LAKE OCONEE — “What would cause pain in the back of my heel?”



The human foot is a remarkable structure.  An architectural masterpiece,  it is also truly a “mirror of systemic disease.” Despite the fact that we generally only think of the foot as an area effected by corns, calluses, ingrown toenails, warts and athlete’s foot, many diseases can show up in our feet. Sometimes the foot is the first location of such diseases. Diabetics for example, may have burning sensations in their feet years before the clinical onset of Diabetes.

The back of the heel is a prime example of this. Patients with Rheumatoid Arthritis may develop nodules in this location. Gout also affects this area. But for the most part, pain in the back of the heel is usually mechanically induced and is often related to a tight calf muscle.

Our calf muscles get a lot more use than we realize. Every time you walk a single step your calf muscles contract. Imagine how many times this occurs in our lifetimes and the force at which this must occur while playing a round of golf or running. 

Each time this occurs the muscles get a little stronger and a little tighter and loose some of their flexibility. Because of this we develop a disproportionate amount of tightening in relation to flexibility — the same problem all great athletes face. 

Over a period of time this tightening causes a pulling at the attachment of the muscles (the insertion of the Achilles tendon). If this pulling continues, bone at the back of the heel begins to be torn away and bone spurs develop. These spurs can be quite large and cause a great deal of pain. A bursa can develop as well. In later stages, surgery may be necessary. If left untreated the spurs may actually separate from the base of the bone and the tendon can rupture. But in almost all cases this can be avoided.

This condition doesn’t only occur in older people but in children for the same reason; tight calf muscles cause an inflammation at the growth center of the heel bone (Sever’s Disease), which can be quite debilitating.

The key to effective treatment is not simply treating the inflammation, but finding the reason the calf muscles are tightening, and thus causing the problem.  For example, people who have one leg longer than the other have a mechanical imbalance that can be responsible for this. 

Treatment consists of stretching the muscles and reducing the pull on them.  Something as simple as a heel lift in the shoe can help greatly.  At times we use a painless trigger point injection to relax the muscles.  A custom foot insert can also be made that is often helpful.

Like most other things we see in medicine, this condition is almost always preventable.  That’s why everyone should be evaluated structurally at least once.  Just as keeping your tires in good alignment helps them last longer and gives your car ride better, proper alignment decreases the stress on your skeletal system.