What Causes Pain in the Back of My Heel When Stretching?

Heel pain when stretching a calf muscle can be a sign of many different ailments. Tendinitis, bone spurs, plantar fasciitis, stress fractures and heel bursitis are just a few causes of heel pain.

First, a quick refresher on heel anatomy: The heel is a structure that includes bones, muscles, tendons and fascia (connective tissue). All of these structures must work together properly to avoid pain and injury.

Here, we dive into the causes of why your heel may hurt when you stretch and what to do about it.

There are five common causes of back-of-heel pain when you stretch your calves, all with their own set of symptoms and sensations (burning, ripping, sharp or dull pain, etc.).

Achilles tendinitis is inflammation of the Achilles tendon at the bottom of your calf muscles, according to the Mayo Clinic. This tendon connects the bone of the heel to the muscles of the calf. The tendon is commonly inflamed by overuse during sports or running.

What are the symptoms of Achilles tendinitis? You may experience mild to severe Achilles pain, as well as tenderness and swelling. The tendon may be aggravated by flat arches and trauma. If untreated or injured further, the Achilles tendon may tear or rupture completely.

The pain may increase during stretching because of the inflammation of the tissues. Some discomfort during stretching is normal. However, if you have a tearing feeling in your heel when stretching, stop immediately. Never stretch to the point of pain.

Will Achilles tendinitis ever go away? It typically takes about 6 to 8 weeks for Achilles tendinitis to improve, according to Timonium Foot and Ankle Center. If surgery is needed, it may take up to 6 months to return to your normal activities, according to Kaiser Permanente.

Bone spurs usually build where the ligament and tendon meet the bone. Bone tissue is deposited here because the body feels excessive stress along the ligament or tendon. Pain results when this bony buildup rubs against surrounding tissues.

What are the symptoms of a bone spur? When stretching, the pain may increase due to the bone spur stressing the tissues of the heel. It can cause sharp, burning pain and a loss of motion, which are associated with plantar fasciitis. Some people don't have any symptoms. If that's the case for you, you can skip treatment, according to the Cleveland Clinic.

If the bone spurs are causing discomfort, home remedies (think: applying ice and wearing supportive shoes) can help, per the Cleveland Clinic. If those measures aren't effective, physical therapy and surgery are options.

Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot, from the toes to the heel, as explained by the Cleveland Clinic.

What are the symptoms of plantar fasciitis? It usually causes sharp, stabbing heel pain in the morning or after a long period of rest or standing. Plantar fasciitis is often confused with a bruised heel, but the difference between plantar fasciitis and a bruised heel is that you're more likely to experience plantar fasciitis pain in the morning or after a long period of inactivity, according to Texas Foot Works. In addition, plantar fasciitis pain "may also radiate outwards to the arch of the foot, which doesn't happen with a bruised heel," per Texas Foot Works.

This often affects people with overweight or obesity, those who are pregnant or have inadequate shoe support. Plantar fasciitis is also an inflammatory process and may be aggravated by stretching the heel where the plantar fascia attaches.

If you're wondering, "how can I exercise if I have plantar fasciitis?" the answer is that activities should be limited to low-impact options like swimming and stretching, as long as it doesn't cause pain, according to Monroe Foot and Ankle Care.

Treatment options for plantar fasciitis include resting, changing activities, icing, stretching and other at-home tactics, according to the American Academy of Orthopaedic Surgeons (AAOS). Cortisone shots and wearing a cast can also be helpful. Surgery is another treatment option, but it's relatively rare, since 90 percent of people recover improve with over time through this non-surgical tactics, per the AAOS.

Stress fractures are tiny cracks in bone tissue. They commonly result from repetitive injury or overuse injury. The lower extremity, including the heel, can be affected because the weight-bearing joints are susceptible to this type of injury.

Stress fractures may occur from overuse where tissue attaches to bone because of the pull of the soft tissue on the bone, as explained by the AAOS. The hallmark symptom of a stress fracture is pain.

A stress fracture may take up to 6 to 8 weeks to heal, according to the American Academy of Orthopaedic Surgeons. But more serious fractures may have a longer recovery.

Heel bursitis is the inflammation of a bursa (fluid-filled sac) between your heel bone and Achilles tendon. Common causes include a sharp increase in running, walking or jumping, not properly stretching or warming up before activities, tight-fitting shoes or infection, according to the Cleveland Clinic.

What are the symptoms of heel bursitis? You may feel pain and tenderness in or behind your heel, especially if you're standing on your toes or reaching to touch them. Your heel may feel warm to the touch and/or be swollen, and the skin around your heel may change color, according to the Cleveland Clinic.

Mild cases of heel bursitis can heal within a few weeks, but more severe cases may take up to 6 to 12 months, according to the Cleveland Clinic.

Treatment for heel pain often includes resting your heel, icing the injured area, stretching and strengthening within a pain-free range and using orthotics or foot supports.

When dealing specifically with Achilles tendinitis, it's OK to walk or stretch your Achilles, as long as it isn't painful, according to University Foot and Ankle Institute. Avoid stretches that put strain on your Achilles tendon, such as stair stretches or hanging stretches. The fastest way to heal Achilles tendinitis is using the above suggestions of icing your tendon and resting from any activities that aggravate the issue.

When dealing with plantar fasciitis, you may be wondering if stretching can hurt it or if it's OK to use massage as a treatment. Stretches like rolling your foot with a tennis ball and doing toe curls and stretches can help heal your plantar fasciitis and ease the pain, according to Loyola Medicine. Massaging the area can also help.

However, some injuries may require physical therapy or surgery to fix. To get a personalized recommendation, talk with your doctor (more on that below).

To accurately identify the underlying cause of heel pain when stretching your calf muscle and get proper treatment, make an appointment with your doctor to get checked out. Pain in your foot could be coming from somewhere else, including your lower back.

According to the American Association of Neuromuscular & Electrodiagnostic Medicine, nerves that exit the spine can become compressed, leading to a condition called lumbar radiculopathy. In addition to pain, this disease can cause numbness, tingling and weakness in the leg.

If Achilles tendinitis is left untreated, the tendon could rupture, according to the Cleveland Clinic.

If bone spurs are left untreated, your activity and mobility levels may be severely limited, as you may not be able to put any weight on your foot, according to Steward Medical Group Orthopedic and Sports Medicine.

If plantar fasciitis is left untreated, you could experience bone spurs, a plantar rupture (where the plantar fascia rupture) or plantar fibromatosis (where non-cancerous nodules grow along the plantar fascia), according to New York Orthopedics.

If a stress fracture is left untreated, tiny cracks in the bone can cause significant issues that can hamper your mobility, not to mention, cause a lot of pain, according to Foot and Ankle Surgeons of New York.

And finally, if heel bursitis is left untreated, you may experience chronic pain and inflammation, according to Arthritis Health, which can limit your mobility.