Quick answer: Pain In Back Heel Of Foot has multiple potential causes including mechanical, neurological, vascular, and inflammatory. The most common causes we identify are overuse, ill-fitting shoes, and biomechanical imbalance. Red flags requiring urgent evaluation: warmth/redness (infection), inability to bear weight (fracture), and unilateral swelling without injury (DVT). Call (810) 206-1402.

✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026

Pain in Back Heel of Foot [Causes, Symptoms & BEST Treatment!]

The #1 cause of pain in the back of the heel of the foot is insertional Achilles tendonitis! This can lead to a back of the heel spur and morning pain! Pain in Back Heel of Foot is usually due to Achilles tendinitis or a Haglund’s deformity. Both present as swollen painful areas in the back of the foot!

Most Likely

• Achilles Tendinitis

Achilles tendinitis is usually not related to a specific cause or injury. It can happen gradually due to overuse in the back of the heel. It onsets gradually, but one day it will really start to bother you. Symptoms:

• Pain and stiffness in the morning.
• It can worsen with activity.
• Severe pain the morning after exercising.
• Swelling and pain along the achilles tendons.

• Heel Lump or Bump

This is also known as a hagland’s bump. This is actually the formation of a hard stiff bony prominence from the back of your heel that can push against the back of your shoe. Symptoms:

• Hard bony bump.
• Pinches the skin when you put on shoes.
• Swelling in the back of the heel.
• Red inflammation.

• Painful Foot Arch

A Painful Foot Arch is caused by a condition known as plantar fasciitis. This is overused and inflamed tissue at the bottom of your foot. Learn how to treat it. Symptoms:

• Pain along the arch or bottom of the heel.
• Worse in the morning and after rest.
• Better with massaging, icing and 30 minutes of movement.

• Tarsal Tunnel Syndrome

The posterior tibial nerve runs along the back and inside of the ankle. If it is constricted you will feel feel numbness, burning and tingling. Symptoms:

• Numbness, burning and tingling.
• Sharp, shooting pain.
• Radiates as you press against the nerve.

• Heel Spur

Heel Spur pain is similar to arch pain or plantar fasciitis. It is the result of the ligaments at the bottom of the foot stretching the heel bone. It eventually over years forms a spur. Symptoms:

• Pain along the arch or bottom of the heel.
• Worse in the morning and after rest.
• Better with massaging, icing and 30 minutes of movement.

• Bruised Heel

Bruising of the heel is very similar  results in an injury to the cushioning at the bottom of your heel. This is common in older people. It can lead to aching under the heel bone. Symptoms:

• Chronic aching pain.
• Gets worse with more activity.

• Stress Fracture of the Calcaneus:

This can happen without a traumatic injury. Usually in people who have increased their activity recently! There is little inflammation like in plantar fasciitis. Symptoms:

• Chronic aching pain.
• Gets worse with more activity.

Less Common

1. Broken Heel (Calcaneal Fracture)
2. Posterior Impingement Syndrome
3. Sever’s Disease (Traction Apophysitis at Achilles Insertion onto Calcaneous)
4. Achilles Bursitis
5. Referred pain from Neural Structures or Lumbar Spine

Good luck with your Pain in Back Heel of Foot!

Conservative Foot Treatment Options in Michigan: From Orthotics to EPAT

Michigan patients with foot and ankle conditions benefit from access to the full range of conservative treatment options at Balance Foot & Ankle. Custom orthotics fabricated from a 3D scan of the patient’s foot provide structural correction for flatfoot, high arch, and biomechanical overload conditions that OTC insoles cannot adequately address. EPAT (extracorporeal pulse activation therapy) provides a non-surgical treatment option for plantar fasciitis, Achilles tendinopathy, and other tendon conditions that resist initial conservative care — clinical evidence shows 70-80% cure rates for chronic plantar fasciitis. Ultrasound-guided injection therapy allows precise corticosteroid, PRP, or local anesthetic delivery to specific anatomical targets including the plantar fascia insertion, retrocalcaneal bursa, Morton’s neuroma interspace, and ankle joint. Physical therapy coordination with specific home exercise prescription addresses strength and flexibility deficits that perpetuate foot and ankle conditions. Michigan patients who want conservative treatment options before considering surgery can call Balance Foot & Ankle at (810) 206-1402 for an evaluation at our Howell or Bloomfield Hills office.

Expert Podiatric Care for Michigan Patients: Balance Foot & Ankle

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Related Treatment Guides

• Achilles Tendinopathy Treatment
• Achilles Tendon Rupture Repair
• Custom 3D Orthotics

Michigan patients with any foot or ankle condition — whether a first-time acute problem or a chronic issue that has not responded to self-care — can access expert podiatric evaluation and treatment at Balance Foot & Ankle. Our fellowship-trained podiatric surgeons provide thorough diagnostic evaluation using weight-bearing digital X-rays and musculoskeletal ultrasound, followed by targeted conservative or surgical treatment appropriate to the specific diagnosis. We treat the full spectrum of podiatric conditions: plantar fasciitis, Achilles tendinopathy and rupture, Haglund’s deformity, bunions, hammertoes, neuromas, peripheral neuropathy, diabetic foot complications, toenail fungus, ankle instability, stress fractures, and more. Balance Foot & Ankle accepts Blue Cross Blue Shield of Michigan, Aetna, UnitedHealthcare, Cigna, Medicare, and most Medicare Advantage plans. Same-week new patient appointments are available at our Howell (4330 E Grand River, serving Livingston County) and Bloomfield Hills (43494 Woodward Ave #208, serving Oakland County) offices. Call (810) 206-1402 to schedule.

Clinical References

1. Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes. American Journal of Sports Medicine. 2002;30(2):287-305.
2. Kvist M. Achilles tendon injuries in athletes. Sports Medicine. 1994;18(3):173-201.
3. Den Hartog BD. Insertional Achilles tendinosis: pathogenesis and treatment. Foot and Ankle Clinics. 2009;14(4):639-650.

Dr. Hoy’s Complete Pain Relief Line — Dr. Tom’s Picks (2026)

Dr. Hoy’s Natural Pain Relief is Dr. Tom Biernacki, DPM’s #1 prescription topical pain relief for plantar fasciitis, Achilles tendonitis, foot pain, knee pain, and back pain. Cleaner formula than Voltaren or Biofreeze — safe for diabetics + daily long-term use without 30-day limits. Below is the complete Dr. Hoy’s product line, organized by use case.

Top 10 Premade Orthotics — Dr. Tom’s Picks (2026)

Dr. Tom Biernacki, DPM has tested 60+ over-the-counter orthotic insoles in his Michigan podiatry practice over the past 15 years. Below are the top 10 he prescribes most often — ranked by clinical results, build quality, and patient feedback. PowerStep + CURREX brands are Dr. Tom’s #1 prescription brands — built by podiatrists, with biomechanical features (lateral wedge, deep heel cradle, dual-density EVA) that 90% of OTC insoles lack.

Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)

If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.

What is Foot pain?

Foot pain is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.

Symptoms and warning signs

Common signs of foot pain include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.

Conservative treatment options

Most cases of foot pain respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.

When is surgery considered?

Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.

Recovery timeline and prevention

Recovery from foot pain varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.