Pain in the posterior heel around the Achilles tendon insertion may arise from one or more of the following structures:
- Insertion of the Achilles tendon into the calcaneus (Tendinitis)
- Retrocalcaneal bursa (Bursitis)
- Inflammation of the bursa between the skin and the Achilles tendon (Haglund syndrome)
- Inflammation of the calceneal process (Sever’s disease)
| 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 |
Physical testing
Examination shows swelling and tenderness in the posterior part of the heel. If a calcaneal prominence is present, it is usually more prominent on the lateral side of the heel. A superficial bursa (pump bump) may be present and may be inflamed by wearing shoes. In Achilles tendinosis, the pain is present directly on the Achilles tendon and is increased by squeezing the tendon. The tendon may be thickened and present a nodule. Retro-calcaneal bursitis can cause pain in front of the Achilles tendon that is increased by squeezing the bursa from side to side and just in front of the Achilles tendon.
Exercise and stretching
Achilles tendon stretch with bent knee:
- Stand facing a wall, unaffected limb in front and with knee bent for support, limb back, knee also bent, toes slightly bent and toes pointed inward.
- Keeping the heels of both feet flat on the floor, lower your hips toward the wall.
- Hold the stretch for 30 seconds, then relax for 30 seconds.
- Perform 2 or 3 sets of 4 reps per day, for 3 to 4 weeks.
Stretching of the Achilles tendon:
- Stand facing a wall with the knee of the unaffected limb bent, the affected limb straight, and the toes pointed slightly inward.
- Keeping the heels of both feet flat on the floor, lower your hips toward the wall.
- Hold the stretch for 30 seconds, then relax for 30 seconds.
- Perform 2 or 3 sets of 4 reps per day, for 3 to 4 weeks.
Eccentric calf:
- Stand on the bottom step of a staircase with your heels sticking out.
- En partant sur la pointe des pieds, abaissez vos talons lentement aussi loin que cela est confortable. Lorsque vous atteignez la position confortable la plus basse, poussez jusqu’à la position de départ. Répétez 10 à 15 fois.
- Perform the exercise 2 to 3 times a day, for 3 to 4 weeks.
- When you first do this exercise, use both feet. As you get stronger and more comfortable, progress to using one foot at a time.
