Practice 10-Minute Consultation

Pain at the back of the heel

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1366 (Published 29 March 2016) Cite this as: BMJ 2016;352:i1366
  1. Sarah Morton, academic primary care F2 doctor1,
  2. Aisha Newth, primary care teacher development lead1,
  3. Azeem Majeed, professor of primary care1
  1. 1Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
  1. Correspondence to: S Morton sarah.morton{at}doctors.org.uk
  • Accepted 7 January 2016

What you need to know

  • Achilles tendinopathy is the most common cause of chronic posterior heel pain

  • Achilles tendinopathy is a clinical diagnosis and imaging is not needed unless there is diagnostic uncertainty

  • Eccentric calf muscle exercises are the traditional means of strengthening the Achilles tendon

A 41 year old man complains of longstanding pain at the back of his left heel and stiffness when he gets up. The pain is worse when he plays tennis. He asks for advice on what it is and what can be done.

Pain at the back of the heel arises from a limited number of anatomical structures: the Achilles tendon, the calcaneal bursa, or the surrounding soft tissues (fig 1). This limits the likely differential diagnoses. Achilles tendinopathy is the most common cause of posterior heel pain.1 Its incidence is estimated at 1.85 per 1000.2 It is also important to note that Achilles tendinopathy may underlie other pathologies, particularly partial tears of the Achilles tendon.3

Fig 1 Anatomy of the heel

What you should cover

Take a history

Begin by understanding the pain: see table 1 and figure 1

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