Back of Heel Pain After Walking: Common Causes

Back of Heel Pain After Walking: Common Causes

Back of heel pain walking is a common symptom people notice after longer walks or periods of activity. The discomfort is usually felt at the back of the heel where the Achilles tendon attaches to the heel bone. In some cases the area may feel sore, swollen or irritated after walking.

The back of the heel contains several structures including the Achilles tendon, small fluid-filled bursae and the heel bone itself. When these tissues become irritated, pain can develop during or after walking.

At Sydney Physio Clinic, back of heel pain is a frequent reason people seek physiotherapy. Understanding the possible causes can help guide early management and prevent symptoms from becoming more persistent.

Where Exactly Is the Back of the Heel?

The back of the heel refers to the area where the Achilles tendon attaches to the heel bone (calcaneus). This region experiences high forces during walking because the calf muscles pull through the tendon to lift the heel from the ground.

Several structures are located in this area, including:

• The Achilles tendon
• The heel bone (calcaneus)
• The retrocalcaneal bursa
• The superficial bursa near the skin

Because these structures are close together, irritation in this region can sometimes feel like a single area of pain.

Achilles Tendon vs Haglund’s Irritation

One of the most common causes of back of heel pain walking is irritation of the Achilles tendon.

When the tendon becomes overloaded, small changes may occur within the tissue. This condition is commonly known as Achilles tendinopathy. Symptoms may include stiffness, soreness after activity and tenderness along the tendon.

Another possible cause is irritation from a bony prominence at the back of the heel known as Haglund’s deformity. This can create pressure between the heel bone and footwear, leading to inflammation in the surrounding tissues.

Bursitis at the Back of the Heel

Bursae are small fluid-filled sacs that help reduce friction between structures in the body.

At the back of the heel, bursae sit between the Achilles tendon and the heel bone. When these bursae become irritated, a condition known as retrocalcaneal bursitis may develop.

This can cause symptoms such as:

• Swelling at the back of the heel
• Pain when walking uphill
• Discomfort when wearing certain shoes
• Tenderness when pressing the back of the heel

Bursitis often develops gradually when repetitive friction or pressure irritates the area.

Footwear Factors That Contribute to Heel Pain

Footwear can sometimes play an important role in back of heel pain walking.

Shoes with a rigid heel counter or tight upper section may place pressure on the back of the heel. This can irritate the Achilles tendon or surrounding bursae.

Common footwear-related contributors include:

• Stiff shoes that rub against the heel
• Minimal cushioning
• Poor arch support
• Sudden changes in footwear

Choosing supportive footwear with adequate cushioning may help reduce irritation in some cases.

Why Heel Pain Sometimes Appears After Activity

Some people notice that back of heel pain walking becomes more noticeable after activity rather than during it.

This can occur because repeated loading during walking gradually irritates the tissues around the Achilles tendon. Once activity stops and the area cools down, stiffness and discomfort may become more noticeable.

You may also notice similar symptoms first thing in the morning or after sitting for long periods. Our guide on Achilles pain first thing in the morning explains why this occurs.

How Physiotherapy Can Help

Physiotherapy can be very effective for managing back of heel pain walking. A physiotherapist will assess factors that may be contributing to irritation around the Achilles tendon and heel.

This may include evaluating:

• Calf muscle strength
• Ankle mobility
• Walking mechanics
• Foot posture

Treatment often focuses on improving tendon strength and gradually increasing load tolerance through structured exercises.

At Sydney Physio Clinic, rehabilitation programs are tailored to the individual and may include strengthening exercises, movement retraining and load management strategies.

In some cases, treatments such as shockwave therapy may be used to help stimulate healing in irritated tendon tissue.

Simple Tips to Reduce Back of Heel Pain

If you are experiencing back of heel pain walking, several simple strategies may help reduce irritation.

• Gradually increase walking distances
• Wear appropriately supportive footwear
• Avoid shoes that rub the back of the heel
• Perform calf strengthening exercises
• Reduce hill walking temporarily

These strategies can help reduce strain while the affected tissues settle.

Supports That May Help

Some people find temporary supports helpful while managing heel pain.

Examples may include:

• Heel cups to reduce strain through the Achilles tendon
• Orthotic insoles to support foot mechanics
• Heel lifts to temporarily reduce tendon load

These supports may help reduce irritation during walking. However, rehabilitation exercises remain the most important part of long-term recovery.

When Further Assessment Is Needed

It may be helpful to seek professional advice if back of heel pain walking persists.

• Pain lasts longer than two weeks
• Swelling develops at the back of the heel
• Walking becomes increasingly painful
• The area becomes very tender to touch

If symptoms continue, consider booking an assessment with a physiotherapist who can guide appropriate treatment.

Frequently Asked Questions

Why does the back of my heel hurt when I walk?

This can occur when the Achilles tendon, bursae or heel bone become irritated from repetitive loading or pressure.

Can shoes cause pain at the back of the heel?

Yes. Shoes with rigid heel counters or tight uppers can create pressure and friction at the back of the heel.

Is back of heel pain the same as Achilles tendinitis?

Not always. While Achilles tendon irritation is a common cause, bursitis or Haglund’s deformity may also cause similar symptoms.

Should I stop walking if my heel hurts?

Reducing walking distance temporarily may help, but complete rest is not always necessary.

How long does heel pain take to settle?

Recovery time varies depending on the cause. Many cases improve with strengthening exercises and appropriate load management.

Summary

Back of heel pain walking can occur when structures around the Achilles tendon become irritated during activity. Common causes include tendon overload, bursitis and pressure from footwear.

With appropriate rehabilitation, strengthening exercises and physiotherapy guidance, most cases improve and normal activity can gradually resume.

This information is general in nature and does not replace individual medical advice. If symptoms persist, seek assessment from a qualified physiotherapist.