Pain in the back of your heel when you bend over can stem from a few different conditions, all of which are exacerbated by the increased strain on the Achilles tendon and surrounding structures during bending. Here's a breakdown of the common causes:
Common Causes of Posterior Heel Pain
- Achilles Tendonitis: This involves inflammation of the Achilles tendon, which connects your calf muscles to your heel bone. Bending over stretches the tendon, which can cause pain if it's already inflamed.
- Achilles Tendon Bursitis (Retrocalcaneal or Retroachilles Bursitis): Bursae are fluid-filled sacs that cushion tendons and bones. Inflammation of the bursae located between the Achilles tendon and the heel bone can cause pain that worsens with movement, especially bending.
- Heel Spur at the Back of the Heel (Haglund's Deformity or "Pump Bump"): This is a bony enlargement on the back of the heel. Bending can cause the Achilles tendon to press against this bony prominence, leading to pain and irritation. This is sometimes referred to as "pump bump" because it is aggravated by wearing shoes with a stiff back, like pumps.
- Calcaneal Apophysitis (Sever's Disease) [In Adolescents]: While less likely in adults, in adolescents (typically between 8 and 14), this condition involves inflammation of the growth plate in the heel bone. Bending can put stress on this growth plate, causing pain. While it's unlikely if you're an adult, it's worth considering if you're a young person experiencing this pain.
Why Bending Makes It Worse
Bending over increases the dorsiflexion (pointing the toes upward) of the foot, which stretches the Achilles tendon. This stretch can aggravate any existing inflammation or irritation in the tendon, bursa, or surrounding tissues, leading to the pain you experience.
What to Do
If you're experiencing this pain, consider these steps:
- Rest: Avoid activities that worsen the pain.
- Ice: Apply ice to the back of your heel for 15-20 minutes at a time, several times a day.
- Over-the-counter pain relievers: Medications like ibuprofen or naproxen can help reduce pain and inflammation.
- Stretching: Gentle stretching of the calf muscles and Achilles tendon can help improve flexibility.
- Proper footwear: Wear shoes with good arch support and cushioning. Avoid shoes with a stiff back that might irritate a Haglund's deformity.
- See a doctor: If the pain is severe or doesn't improve with home treatment, consult a doctor or physical therapist. They can diagnose the cause of your pain and recommend appropriate treatment, which might include physical therapy, orthotics, or, in rare cases, surgery.
In summary, pain at the back of your heel when bending is usually linked to Achilles tendon problems or heel bone issues, and seeing a doctor for a proper diagnosis is always recommended for persistent or severe pain.
