Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Quick Answer
Posterior Heel Pain: Achilles Tendinopathy vs. Retrocalcanea relates to plantar fasciitis — typically caused by tight calves and arch overload. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Twp: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Treatment at Balance Foot & Ankle: EPAT Shockwave for Heel Pain →
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Pain at the back of the heel — the posterior heel — is a common complaint that encompasses several distinct conditions with overlapping symptoms. Knowing which condition you have is not merely academic: each requires a different treatment approach, and confusing them leads to months of misdirected therapy.
The Anatomy of the Posterior Heel
The posterior heel contains several structures that can independently produce pain:
- Achilles tendon: The largest tendon in the body, inserting into the posterior calcaneal tuberosity. It transmits the force of the gastrocnemius and soleus muscles and is essential for push-off.
- Retrocalcaneal bursa: A fluid-filled sac between the Achilles tendon and the superior aspect of the calcaneus, providing cushioning to reduce friction as the tendon glides over the bone during ankle motion.
- Superficial calcaneal bursa: Located between the skin and the back of the Achilles tendon at the heel counter level.
- Haglund’s deformity: A prominent bony protrusion on the superior-posterior calcaneus (sometimes called “pump bump”) that can compress and inflame the retrocalcaneal bursa.
Achilles Tendinopathy: Causes and Symptoms
Achilles tendinopathy encompasses both tendinitis (acute inflammatory) and tendinosis (chronic degenerative) changes within the tendon. It is divided into two types by location:
- Non-insertional tendinopathy: Affects the mid-substance of the Achilles tendon, approximately 2–7 cm above the heel bone insertion. This is the most common type, typically presenting as morning stiffness and aching that improves after a few minutes of activity (“warm-up effect”), then worsens again with prolonged activity. The tendon is thickened, tender to palpation at the mid-tendon, and may have a palpable nodule.
- Insertional tendinopathy: Affects the tendon where it attaches to the calcaneus. Associated with calcification at the insertion point, retrocalcaneal bursitis, and Haglund’s deformity. Pain is at the very back of the heel and is reproduced by squeezing the posterior calcaneus or dorsiflexing the ankle.
Retrocalcaneal Bursitis: Causes and Symptoms
Retrocalcaneal bursitis is inflammation of the bursa between the Achilles tendon and heel bone. It is most often caused by repetitive dorsiflexion stress, shoe heel counter pressure, Haglund’s deformity compressing the bursa, or insertional Achilles tendinopathy that secondarily inflames the adjacent bursa.
The key distinguishing feature is tenderness in the retrocalcaneal recess — the soft area just anterior to the Achilles tendon insertion on both sides of the tendon. Squeezing this area (the two-finger squeeze test) reproduces pain. The bursa may be palpably swollen. Dorsiflexion compresses the bursa against the calcaneus and reproduces or worsens pain — helping distinguish it from mid-substance Achilles tendinopathy where dorsiflexion stretches the tendon but doesn’t compress a bursa.
Haglund’s Deformity (Pump Bump)
Haglund’s deformity refers to a bony enlargement of the posterior-superior calcaneal tuberosity. It creates a rigid bony prominence that irritates the heel counter of shoes (causing superficial bursitis) and compresses the retrocalcaneal bursa during dorsiflexion. Rigid, closed-back shoes with a hard heel counter are the primary provocative factor.
Treatment Approach
Treatment differs meaningfully between these conditions:
- Non-insertional Achilles tendinopathy responds best to eccentric heel drop exercises (the Alfredson protocol), load management, heel lift orthotics to reduce tendon tension, and PRP injection for recalcitrant cases.
- Insertional Achilles tendinopathy and retrocalcaneal bursitis are treated with heel lifts, shoe modification (open-back or flexible heel counter shoes), immobilization in a boot during acute flares, carefully placed cortisone injection into the bursa (not the tendon), and physical therapy. Surgery to remove the Haglund’s deformity and calcific deposits is effective for cases failing conservative management.
When to See a Podiatrist
Any posterior heel pain persisting more than 3–4 weeks should prompt evaluation. Diagnostic ultrasound can distinguish between tendon pathology, bursitis, and calcification in real-time at the first appointment — guiding treatment without waiting for MRI scheduling.
Back-of-Heel Pain? Get an Accurate Diagnosis
Dr. Biernacki evaluates posterior heel pain with on-site diagnostic ultrasound at our Bloomfield Hills and Howell offices. Same-week appointments available.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
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3980 E Grand River Ave, Suite 140
Howell, MI 48843
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43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Book Your AppointmentDifferential Diagnosis: What Else Could It Be?
Not every case of haglund’s deformity is straightforward. In our clinic we routinely rule out three look-alike conditions before confirming the diagnosis. If your symptoms don’t match the classic presentation, one of these may explain the pain — which is why physical exam matters more than self-diagnosis.
| Condition | How It Differs |
|---|---|
| Retrocalcaneal bursitis alone | Anterior to the Achilles insertion, no posterior bone prominence. |
| Insertional Achilles tendinopathy | Pain at the tendon-bone junction; calcification may be present on X-ray. |
| Sever’s disease (pediatric) | Child or adolescent with growth-plate pain; Haglund presents in adults. |
Red Flags — When to See a Podiatrist Now
Seek same-day evaluation at Balance Foot & Ankle if you notice any of the following:
- Pain preventing use of regular closed-back shoes
- Open sore or breakdown over the posterior heel
- Failed 6+ weeks of shoe modification and stretching
- Associated insertional Achilles tendinopathy with calcification
Call (810) 206-1402 or request an appointment. Our Howell and Bloomfield Hills offices reserve same-day slots for urgent foot and ankle issues.
In Our Clinic: What We See
Clinical perspective from Dr. Tom Biernacki, DPM — Balance Foot & Ankle, Howell & Bloomfield Hills, MI:
Haglund’s deformity — the ‘pump bump’ — is the posterior heel prominence that irritates every closed-back shoe the patient owns. In our clinic we address all three layers: the bone prominence (shoe modification, backless shoes), the retrocalcaneal bursa (ice and NSAIDs), and the often-inflamed Achilles insertion (eccentric heel drops, heel lifts). We rarely operate in the first 6 months — conservative care works in 70% of patients. When surgery is needed, we resect the prominence and address any calcified Achilles insertion. Dr. Biernacki always photographs patient shoes at the visit: fixing the shoe often fixes the Haglund.
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Top Podiatrist-Recommended Insole
- The Pinnacle Full length insoles for men & women provide maximum cushioning, from high activity to moderate support. The PowerStep arch support shape provides stability to the foot and ankle, helping to relieve foot pain.
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- The Pinnacle plantar fasciitis insoles offer superior heel cushioning and arch support. The dual-layer cushioning is designed to reduce stress and fatigue, while PowerStep premium arch support is designed for plantar fasciitis relief.
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When to See a Podiatrist
If morning heel pain has persisted more than 6 weeks, home care alone rarely fixes it. At Balance Foot & Ankle, we combine in-office ultrasound diagnostics, custom orthotics, and — when needed — shockwave or PRP to resolve plantar fasciitis that hasn’t responded to stretching and inserts. Most patients are walking pain-free within 4-8 weeks of starting a structured plan.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
In-Office Treatment at Balance Foot & Ankle
When conservative care isn’t enough, Dr. Tom Biernacki and the team at Balance Foot & Ankle offer advanced, same-day options — including Plantar Fasciitis Surgery Bloomfield Hills at our Howell and Bloomfield Hills clinics.
Same-day appointments available. Call (810) 206-1402 or book online.
Pros & Cons of Conservative Care for plantar fasciitis
Advantages
- ✓ Conservative care resolves 90%+ of cases
- ✓ Multiple home treatment options
- ✓ Strong evidence base
- ✓ Imaging often not required
Considerations
- ✗ Recovery takes 6-12 weeks
- ✗ Mistakes prolong recovery
- ✗ Untreated can become chronic
- ✗ Can mimic other conditions
Dr. Tom’s Recommended Products for plantar fasciitis
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
PowerStep Pinnacle Maxx Dr. Tom’s Pick
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Best for: Overnight stretch for morning pain relief
Hoka Bondi 9 Dr. Tom’s Pick
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TriggerPoint Footballer Dr. Tom’s Pick
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Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
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About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
Frequently Asked Questions
Can I see a podiatrist for heel pain without a referral?
How long does plantar fasciitis take to heal?
Should I walk on my heel if it hurts?
What does a podiatrist do for heel pain?
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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