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
- Sarah Morton, academic primary care F2 doctor1,
- Aisha Newth, primary care teacher development lead1,
- Azeem Majeed, professor of primary care1
- 1Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
- 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⇑ …
Log in
Log in using your username and password
Log in through your institution
Subscribe from £173 *
Subscribe and get access to all BMJ articles, and much more.
* For online subscription
Access this article for 1 day for:
£38 / $45 / €42 (excludes VAT)
You can download a PDF version for your personal record.