Heel Bursitis: Back of Heel Pain and What Gently Helps

Heel bursitis is irritation of a small, fluid filled cushion that sits at the back of the heel, right in the dip in front of where the Achilles tendon attaches to the bone. Clinicians usually call it retrocalcaneal bursitis. It shows up as a tender, sometimes puffy spot above the heel, it flares in stiff shoes, and it is at its most eloquent on the first steps of the morning. It is not dangerous. It is simply slow, because you use your heel all day and it never quite gets a holiday.

Where heel bursitis hurts, and why there

That small bursa exists to stop the Achilles tendon rubbing on the heel bone every time your ankle moves. When the area gets more traffic than it is used to, the cushion becomes inflamed and the tendon starts sliding over a swollen, sensitive surface.

The usual triggers are unremarkable: a new pair of shoes with a firm back, a sudden increase in walking or running, hill work, or a season of standing on hard floors. It also appears alongside inflammatory conditions such as rheumatoid arthritis, and in some people the shape of the heel bone itself leaves less room in that dip.

What heel bursitis is confused with

Almost everything at the back of the foot feels similar at first. Achilles tendon pain, an inflamed insertion, a bone spur, and plantar fasciitis all get mistaken for one another, and they often coexist. Achilles trouble is common company: lifetime injury incidence sits at about 2.35 per 1,000 people, and roughly 24 percent of athletes will meet it at some point (StatPearls, 2024).

Two simple distinctions help. Bursitis is tender when you pinch the soft dip just in front of the tendon from both sides. Tendon pain sits in the cord itself and hurts most when you load it. And pain underneath the heel, especially that stabbing first step out of bed, points to the plantar fascia rather than the bursa. Our Feldypedia entry on bursitis covers the wider family of these irritated cushions.

What helps heel bursitis settle

Take the pressure off first. That means shoes with a soft or open back for a few weeks, a small heel raise to reduce the pull through the area, and a pause on the hills. Ice after a long day is a reasonable comfort measure. None of this is heroic, and all of it works better than pushing through.

Then look at how you walk. A heel that has been sore for weeks changes your gait, and that change often outlives the original irritation. You start rolling to the outside, or shortening the step, or lifting the whole leg differently. Those adaptations quietly load the calf, the knee, and the low back.

This is where slow, attentive movement earns its keep. The Feldenkrais Method® uses small, comfortable movements to let the nervous system notice the extra effort it has been holding, so easier coordination can return without anything being forced. Feldy turns that into short audio lessons you follow at home, most of them lying down, where the heel carries no weight at all. You can try the program free for 7 days.

For the surrounding tissue once the sore spot has calmed, our guides on why a heel hurts when walking and gentle Achilles tendon movement pair naturally with this page. Go gently, and stop anything that sharpens the pain.

Common Questions about heel bursitis (FAQ)

What does heel bursitis feel like?

A sore, sometimes puffy spot at the back of the heel, just above where the Achilles tendon meets the bone. It is usually worst when a firm shoe counter presses on it, when you first get up in the morning, and when you push off to walk uphill. Squeezing the back of the heel from both sides often reproduces it.

How is heel bursitis different from Achilles tendinopathy?

By exactly where it hurts. Bursitis is tender in the soft dip just in front of the tendon, and squeezing from both sides finds it. Achilles pain sits in the cord of the tendon itself, a little higher, and hurts most when you load it, for example rising onto your toes. The two frequently sit together.

Is heel bursitis the same as plantar fasciitis?

No. Plantar fasciitis hurts underneath the heel, and its signature is a stabbing first step out of bed. Heel bursitis hurts at the back of the heel and is provoked by shoe pressure. They are different structures, though both can make walking miserable and both benefit from patience.

What shoes help heel bursitis?

Shoes with a soft or low back that do not press on the sore spot, and a small heel lift to take some tension off the area. Rigid heel counters, stiff boots, and brand new trainers with a firm collar are the usual culprits. Backless shoes for a few weeks are a simple relief for many people.

How long does heel bursitis take to heal?

Commonly several weeks, and sometimes a few months if the pressure that caused it continues. The heel is asked to work every time you take a step, so recovery is rarely quick. Progress usually shows as fewer bad mornings rather than a sudden clear day.

When should I see a doctor about back of heel pain?

See a doctor if the heel is red, hot, or very swollen, if you have a fever, if the pain arrived with a sudden snap, if you cannot rise onto your toes, or if it has not improved in a few weeks. Those signs need a proper examination rather than home care.