar fascia , which begins at the back of the calcaneus and extends toward the front of the foot, contributing to the stability of the plantar arch.

This fatty pad can atrophy with age or repeated microtrauma, which reduces the heel’s shock absorption capacity, making it more vulnerable to pain. Osteopaths often focus on the tissue quality of this area, its mobility, and any fibrosis.

Neurological elements: tibial nerve and plantar branches

The posterior tibial nerve , descending on the medial aspect of the leg, crosses the retromalleolar region and divides near the heel into the medial and lateral plantar nerves. It may also give off a sensory branch to the heel called the medial calcaneal nerve , which innervates the skin of the heel.

Compression or irritation of this nerve, particularly in the context of tarsal tunnel syndrome, can cause pain radiating to the heel or sensations of burning, tingling, or numbness. This neuropathic pain is sometimes confused with mechanical pain.

Interactions with ascending chains

The anatomy of the heel cannot be separated from its integration into the posterior chain. Any mobility restriction at the knee, hip, or pelvis can alter the load on the heel. For example, hamstring tension or pelvic tilt can cause reflex hypertonia of the triceps surae, increasing the pull on the Achilles tendon.

The osteopath will take these ascending and descending interactions into account, analyzing the link between proximal fixations and local symptoms. The goal is to understand why this area is suffering, and where the overload comes from.

The main causes of posterior heel pain

Posterior heel pain is not a homogeneous entity, but a symptom that can arise from several pathological or dysfunctional mechanisms. It can be acute or chronic, inflammatory or mechanical, localized or projected. In their clinical approach, osteopaths must learn to distinguish these different, often intertwined, causes in order to direct treatment toward the source of the imbalance. This section offers an exploration of the main etiologies encountered in clinical practice, grouping them according to their nature.

Achilles tendonitis: overloading the tendon giant

Tendinitis (or more precisely, tendinopathy) of the Achilles tendon is the most common cause of posterior heel pain in adults. It results from excessive or inappropriate use of the tendon, often linked to:

• Overwork in sports (running, jumping, dancing);
• Training errors (sudden increase in intensity or volume);
• A bad shoe (heel too stiff or too flat);
• A biomechanical alignment disorder (pronating or supinating foot).

The patient describes pain located a few centimeters above the heel bone, exacerbated by walking or climbing stairs. In the morning, stiffness is common. Palpation reveals a painful and sometimes thickened area. The osteopath will seek to identify mobility restrictions in the calf, knee, or pelvis that may contribute to this overload.

Retrocalcaneal bursitis: inflammation of the tampon

Retrocalcaneal bursitis is inflammation of the bursa between the Achilles tendon and the calcaneus. It is often secondary to mechanical compression, as in Haglund’s syndrome (see below), or chronic irritation from rubbing against shoes.

Clinic:

• Pain at the posterior base of the heel, centered on the bursa;
• Redness, local swelling, sometimes feeling like a “hard blister”;
• Pain on pressure and weight bearing.

The osteopath will be able to relieve the mechanical tensions responsible for the compression and improve local drainage, while advising on external aggravating factors (shoes, posture).

Haglund’s syndrome: conflict between bone, tendon and shoe

Haglund’s syndrome is a mechanical impingement between a posterior-superior bony outgrowth of the calcaneus, the Achilles tendon, and the shoe. It primarily affects young women, runners, or people who wear stiff heels.

It often combines:

• Retrocalcaneal bursitis;
• Achilles tendinopathy;
• A visible or palpable growth.

The pain is worse when putting on shoes, during plantar flexion, or at the end of the day. Osteopathic treatment aims to reduce posterior tension and improve the mobility of the entire foot, leg, and pelvis.

Sever’s disease: painful growth in children

In children, particularly boys between the ages of 8 and 13, Sever’s disease is a common cause of heel pain. It results from excessive traction on the posterior growth plate of the calcaneus, where the Achilles tendon inserts.

This apophysitis is often bilateral, linked to rapid growth and sustained physical activity. It manifests itself by:

• Pain when walking or running;
• Tenderness to pressure on the calcaneal tuberosity;
• A relief at rest.

Osteopathy intervenes here in addition to rest, by rebalancing growth tensions and optimizing the child’s general posture.

Stress fracture: insidious pain in the calcaneus

Less common, but not to be overlooked, a calcaneal stress fracture can occur after repeated impacts, especially in long-distance runners, military personnel, or overweight individuals. It manifests as a dull, progressive pain that increases with exertion and subsides at rest.

Diagnosis requires imaging (MRI or scintigraphy) because standard X-rays can be normal in the early stages. If the osteopath suspects this type of lesion, he or she should promptly refer the patient for medical advice and suspend any direct manipulation of the area.

Leg inequalities, postural disorders and plantar overload

Some posterior heel pain does not have an obvious lesional origin, but results from an overall biomechanical imbalance :

• Inequality in length of lower limbs;
• Sacroiliac dysfunction;
• Lumbar hyperlordosis or posterior chain disorder;
• Poor absorption of stress at the foot level.

In these cases, the pain is often chronic, diffuse, asymmetrical, and manifests itself with fatigue. The osteopath will play a central role here in identifying and correcting remote causes, sometimes unsuspected by the patient.

Clinical picture: How does the pain manifest?

Posterior heel pain does not always present uniformly. Depending on the cause, the patient’s age, activity level, posture, and medical history, clinical manifestations can vary considerably. Understanding the different ways in which this pain is expressed allows the osteopath to better guide their functional diagnosis and distinguish between pain of mechanical, inflammatory, or neurological origin. This section explores typical and atypical symptoms , as well as their evolution over time and according to patient profiles .

Localized pain: fixed point or diffuse area

In the majority of cases, the pain is located on the posterior surface of the heel , either precisely at the insertion of the Achilles tendon on the calcaneus, or slightly above or below, depending on the structures involved:

• Pain just above the heel often points to Achilles tendinopathy;
• Pain at the posterior base of the calcaneus suggests retrocalcaneal bursitis or Haglund’s syndrome;
• Pain in the center of the heel in a child is suggestive of Sever’s disease.

The patient may describe the pain as:

• Acute or throbbing pain during exercise (walking, running, climbing stairs);
• Dull, heavy or burning sensation when resting or at the end of the day;
• Prickly or electric , in case of involvement of a peripheral nerve.

The osteopath must here precisely question the conditions of appearance, the aggravating and relieving factors, as well as the quality felt by the pain.

Morning stiffness: an indicator of inflammation

A symptom often reported in cases of tendinopathy or bursitis is stiffness upon standing up . The patient feels as if they are walking on a stone, unable to “roll” their step. This sensation generally fades after a few minutes of movement. It indicates local inflammation , with nocturnal tissue retraction.

This sign is important because it can precede pain during exercise and indicate an early phase of the pathology. Persistent stiffness, beyond 15 to 20 minutes, should alert to a more advanced condition or a systemic inflammatory component (rare but should be considered in cases of arthritis).

Pain during exertion: the ramp-up test

Posterior heel pain is often triggered or aggravated by weight bearing , particularly:

• When running , especially when going uphill or during the push phase;
• When going up or down stairs ;
• In prolonged standing (frequent case among professionals standing all day);
• After changing shoes, especially to a lower or stiffer heel.

Some patients note that the pain appears hot (at the beginning of the activity), improves during exercise, and then returns cold (a few hours after stopping). This profile is typical of chronic tendinopathies.

The osteopath will be able to observe compensations in walking : lateralized support, rotation of the foot, reduction of stride lengthening, etc. These adaptations must be corrected to avoid chronicity.

Associated symptoms: warning signs or signs of chronicity

Certain associated signs must be carefully noted, because they point towards complications or particular forms:

• Local swelling : suggestive of bursitis or active inflammation;
• Redness and heat : inflammatory, even infectious indicator;
• Burning or tingling sensations : neurological signs, suggesting medial calcaneal nerve damage or tarsal tunnel syndrome;
• Visible deformity : posterior hump of the calcaneus, typical of Haglund’s syndrome;
• Loss of strength in plantar flexion: rare but possible, especially after a partial tendon rupture.

These clinical elements should prompt a thorough assessment , and sometimes a referral to medical imaging or specialist consultation.

Evolution according to age and patient profile

• In children : Posterior heel pain is often related to growth, as in Sever’s disease. It is exacerbated by sports and wearing unsuitable shoes.
• In active adults or athletes : tendinopathies and bursitis dominate the picture. They often develop in flare-ups, with periods of remission and flare-ups.
• In the elderly : Pain can be chronic, linked to tendon degeneration, loss of fat pad, or a change in walking pattern. It is sometimes accompanied by a fear of falling.

The osteopathic approach must be adapted to these different profiles: myotendinous relaxation, postural rebalancing, overall work on the ascending and descending chains.

Osteopathic clinical assessment: listening to the body in movement

Observation of standing posture, walking, and dynamic testing is crucial. The osteopath will look for:

• A limitation of dorsiflexion or plantar flexion;
• Restriction of mobility of the tibiotarsal, subtalar or midfoot joints;
• Excessive tension of the triceps surae;
• Upward (knee, hip, pelvis) or downward (arch, toes) compensations.

This clinical picture, enhanced by fine palpation and tissue listening, allows a functional osteopathic diagnosis to be made : not in terms of pure pathology, but in terms of imbalances to be corrected to restore fluid and pain-free function.

Diagnosis: Between clinical examination and imaging

When faced with posterior heel pain, making an accurate diagnosis is essential, both to tailor osteopathic treatment and to rule out more serious pathologies. Diagnosis should not be limited to a local observation: it is part of a comprehensive understanding of the body, its mechanics, its postural adaptations, and sometimes its traumatic memories. This section explores the different stages of the assessment, from osteopathic history taking to the possible use of medical imaging.

Osteopathic anamnesis: listening to what the body wants to say

Interviewing is the first step in diagnosis. It allows us to reconstruct the history of the pain , the circumstances of its onset, its development and its repercussions. The osteopath will ask questions in particular about:

• The mode of onset : sudden or gradual, after exertion or at rest?
• The rhythm : morning pain, pain on exertion, night pain?
• Aggravating and relieving factors : type of shoes, physical activity, positions?
• The context : returning to sport, changing positions, stress, weight gain?
• History : previous trauma (sprains, fractures), chronic pathologies, surgery of the lower limb or spine, drug treatments?

But beyond the facts, the osteopath also listens to the bodily and emotional resonances that this pain can carry. Heel pain can symbolize difficulty “putting your foot down,” moving forward, or even an overload carried for too long.

Observation and palpation: the intelligence of manual gestures

The clinical examination begins with a global postural observation : how does the patient stand? Where does he place his weight? Is there a collapse of the plantar arch, a tilt of the pelvis, a rotation of the knee?

Gait analysis is also rich in information: stride length, symmetry, foot roll, and pain-relieving posture. A compensatory limp, even a slight one, can indicate chronic overload or distant joint blockage.

Palpation then refines the diagnosis. It allows:

• Locate the pain precisely;
• Distinguish the affected structures (tendon, bursa, bone, subcutaneous tissue);
• Assess temperature, texture, tissue mobility;
• Look for edema, myofascial tension, fibrosis.

Osteopathic tests complete the examination: passive mobilization of the foot and ankle, triceps surae elongation tests, calcaneal compression, posterior chain test, etc. These tests point towards specific tissue dysfunctions or joint restrictions to be corrected.

Specific clinical tests: refining the hypothesis

Certain tests can help to determine the origin of the pain:

• Royal London sign : pain on palpation of the Achilles tendon, which decreases during isometric contraction against resistance, suggestive of tendinopathy.
• Calcaneus squeeze test : pain when compressing the bone laterally, suspected stress fracture.
• Thompson test : absence of plantar flexion during calf compression, a sign of a partial or complete rupture of the tendon.
• Passive dorsiflexion test : increased pain during passive stretching of the triceps surae in bursitis or tendonitis.
• Tinel test at the tarsal tunnel : reproduces pain radiating towards the heel, suggesting a neurological component.

These tests must be interpreted with care, placing them in the overall context of the patient.

The role of medical imaging: confirmation or exclusion

The osteopath does not make a medical diagnosis in the strict sense, but can refer the patient for further examination if necessary:

• Standard X-ray : Useful for visualizing bony growths (Haglund’s syndrome), calcaneal abnormalities, or ruling out a fracture.
• Musculotendinous ultrasound : used to assess the integrity of the Achilles tendon, inflammation of the bursae, muscle tears or chronic injuries.
• MRI : reserved for persistent or complex cases, it visualizes soft tissues, bone edema, and allows confirmation of a stress fracture.
• Bone scan : rarely used, but can be useful for difficult diagnoses, particularly in athletes.

The aim is not to replace the doctor, but to collaborate in cases of doubt or suspicion of serious pathology, in order to ensure optimal safety for the patient.

Functional osteopathic diagnosis: seeing beyond the painful area

Finally, the osteopath establishes a functional diagnosis , that is, a mapping of mobility restrictions and biomechanical imbalances that contribute to the pain. This may include:

• Loss of mobility in the ankle, knee, hip or pelvis;
• A global postural asymmetry;
• Remote muscle hypertonia;
• A neuromuscular coordination disorder.

This diagnosis allows for the construction of an individualized treatment plan , aimed at releasing areas of tension, reharmonizing supports, and restoring locomotor function in its entirety.

Osteopathic approach: Understanding and treating the whole

In the management of posterior heel pain, osteopathy stands out for its ability to go beyond a strictly localized approach to the symptom. Where other disciplines may focus on the tendon, bursa, or bone, the osteopath examines the body as a whole , its spatial organization, its dynamics, and its adaptations. The heel, in this context, is not just a painful area: it is an alarm signal , often the visible end point of an older, deeper imbalance. This section explores the main axes of the osteopathic approach, between local techniques and treatment of remote causes.

Goals of osteopathic treatment: restore function, not just make pain go away

The role of the osteopath is not simply to relieve inflammation or loosen a tendon. It is to:

• Restore tissue mobility where it is restricted;
• Reharmonize the muscle chains ;
• Optimize plantar support and overall posture ;
• Allow the body to regain its self-regulation .

This approach involves not stopping at the symptomatic area. Heel pain can be the result of sacroiliac blockage, hypertonia of the quadratus lumborum, diaphragmatic dysfunction, or even a plantar proprioception disorder.

Tissue work and myofascial release: restoring flexibility to tissues

Initially, the osteopath often acts locally on the tissues surrounding the heel:

• Release of the triceps surae (gastrocnemius and soleus) by post-isometric muscular techniques or gentle inhibition;
• Decompression of the Achilles tendon , working on its mobility in relation to the calcaneus and the bursae;
• Drainage and mobilization of subcutaneous tissues (fascia, fat pad) in cases of local inflammation or edema;
• Myofascial decompression techniques of the posterior chain (plantar fascia, posterior compartment of the leg, lumbar fascia).

This work aims to restore smooth sliding of structures , release accumulated tension, and soothe local inflammation.

Postural and biomechanical balance of the lower limb: from the ankle to the pelvis

The osteopath then examines the lower limb as a whole :

• Ankle: mobility of the tibiotarsal, subtalar, midfoot joints;
• Knee: look for rotation or flexion-extension restrictions;
• Hip: assessment of rotation, anteversion, abduction movements;
• Pelvis: position of the iliacs, sacroiliac mobility, lumbopelvic balance.

A restriction of mobility at the hip, for example, can lead to compensatory overload of the triceps surae , and therefore of the Achilles tendon. Similarly, a tilt of the pelvis can alter the distribution of weight between the two feet, promoting excessive pressure on the painful heel.

Osteopathy corrects these secondary joint dysfunctions to relieve the posterior region of the heel.

Involvement of the spine, diaphragm and ascending chains

Osteopathic treatment also explores remote areas , including:

• Lumbar spine : L5-S1 dysfunction can influence calf tone via nerve roots;
• The diaphragm : its tension can create hyperpressure towards the pelvis and lower limbs;
• The craniosacral system : disturbed in certain chronic pains, it is assessed in a global approach.

The osteopath acts on these structures remotely when he identifies a loss of mobility or a tissue imbalance that could maintain the symptoms.

Static adjustment and neuromuscular integration

Once the tensions are released and mobility restored, the osteopath guides the body towards a new functional organization , more fluid, more balanced. This involves:

• Foot and pelvic re-centering exercises ;
• Advice on suitable footwear (drop, flexibility, support);
• Recommendations for gentle mobilizations at home , to maintain the benefits of the session.

In some patients, plantar proprioception training is offered through conscious support, balance exercises, or targeted sensory stimulation. This allows the foot to “re-appropriate” its dynamic support function.

The emotional and symbolic dimension of heel pain

In some cases, especially when the pain is chronic or without obvious cause, the osteopath can explore a more emotional or symbolic dimension . The heel is what connects us to the ground, to our base. Pain in this area can evoke a lack of anchoring , difficulty moving forward, or an overload supported for too long.

Without excessive interpretation, the osteopath can listen to what the body is expressing, and accompany the patient in a more conscious and peaceful bodily reappropriation .

Complementary treatments and practical advice

In addition to osteopathic treatment, a range of measures can help relieve posterior heel pain and prevent its recurrence. It’s not just about relieving a symptom, but also about creating the right conditions for healing and rebalancing the body. These treatments include natural approaches, ergonomic advice, targeted exercises, and sometimes the temporary use of orthopedic devices. The goal is to involve the patient in their own care, with a focus on therapeutic education and empowerment.

Proper stretching and gentle exercises: restore flexibility without aggravating it

One of the pillars of support for heel pain is the rebalancing of the muscle chains , particularly the posterior ones:

• The triceps surae (gastrocnemius and soleus) is often the cause: its shortening or hypertonia increases the traction on the Achilles tendon.
• The plantar fascia , whether stretched or retracted, contributes to the loss of flexibility in the rearfoot.

Recommended progressive stretches :

• Standing calf stretch against a wall, knee straight then knee bent;
• Passive stretch of the sole of the foot in dorsiflexion with the toes extended, sitting or lying down;
• Gently massage your feet with a tennis ball or a spiky ball.

These exercises should be performed without any sharp pain, in a progressive manner, twice a day for 30 seconds to 1 minute. The osteopath adapts their intensity according to the stage of inflammation.

Shoes and soles: thinking about the foot’s environment

Shoes play a fundamental role. Poor footwear can maintain or worsen pain:

• Too rigid: generates conflicts with the calcaneus (e.g. Haglund syndrome);
• Too flat: increases traction on the Achilles tendon;
• Too soft: lack of arch support.

Practical advice :

• Choose a shoe with a slight drop (slightly raised heel) if the tendon is painful;
• Avoid rigid buttresses if bursitis is the cause;
• Favor soft cushioning , especially for the elderly or overweight.

The osteopath can also refer you to a podiatrist for the design of custom-made orthopedic insoles. These can:

• Rebalance the supports;
• Reduce tendon traction;
• Compensate for unequal length of the lower limbs.

The goal is always to regain normal function , not to correct compensation for life if it is no longer necessary.

Icing, rest and self-care: supporting the inflammatory phases

In the acute phase, particularly in cases of tendonitis or bursitis, natural anti-inflammatory measures can help:

• Heel icing : 10 to 15 minutes, 2 to 3 times a day, never directly on the skin;
• Relative rest : avoid triggering activities without falling into total immobilization;
• Foot elevation : useful if edema is present, at the end of the day.

Medicinal plants can also be suggested (in agreement with the healthcare professional): arnica, harpagophytum, turmeric, etc. For local or oral use, they offer gentle and natural support for the tissue regulation phase.

Correction of everyday gestures: ergonomics in motion

Heel pain is often caused by repeated movements or inappropriate postures :

• Prolonged standing without change of support;
• Walking on hard ground without cushioning;
• Prolonged sitting position with crossed legs, affecting the pelvis and lower limb.

The osteopath can offer:

• Postural micro -breaks at work;
• Alternating postures (sitting/standing/walking);
• Tips for reorganizing your workspace or daily routine .

The idea is to get the patient to inhabit their body differently , with more awareness and fluidity.

Integrate a body care routine

To avoid recurrences, a maintenance routine is essential:

• Self-massages: sole of the foot, calf, buttocks;
• Gentle joint mobilizations in the morning (ankle, knee, pelvis);
• Warm or alternating (warm/cold) foot bath at the end of the day to activate circulation;
• Balance exercises (on one leg, eyes closed, on an unstable cushion) to strengthen proprioception.

This routine can be designed with the osteopath according to the patient’s profile, age, history and objectives.

Working on emotions and stress: the mind-body connection

Some heel pain develops or worsens in a context of psychological or emotional tension : professional overload, conflict, loss of bearings, chronic anxiety.

The osteopath, if he perceives the signs, can suggest:

• Somato-emotional release techniques ;
• Caring verbal and physical listening;
• Referral to additional support if necessary (psychologist, relaxation, yoga).

Taking care of your heel sometimes also means taking care of what is preventing us from moving forward serenely .

Osteopathic clinical cases: Concrete illustrations

To illustrate the richness of the osteopathic approach to posterior heel pain, nothing beats real clinical cases or those inspired by daily practice . These examples allow us to understand how theoretical principles translate into care, and how listening closely to the body, beyond the symptoms, guides us towards individualized solutions. These cases are deliberately varied: athletes, children, the elderly, each providing a particular insight into the mechanisms at play and the relevance of osteopathic care.

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Case 1 – The Regular Runner and Chronic Achilles Tendinopathy

Profile : 42-year-old male engineer, runs three times a week for 6 years. Persistent pain in the back of the right heel for 3 months, which appeared gradually after changing shoes (minimalist model).

Symptoms :

• Pain when loading and at the start of running;
• 15-minute morning stiffness;
• Dull ache that persists after training.

Osteopathic assessment :

• Hypertonia of the right triceps surae;
• Restriction of midfoot mobility;
• Right posterior rotation sacral dysfunction;
• Stiffness of the T9-T10 joint, linked to prolonged sitting posture.

Treatment :

• Post-isometric release of the gastrocnemius and soleus;
• Myofascial decompression of the Achilles tendon;
• Joint release of the sacrum and thorax;
• Progressive stretching tips and shoe modification.

Result : Significant improvement from the second session. The patient gradually resumes running, with less stress on the tendon. Awareness of the importance of listening to one’s body.

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Case 2 – 11-year-old child with Sever’s disease

Profile : 11-year-old boy, very active, plays soccer 5 times a week. Bilateral heel pain for 2 months, aggravated by physical activity.

Symptoms :

• Diffuse pain in the back of the heel after workouts;
• Slight limping at the end of the day;
• Heels tender to palpation.

Osteopathic assessment :

• Significant tension in the posterior chain (hamstrings, calves);
• Restriction of mobility of the left foot (subtalar joint);
• Lumbar compensation by hyperlordosis.

Treatment :

• Gentle muscle inhibition and active global stretching techniques;
• Joint mobilizations of the foot and pelvis;
• Moderate activity tips, icing, and daily stretching.

Result : 60% reduction in pain in 2 weeks, supervised resumption of activity. Osteopathy helped release growth tensions and prevent chronic progression.

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Case 3 – 68-year-old woman with heel pain related to fat pad loss

Profile : Retired woman, regular walker, has been complaining for several months of pain in her left heel, with no known traumatic cause.

Symptoms :

• “Stones in the shoe” type pain at the end of the day;
• Feeling of crushing the heel on hard ground;
• Pain increased without shoes.

Osteopathic assessment :

• Visible atrophy of the posterior fat pad;
• Asymmetrical postural supports;
• Pelvic compensation by left anteversion;
• Hypomobility of the left hip.

Treatment :

• Subcutaneous tissue decompression techniques;
• Overall work of the left lower limb and pelvis;
• Recommendation of an arch support (lightweight shock-absorbing sole);
• Gentle postural education.

Result : Progressive pain relief, improved walking tolerance. Improved posture and body image in daily life.

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Case 4 – Young dancer and Haglund syndrome

Profile : 17 year old girl, ballet dancer, pain in the back of her right heel after pointe.

Symptoms :

• Discomfort when putting on shoes;
• Sharp pain when pressing on the buttress;
• Posterior swelling of the calcaneus.

Osteopathic assessment :

• Obvious mechanical conflict between the calcaneus and the tendon;
• Hypertonia of the fibulae and imbalance of support;
• Dysfunction of the ipsilateral midfoot and pelvis.

Treatment :

• Local decompression, release of the triceps and fibulae;
• Mobilization of the midfoot and realignment of the pelvis;
• Tips for suitable footwear for dance.

Result : significant improvement, better management of toe support, prevention of relapses by correcting ascending imbalances.

Open conclusion – Return to your foundations to move forward differently

Posterior heel pain, so common yet often trivialized, reveals much more than a simple local problem of overload. It is at the crossroads of biomechanics, body history, daily posture, and sometimes emotional experience. In this, it offers a privileged field of exploration for osteopathy, a discipline that considers the symptom not as an enemy to be fought, but as a messenger to be listened to .

Throughout this article, we have seen how many faces this pain can take: Achilles tendinopathy, bursitis, Sever’s disease, Haglund’s syndrome, stress fracture… But behind the diversity of diagnoses, one common point remains: a loss of functional harmony in the body. This loss can be local, in the relationship between the tendon and the bone; or systemic, in the way the body manages its supports, compensates for its imbalances, absorbs shocks and expresses tensions.

In the osteopathic approach, treating the heel is not about attacking it. It is about understanding why it is suffering . Why this left heel, and not the right? Why this pain today, and not a year ago? What is the body trying to say through this painful point of support? These questions, far from being theoretical, guide the entire manual practice of the osteopath. They open the way to a comprehensive treatment, respectful of the body’s rhythm and its history.

The osteopath’s hands do not seek to force, but to dialogue. They perceive tensions, densities, blockages, but also areas of vitality, movement, and potential for repair. In the case of posterior heel pain, they explore local tissue fixations, but also compensations of the knee, hip, pelvis, spinal rotations, and support asymmetries. They seek to free movement , restore the body’s ability to adapt, and restart natural self-regulation circuits.

But this functional restoration cannot be complete without the involvement of the patient himself. The osteopath can loosen the knots, but it is up to the patient to learn to inhabit his supports differently , to better distribute his loads, to respect his limits. This involves concrete adjustments (shoes, stretching, rhythm of life), but also a more subtle awareness: that of the way he stands, walks, takes… and moves forward.

Heel pain then becomes an opportunity for transformation . It invites us to slow down, to readjust our inner and outer posture, to take our steps differently – no longer in haste, but with awareness. This is how it can be a gateway to deeper, more comprehensive, and more lasting care.

This approach is in line with a holistic vision of care: one that considers the body not as a sum of mechanical parts, but as a living being, traversed by forces, memories, rhythms. It echoes the symbolism of the heel, the root of the foot, the anchor point to the ground: when this area becomes painful, it is sometimes a call to find a sense of rooting , a lost stability, a more just connection with the earth as with oneself.

Rather than closing this reflection with certainties, let’s open it to personal resonance . What does your heel say? What burdens are you carrying that no longer belong to you? What part of yourself yearns to move forward differently? What if pain were not only to be silenced, but to be listened to like a murmur from the body towards greater coherence?

Osteopathy, in its subtle and embodied practice, offers a space for this listening. It invites us to return to our bases , in the most concrete as well as the most existential sense. And it is perhaps there, in this ability to find the right step, that true healing takes place.

Exercise and stretching

Exercises and Stretches: Restore Heel Flexibility and Strength

Therapeutic support for posterior heel pain cannot be limited to manual techniques. It also relies on active patient participation , particularly through simple exercises aimed at loosening, strengthening, and reharmonizing the posterior chain. These exercises, if performed correctly and adapted to the level of pain, promote tissue healing, reduce the risk of recurrence, and strengthen bodily autonomy.

Achilles tendon stretch with flexed knee: targets the soleus muscle

This exercise specifically stretches the soleus, which is often chronically contracted when the tendon is overloaded.

• Starting position : Standing facing a wall, with the non-injured foot placed in front with the knee bent, the affected foot at the back with the knee also bent. The toes of both feet are pointed slightly inward.
• Movement : Keeping both heels firmly planted on the floor, gently bend your hips forward toward the wall until you feel a deep stretch in the back of your ankle and lower calf.
• Duration : Hold the stretch for 30 seconds, then release for 30 seconds.
• Frequency : Perform 2 to 3 sets of 4 repetitions, twice a day, over a period of 3 to 4 weeks.

This stretch is particularly useful in subacute and chronic phases.

Triceps Surae (Gastrocnemius) Stretch: Release the Posterior Chain

This variation targets the more superficial gastrocnemius muscle, which is often hypertonic in active people or walkers.

• Starting position : Standing facing a wall, place the non-painful foot in front with the knee bent. The painful limb is positioned behind, with the leg straight and the toes pointing slightly inward.
• Movement : Slowly lower your pelvis forward until you feel a stretch in the back of your leg, in the upper calf area.
• Duration and frequency : same as the previous stretch.

Alternating these two stretches allows for a synergistic action on both portions of the triceps surae, reducing tension on the Achilles tendon.

Eccentric calf strengthening: stimulate without overloading

Eccentric work is one of the pillars of tendinopathy rehabilitation. It consists of actively slowing down muscle lengthening , which promotes the reorganization of tendon fibers.

• Starting position : Stand on a stair step with your heels hanging off the ground, holding onto a railing for balance.
• Movement :
  1. Raise onto tiptoe using both legs;
  2. Slowly lower yourself back down onto the sore leg alone, letting the heel drop as low as comfortably possible.
• Repetitions : 10 to 15 repetitions, 2 to 3 times per day.
• Progression : Start with both feet, then progress to unilateral support as strength increases.

This approach not only strengthens the calf muscles, but decreases tendon pain by stimulating tissue adaptation .

References

General scientific and medical references

1. Maffulli, N., et al. (2003). Clinical diagnosis of Achilles tendinopathy with tendinosis. Clinical Journal of Sport Medicine, 13(1), 11–15.
2. Alfredson, H., et al. (1998). Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. American Journal of Sports Medicine, 26(3), 360–366.
3. Khan, K. M., et al. (2002). Histopathology of common tendinopathies. Update and implications for clinical management. Sports Medicine, 27(6), 393–408.
4. Saxena, A., & Fullem, B. (2004). Haglund’s deformity and retrocalcaneal bursitis in the elite athlete. Foot and Ankle International, 25(11), 779–783.
5. Weiss, L. A., et al. (2002). Calcaneal apophysitis (Sever disease): Presentation and treatment. Clinical Pediatrics, 41(6), 341–344.

Podiatry, biomechanics and postural chains

6. Basmajian, J. V., & Deluca, C. J. (1985). Muscles Alive: Their Functions Revealed by Electromyography. Williams & Wilkins.
7. Kapandji, IA (2010). Joint Physiology – Volume 2: Lower Limb. Maloine.
8. Root, M. L., Orien, W. P., & Weed, J. H. (1977). Normal and abnormal function of the foot. Clinical Biomechanics Corp.

Osteopathic references

9. Greenman, P. E. (2003). Principles of Manual Medicine. Lippincott Williams & Wilkins.
10. Lederman, E. (2005). The Science and Practice of Manual Therapy. Elsevier.
11. Barral, J.-P., & Mercier, P. (1988). Osteopathic approach to fascia. Sully Editions.
12. Sutherland, WG (1990). Teachings in the Cranial Field. Sully Publishing.

Pain, symbolism and the mind-body connection

13. Damasio, A. R. (1994). Descartes’ Error: Emotion, Reason, and the Human Brain. G. P. Putnam’s Sons.
14. Alice Miller. (1981). The Drama of the Gifted Child. Basic Books.
15. Lemoine, M. (2018). Pain and the Body: An Anthropological and Clinical Approach. Érès.

Prevention, sport and practical recommendations

16. American College of Sports Medicine (ACSM). (2021). ACSM’s Guidelines for Exercise Testing and Prescription.
17. Gait & Posture Journal (various articles on gait, support, and foot biomechanics).
18. Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43(6), 409–416.

CONDITION	CLINICAL FEATURES	INITIAL TREATMENT
Achilles tendonitis	*Sometimes acute pain *Worsens with increased activity or pressure on the area *Pain along the Achilles tendon * Occasional palpable prominence of tendon thickening	*Eccentric exercises *Decreases pressure on the affected area *Heel lifts, other orthotics
Haglung’s syndrome	*Pain caused by retrocalcaneal bursitis *Positive radiographic findings	*Reduces pressure on the affected area
Retrocalcaneal bursitis	*Pain, erythema, swelling between the calcaneus and the Achilles tendon *Tenderness on direct palpation	*Reduces pressure on the affected area
Sever’s disease (Calcaneal apophysitis)	*Pain in children and adolescents *Worsens with increased activity *Tension at the Achilles insertionPain with passive dorsiflexion