Pain in the Back of the Heel? Here's What It Means and What to Do
Updated October 20261 minute read
Pain at the back of the heel usually involves the Achilles tendon or its attachment — Achilles tendinopathy — often worse at the start of activity or first thing in the morning. It's an overload problem that responds to progressive calf and tendon strengthening, not rest. Important exception: a sudden pop or sharp blow to the back of the heel with weakness pushing off can mean an Achilles rupture — seek prompt care.
What this usually means
Most likely causes. Achilles tendinopathy (mid-tendon or where it attaches to the heel) is the leading cause of back-of-heel pain. Less common causes. Irritation of the bursa or bony prominence at the back of the heel, often related to footwear, can also cause it.
What you can try at home
Reduce a recent spike in running or jumping, choose footwear that doesn't dig into the back of the heel, and begin gentle progressive calf strengthening. Avoid complete rest — controlled loading helps tendons.
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When to see a physical therapist
If back-of-heel pain persists, a PT can confirm it's the Achilles and guide a loading program.
Red flags — don't wait
Seek prompt care for a sudden pop or sharp blow to the back of the ankle with weakness pushing off (possible rupture), or a hot swollen foot with fever.
Already seen a doctor, or have imaging? Request a match — free.
If a doctor has checked you out and physical therapy is an option, tell us where you are. We'll send you cash-pay PTs nearby who treat this, with their prices and first openings — bring your results to the first visit. You choose; we don't give medical advice.
We check two or three cash-pay PTs near you. We reply within 1 business day with next steps.
How a PT treats this
Treatment uses progressive calf and tendon loading and graded return to activity.
Frequently asked questions
Most often, yes — especially if it's worse starting activity or in the morning.
Sources (5)
- Martin RL, et al. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. Clinical Practice Guideline. J Orthop Sports Phys Ther. 2018. — PubMed
- AAOS OrthoInfo: Achilles Tendinitis. — AAOS OrthoInfo
- MedlinePlus: Achilles tendinitis. — NIH/MedlinePlus
- Silbernagel KG, et al. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007. — AJSM
- Ochen Y, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019. — BMJ
This article is for education only and isn't medical advice. Always talk to a licensed clinician about your specific situation.