Why Does the Back of My Heel Hurt? Could It Be Retrocalcaneal Bursitis?

Why Does the Back of My Heel Hurt? Could It Be Retrocalcaneal Bursitis?

Pain right at the back of the heel, especially during activity or in certain shoes, is often caused by retrocalcaneal bursitis, inflammation of the cushioning sac between the heel bone and Achilles tendon. It's usually linked to repeated stress from overuse, tight footwear, or a bony prominence called Haglund's deformity, and can feel like Achilles tendinopathy or plantar fasciitis, which is why an accurate diagnosis matters. Physiotherapy, combined with load management and supportive footwear, is typically the most effective route to recovery.

If you're feeling pain right at the back of your heel, especially when walking, running, or wearing certain shoes, you might be dealing with retrocalcaneal bursitis.

It's a common but often overlooked cause of heel pain, particularly in active individuals. The good news? With the right approach, it's very manageable.

What Is Retrocalcaneal Bursitis?

Retrocalcaneal bursitis is the inflammation of a small fluid-filled sac (bursa) that sits between your heel bone (calcaneus) and the Achilles tendon.

This bursa acts like a cushion, reducing friction as you move. But when it becomes irritated, even simple movements like walking or standing can become uncomfortable.

Why Does Retrocalcaneal Bursitis Happen?

In most cases, it develops gradually due to repeated stress on the heel. Common causes include:

• Overuse – running, jumping, or long periods on your feet
• Tight or poorly fitting footwear – especially rigid heel counters
• Haglund's deformity – a bony prominence that increases friction
• Inflammatory conditions – such as arthritis or gout
• Age-related changes – tissues become less resilient over time

It's particularly common in runners, dancers, and anyone regularly loading their calves and Achilles.

What Are the Symptoms to Watch For?

Symptoms tend to build up over time rather than appear suddenly. You may notice:

• Pain at the back of the heel (especially during activity)
• Swelling or redness in the area
• Stiffness in the ankle, particularly first thing in the morning
• Discomfort when wearing certain shoes
• Occasionally, a creaking or cracking sensation with movement

Could It Be Something Else?

Heel pain isn't always straightforward. Retrocalcaneal bursitis can sometimes feel like Achilles tendinopathy or plantar fasciitis.

That's why getting the right diagnosis is important. Treating the wrong condition can slow your recovery.

How Can You Prevent Retrocalcaneal Bursitis?

A few simple habits can go a long way in reducing your risk.

• Wear supportive, well-fitting footwear
• Keep your calves and Achilles flexible with regular stretching
• Gradually increase activity levels (avoid sudden spikes)
• Warm up properly before exercise

Small changes here can make a big difference over time.

What Treatment Options Work?

The key to recovery is reducing irritation while improving how your foot and ankle handle load.

Physiotherapy

A tailored physiotherapy plan is often the most effective route. This may include:

• Hands-on treatment to reduce pain and stiffness
• Targeted exercises to strengthen the calf and ankle
• Mobility work to improve movement and reduce strain

Pain Relief and Healing Support

Depending on your symptoms, additional treatments may help:

• Shockwave therapy – stimulates healing and reduces pain
• Ultrasound therapy – supports tissue recovery
• Injection therapy – used in more persistent cases to reduce inflammation

Long-Term Support (Insoles)

Customised insoles can be a gamechanger for some people. They help:

• Improve foot alignment
• Reduce pressure on the heel
• Distribute load more evenly during walking and running

This is especially helpful if your foot mechanics are contributing to the problem.

Getting Back to Pain-Free Movement

Retrocalcaneal bursitis can be frustrating, but it responds well to the right combination of treatment and load management. The aim is simple:

• Settle the irritation
• Restore strength and flexibility
• Prevent it from coming back

If your heel pain isn't improving or is starting to limit your activity, it's worth getting it assessed properly. A personalised plan can make all the difference in getting you back to doing what you enjoy – without that nagging pain at the back of your heel.

Frequently Asked Questions

How do I know if my heel pain is retrocalcaneal bursitis or something else?

It can be difficult to tell without an assessment, as retrocalcaneal bursitis often feels like Achilles tendinopathy or plantar fasciitis. Getting the correct diagnosis matters, since treating the wrong condition can slow your recovery.

What causes retrocalcaneal bursitis?

It usually develops gradually from repeated stress on the heel, commonly linked to overuse, tight or poorly fitting footwear, a bony prominence called Haglund's deformity, or inflammatory conditions like arthritis or gout.

Can retrocalcaneal bursitis be treated without surgery?

Yes, in most cases. Physiotherapy, load management, and supportive footwear are usually effective. Additional options like shockwave therapy, ultrasound, or injections may help in more persistent cases.

Do insoles help with heel pain from retrocalcaneal bursitis?

They can, particularly if foot mechanics are contributing to the problem. Custom insoles help improve alignment, reduce pressure on the heel, and distribute load more evenly.

How can I prevent retrocalcaneal bursitis from coming back?

Wearing supportive, well-fitting footwear, keeping your calves and Achilles flexible, increasing activity levels gradually, and warming up properly before exercise all help reduce the risk of recurrence.

About the Author:

Shivani Darira

Senior Specialist Physiotherapist

As a Senior Specialist Physiotherapist at Relive Physiotherapy, Shivani has a particular interest in treating musculoskeletal and sports injuries. She holds an MSc in Sports Medicine from the University of Chester and brings a strong clinical foundation to her work with athletes and active clients alike.

Shivani's approach is guided by the principle that movement aids healing, and she takes a dynamic, personalised approach to every client's recovery journey.

Outside the clinic, Shivani enjoys HipHop and Bollywood dance and is currently learning to swim and play tennis.