Pain at the Back of the Foot

The largest and toughest tendon in the body is the Achilles tendon. It is one of the structures that help us balance. It is vital for walking and running. When running, the tendon can store energy and can work like a spring. This springing action can increase running speeds without using very much energy.

Tendons and ligaments are very similar in structure and function. The difference is their attachment. A ligament attaches bones together while a tendon attaches muscle to bone.

From above, the Achilles tendon attaches to the calf muscles: soleus and gastrocnemius muscles. And from below, the tendon attaches to the middle portion of the calcaneus, also called heel bone. Directly above the attachment on heel bone, there is a fluid-filled, pillow-like structure called the Retrocalcaneal Bursa. This serves a cushion between the Achilles tendon and heel bone, preventing these structures from being "rubbed together".

Foot pain is one of the most common complaints in adults of all ages. There are many causes of pain involving this area and pain affecting the posterior or back of the heel involves all structures discussed above. The following are the pathologic conditions involving each structure:


Retrocalcaneal bursitis is a swelling or inflammation of the retrocalcaneal bursa. Excessive use of the ankle sometimes causes irritation in this bursa and causes painful inflammation. This condition is often triggered by heavy exercise or a sudden increase in activity without initial stretching and conditioning.

Calcaneal Spur. Normally, there is a bony prominence that is palpable at the heel bone. This is actually the insertion of the Achilles tendon to the calcaneal bone. Over time, this bony prominence can enlarge and cause irritation to the Achilles tendon. This bony growth is called Haglund's Deformity or pump bump.

Achilles tendinitis is an inflammation of the Achilles tendon. The cause can be due to the conditions above, tear during strenuous activities, or the natural wear and tear degeneration caused by the normal aging process.


 

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