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The most common cause of heel pain is plantar fasciitis. A distant second-place finisher is insertional Achilles tendonitis. This is where pain and swelling is found in the back of the heel, at the point where the Achilles tendon attaches to the heel bone (calcaneus).
This irritation is from chronic tightness of the Achilles tendon and muscle complex. The tendon will try to pull away from the calcaneus.
Typically, this is a problem that has been brewing for a long time. Damage to the Achilles tendon will slowly develop under excessive force. This area can also be irritated from the back of shoes, in the area known as the heel counter.
No matter what causes Achilles irritation, there will be pain and swelling in the back of the heel.
Fortunately, you can always come see us here at the office of Jeffrie C. Leibovitz, DPM for the effective care and treatment you need.
A Little Greek (maybe Geek) Trivia on the Achilles Tendon
The Achilles tendon is the largest tendon in the body. It is attached to the only two muscles below the knee that move us forward. It has to lift over 1 million pounds and absorb over 3-4 million pounds of force in a 5,000-step day for a 150-lb. person!
The backstory of Achilles (the hero) is told by Homer (not Simpson) in The Iliad. If the ancient Greeks knew how strong this tendon is, they may have named it after Hercules.
So What is the Bump? Where Did it Come From?
The damage to the junction of the Achilles and calcaneus is from persistent and repetitive inflammation cycles.
The incredibly strong fibers of the Achilles will eventually stretch and tear under too much force. Like a strong rope under too much tension, a few small fibers will begin to tear or break. Over time, more and more fibers are damaged and the local irritation increases like a small spark that wants to become a bonfire.
The heel bone (calcaneus) will put up a valiant fight to heal over the injured tendon. The bone’s response is to put more bone around the tendon to increase its hold. The back of the calcaneus will change its shape and become squared off.
If the tearing force continues, the bone will start to infiltrate and grow into the tendon. This will look like an upside down icicle or spur on X-ray. Bone will change very slowly. It may take 5-10 years of irritation to see significant changes. Unlike the spur associated with plantar fasciitis, this can cause a world of problems.
Chronic inflammation can also create a bursa at the back of the heel. The bursa is a fluid-filled sac that acts as an airbag to reduce the repetitive impact from a shoe. This may change size on a daily basis.