Dear Doc,
I have pain that starts from the back of my heel and goes up the back of my ankle. It worsens with activity and gets better with rest. What do I have and how can I treat it?

This is a very common problem that occurs in individuals who are both very active and also in those who simply do day-to-day activities. This problem can stem from a few different pathologic problems and has multiple treatments.

The pain that occurs in the back of the heel is due to an inflammed achilles tendon where the tendon inserts on to the heel bone. The pull of the achilles tendon is very strong and is constantly working to allow the foot to push while walking and also aids in balance. There will be very little rest for the achilles tendon and this will cause constant pain while active. Treatments for this problem include anti-inflamatories, a short period of resting the achilles tendon, temporary lifts for your shoes and stretching excersizes once the pain decreases.

Bone spurring may also occur at the back of the heel where the achilles tendon inserts. There will be an area that feels tight and there may be a protrusion of the bone at the back of the heel. This is called a retrocalcaneal exostosis and may be due to a tight achilles tendon. This typically develops over time. This problem can be more severe than just achilles tendonitis as tearing of the achilles tendon may occur. The treatment for this pain includes very similar treatment to achilles tendonitis, however may need physical therapy and in very severe cases, removal of the painful bone with a lengthening of a tight achilles tendon to prevent a tear of the tendon.
If the pain continues to radiate up the back of the ankle/achilles tendon than achilles tendonosis may have occured. This is where the achilles tendon has had partial tears and repaired itself. Over time thickening of the tendon occurs. A tight achilles tendon in combination with the thickened tendon may lead to an achilles tendon rupture. In these severe cases where thickening has occurred immobilization is needed. Therapy and other modalities may be used to treat this problem, however surgical intervention with repair and lengthening is typically needed to prevent a rupture of the tendon.

I hope that the information supplied has been useful! Thank you for reading and enjoy the day.
Peter Stasko, DPM
Fellowship Trained Foot and Ankle Surgeon
Fingerlakes Bone and Joint Center