If your shoe rubs the back of your heel or you have pain near the Achilles tendon attachment, this guide is for you. A bony prominence behind the heel may be Haglund’s, but pain or a bump here can have different causes. Care aims to reduce tissue irritation and improve your ability to be active. Do not copy exercises for plantar heel pain or midportion Achilles pain into this condition without considering where your pain is.
1🦴 What is Haglund’s prominence, and how is it related to the Achilles?
Haglund’s is a prominence at the upper back part of the heel bone. It may contact the back of the shoe or nearby tissues and irritate the area. A prominence alone does not establish how severe the pain is; some people have this bone shape without pain.
The Achilles tendon connects the calf muscles to the heel bone and transmits force during walking and rising onto the forefoot. Insertional Achilles pain, inflammation of a small nearby bursa, and Haglund’s prominence can occur together, but they are distinct. A spur or bony deposit within the tendon attachment is not exactly the same as Haglund’s either.
Bending the ankle far upward can increase compression at the Achilles attachment. Early care for this condition emphasizes exercise on a level surface and avoiding lowering the heel below a step edge. Examination helps establish the cause of pain. If the diagnosis of insertional Achilles pain is still unclear, seek assessment before starting this guide’s strengthening program; these exercises are not designed for rupture, recent injury or postoperative care.
Imaging is needed only in limited circumstances: an X-ray to assess the bone and prominence behind the heel, and ultrasound or MRI for diagnostic uncertainty, suspected tendon injury or treatment planning. Seeing a prominence on an X-ray alone does not identify which tissue is causing the pain.
Arch massage with the toes raised and rolling a bottle under the sole are for plantar fascia-related pain; they are not the main treatment for pain at the back of the heel. With insertional Achilles pain, do not force the ankle upward or press directly on the prominence or painful tendon. If you also have pain under the heel, that programme must be coordinated with your Achilles restrictions.
2🏠 Daily routines
👟 Reduce pressure from the back of the shoe
Choose shoes with a soft back and a suitable fit. If the edge rests on the painful spot, a soft sole alone is not enough.
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- Check pressure behind the heel while walking.
- Check where the back edge of the shoe contacts the prominence, not just how soft the sole is. Test shoes with normal steps before buying; do not ignore focal pressure behind the heel by continuing to walk.
- For daily work, choose shoes that do not irritate the back of the heel and stay secure on the foot during movement.
🦶 Choose heel lifts correctly
A heel lift may help reduce compression at the Achilles attachment. It does not remove the bony prominence.
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- There must still be enough room for your foot inside the shoe.
- The suitable height depends on comfort and shoe fit; this guide does not set one height for everyone. Use ordinary heel lifts in both shoes; if you have an individually prescribed device, follow its instructions. The lift should not bring your heel closer to a hard shoe edge or make it more painful.
- Review the device if it changes balance or walking; heel lifts complement reduced irritation and exercise, rather than replacing them.
- A heel lift differs from an arch-support insole. If an insole is also needed, it should be selected after assessing the foot and must not make the shoe tight or increase contact between the shoe’s heel edge and the prominence; one height is not prescribed for everyone.
🚶 Choose level routes
If walking uphill increases pain behind the heel, choose a level route. An incline together with very flat shoes can increase compression at the Achilles attachment.
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- Reduce inclined walking while pain is aggravated.
- At first, do not add sloping routes and repeated climbs to essential walking. Once level walking is tolerable, increase activity gradually and check the next-morning response before adding inclines.
- If a previous route irritated the back of the heel, do not try to compensate with more effort.
🪑 Make standing tasks easier
Alternate long periods of standing and walking with seated work. Do not press the back of the heel against a hard edge while resting.
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- Reduce unnecessary trips up and down.
- Separate tasks you can do seated from those requiring you to move around. While sitting, rest your feet comfortably on the floor; placing the back of the heel on a hard footstool edge can compress the same painful area.
- If your job requires safety footwear, find a suitable way to reduce irritating contact within that workplace.
🌅 Start gently after rest
Stiffness and pain behind the heel may be worse with the first steps. Do not replace a gentle start with forceful ankle stretching or lowering the heel below a step.
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- Keep comfortable shoes within reach.
- After sitting for a long time, ease your foot back into activity with gentle movement. Forceful calf stretching to relieve stiffness may irritate insertional Achilles pain; this differs from the stretching program for pain under the heel.
- If starting to walk gets harder each day, review the previous day’s activity and exercise.
🚲 Replace irritating activity
If running or jumping worsens the pain, choose lower-load activity such as easy cycling. Taking a break from irritating activity differs from giving up movement permanently.
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- The alternative must be tolerable for your heel.
- To maintain general fitness, choose activity that does not cause irritating shoe contact behind the heel or uncomfortable loading of the tendon. Start short and easy, then assess walking ability after the session and stiffness the next morning.
- Increase alternative activity gradually too; a lower-load sport is not permission for a sudden long session.
🏋️ Do not confuse strengthening with deep stretching
Exercise aims to increase tendon tolerance gradually. Lowering the heel below a step is not a suitable way to start exercises for insertional Achilles pain.
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- Perform suitable strengthening on a level surface.
- Suitable exercise strengthens the calf gradually and does not need forceful stretching. A painful tendon attachment tolerates compression differently from the midportion of the Achilles; lowering from a step edge may compress it more.
- Get therapist guidance when adding weight, single-leg exercise or returning to running, to choose a suitable range and amount.
📝 Record the next-morning response too
Note pain during activity and the heel’s condition afterward. If pain and stiffness gradually increase, stop increasing the load.
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- Do not judge only by temporary pain relief during a session.
- Pain at that moment does not show the tendon’s whole response; compare stiffness, pain and walking ability the next morning with your usual state too. Reduce the amount or difficulty if increased exercise makes symptoms worse.
- If reducing load does not help or symptoms are increasing, do not continue hoping the tendon will adapt; seek assessment.
📋 Choose one stage and progress gradually
The strengthening cards are alternative options and stages; do not do them all together. Once the cause of pain has been confirmed, start with an easier, unweighted version and assess current tolerance and the next-morning response before progressing.
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- Holding the heel still and raising and lowering it are two different methods. To start holding, choose just one suitable version for 1 session daily; do not combine the three versions. This is a starting example; follow your individual program if one has been prescribed.
- Single-leg exercise and added weights increase load; if the easier stage is still difficult or painful, do not progress and get therapist help.
- Achilles rehabilitation generally requires regular, gradual exercise over at least 12 weeks; this is not a reason to delay an initial assessment.
3🏋️ Home exercises
Seated heel-raise hold (Seated Isometric Heel Raise)
Hold the heel raised; aim for 5 holds of 45 seconds with 2 minutes’ rest. Stop for sharp pain behind the heel or painful calf cramping.
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Before you start: After insertional Achilles pain has been confirmed, this unweighted option offers a lighter start to strengthening. Sit on a stable chair with both feet on a level floor and your knee bent at roughly a right angle; seek assessment first if you have had a sudden injury.
How to do it:
- Keep the forefoot of the painful foot on the floor and slowly lift the heel a little.
- Hold the heel still at a tolerable height without moving your knee or body up and down.
- Slowly lower the heel to the floor and rest before the next hold.
Movement tips: Lower the heel only to the floor; do not take it below the foot’s supporting surface or force the ankle upward. Breathe normally during the hold and rest for 2 minutes between holds; the forefoot stays planted and the heel is still. Mild calf fatigue may occur, but sharp pain is not acceptable.
Amount, repetitions and progression: Do 1 session daily of this selected option. Aim for 5 holds of 45 seconds per session, with 2 minutes’ rest between holds. Reduce time or number if not tolerable; increase only when comfortable and no worse the next morning. If pain is worse the next morning, reduce the hold time or number of holds and return to the previously tolerable amount.
Stop immediately if: Sharp pain behind the heel or painful calf cramping occurs.
Common mistakes: Moving up and down repeatedly instead of holding; placing a weight on the knee.
Easier version: Lift the heel less and shorten the hold.
Double-leg heel-raise hold (Bilateral Isometric Heel Raise)
Hold with both heels raised; aim for 5 holds of 45 seconds with 2 minutes’ rest. Stop for sharp pain or instability.
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Before you start: Choose this option after diagnosis and only when standing and the easier version are tolerable. Stand on a level floor in comfortable shoes and hold a wall or stable chair; you do not need a weight or step.
How to do it:
- Share your weight between both feet and slowly lift both heels.
- Hold still at a tolerable height, keeping the ankles aligned with the feet.
- Lower the heels to the floor with control and rest.
Movement tips: Do not lower the heels below a step edge; keep a level floor beneath your feet. Breathe calmly and rest for 2 minutes between holds; your body stays still and your hand stays on the support. Tolerable calf effort may be felt, but sharp pain or limping after exercise is not appropriate.
Amount, repetitions and progression: Do 1 session daily of this selected option. Aim for 5 holds of 45 seconds per session, with 2 minutes’ rest between holds. Reduce time or number if not tolerable; increase only when comfortable and no worse the next morning. If pain is worse the next morning, reduce the hold time or number of holds and return to the previously tolerable amount.
Stop immediately if: Sharp pain behind the heel or loss of balance.
Common mistakes: Swaying the body; holding on the foot’s edge or using a step.
Easier version: Return to the seated version or lift the heels less.
Heel-raise hold on the painful leg (Single-leg Isometric Heel Raise)
Only after the double-leg version is comfortable; aim for 5 holds of 45 seconds with 2 minutes’ rest. Stop for sharp pain behind the heel or instability.
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Before you start: This is not a starting stage; choose it after diagnosis and comfortable tolerance of the double-leg version, preferably with therapist guidance. Stand on a level floor beside a stable support; do not use a weight, and continue the double-leg version if your balance is insufficient.
How to do it:
- Using your hand for support, slowly shift weight onto the painful leg and lift the other foot off the floor.
- Raise the heel of the painful foot to a tolerable height and hold it still.
- Slowly lower the heel to the floor, put the other foot down and rest.
Movement tips: Keep the ankle aligned with the foot and the heel at or above floor level; do not force a higher lift. Breathe normally during the hold and rest for 2 minutes between holds. The heel stays still and your hand stays on the support; difficulty controlling the movement or sharp pain is a reason to return to an easier stage.
Amount, repetitions and progression: Do 1 session daily of this selected option. Aim for 5 holds of 45 seconds per session, with 2 minutes’ rest between holds. Reduce time or number if not tolerable; increase only when comfortable and no worse the next morning. If pain is worse the next morning, reduce the hold time or number of holds and return to the previously tolerable amount.
Stop immediately if: Sharp pain behind the heel or instability occurs.
Common mistakes: Rolling the ankle onto the outer edge; lowering the heel below a step.
Easier version: Use the double-leg version; a shorter hold does not replace readiness for the single-leg stage.
Seated heel raise and lower
When the holding stage has become easier, slowly raise and lower the heel; aim for 3 sets of 15. Stop for sharp or increasing pain behind the heel.
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Before you start: After diagnosis, choose this unweighted movement when pain has decreased and the static hold has become easier. Sit on a stable chair with your feet on a level floor; do not place added weight on the knee.
How to do it:
- Keep the forefoot of the painful foot still and slowly lift the heel.
- Pause at the top for 3 seconds, keeping your knee and body comfortable.
- Lower the heel with control only to the floor, then start the next repetition slowly.
Movement tips: Raise to a comfortable height and return to the floor; do not force the ankle into a deep stretch. Breathe normally and pause between sets until fatigue settles and control returns. The forefoot stays still while the heel moves; mild calf fatigue may occur.
Amount, repetitions and progression: Aim for 3 sets of 15 once daily, with a 3-second pause at the top. Start with fewer tolerable repetitions and increase with correct form; reduce repetitions or sets if increased pain persists into the next day.
Stop immediately if: Sharp or increasing pain behind the heel.
Common mistakes: Adding weight to the knee from the start; suddenly dropping the heel.
Easier version: Reduce repetitions and height, or return to a short seated hold.
Double-leg heel raise and lower (Bilateral Heel Raise on Floor)
After tolerating the easier stage, raise and lower both heels; aim for 3 sets of 15. Stop for sharp pain or instability.
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Before you start: Choose this stage after diagnosis and when the easier version is tolerable without worse symptoms the next morning. Stand on a level floor in comfortable shoes and hold a wall or stable chair; do not use weights or a step.
How to do it:
- Distribute your weight over both feet and slowly raise the heels.
- Pause for 3 seconds at a tolerable height and keep the ankles aligned with the feet.
- Slowly lower the heels to the floor; do not continue by bouncing.
Movement tips: The heels return only to the floor; no part of the movement is below a step edge. Move slowly and breathe normally; pause between sets until control and comfort return. Both heels move with control and the body does not sway; mild calf fatigue may occur.
Amount, repetitions and progression: Aim for 3 sets of 15 once daily, with a 3-second pause at the top. Start with fewer tolerable repetitions and increase with correct form; reduce repetitions or sets if increased pain persists into the next day.
Stop immediately if: Sharp pain behind the heel or loss of balance occurs.
Common mistakes: Bouncing; rolling the ankle or lowering the heel below a step edge.
Easier version: Reduce the height and repetitions, or return to the seated version.
Rise on both legs, lower on the painful leg (Two-up One-down Heel Raise)
A more advanced stage on a level floor; aim for 3 sets of 15. Stop for sharp pain or loss of control.
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Before you start: After diagnosis and comfortable tolerance of the double-leg movement, choose this option with therapist guidance to increase load gradually. Stand on a level floor beside a stable support; do not progress to this stage yet if single-leg control is insufficient.
How to do it:
- Hold the support and slowly raise both heels.
- With control, shift your weight to the painful leg and lift the other foot off the floor.
- Slowly lower the heel of the painful foot only to the floor; put the other foot down again so the next repetition starts on both feet.
Movement tips: During lowering, keep the knee and ankle aligned with the foot; the heel does not go below floor level. Do not hold your breath, and rest between sets until control returns. The difference between rising on both legs and lowering on one should be clear; dropping the heel or sharp pain is not acceptable.
Amount, repetitions and progression: Aim for 3 sets of 15 once daily. Start with fewer tolerable repetitions; reduce the amount and return to the double-leg version if you lose control of lowering or increased pain persists into the next day.
Stop immediately if: Sharp pain behind the heel or inability to lower with control.
Common mistakes: Lowering quickly; starting on a step or shifting weight suddenly.
Easier version: Perform the entire movement on both legs.
Heel raise and lower on the painful leg (Single-leg Heel Raise on Floor)
Use the single-leg movement after the easier stage is comfortable; aim for 3 sets of 15. Stop for sharp pain, instability or loss of movement control.
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Before you start: This is not a starting exercise; choose it after diagnosis and comfortable tolerance of easier stages, preferably with therapist guidance. Stand on a level floor beside a wall or stable chair, wear comfortable shoes and do not use a weight.
How to do it:
- Hold the support and lift the other foot off the floor without bouncing on the painful leg.
- Slowly raise the heel of the painful foot and pause for 3 seconds at a tolerable height.
- Lower the heel with control only to the floor; if control is insufficient, put the other foot down and finish the movement.
Movement tips: Keep the range tolerable and do not lower the heel below floor level; do not roll the ankle onto the outer foot edge. Breathe calmly and pause between sets until control returns. Your body stays still and your hand stays on the support; increased pain or limping after exercise is not appropriate.
Amount, repetitions and progression: Aim for 3 sets of 15 once daily, with a 3-second pause at the top. Start with fewer tolerable repetitions and increase with correct form; reduce repetitions or sets if increased pain persists into the next day.
Stop immediately if: Sharp pain, instability or loss of movement control occurs.
Common mistakes: Bouncing to rise; tilting the ankle or lowering the heel below a step.
Easier version: Use both legs; fewer repetitions do not replace readiness for this stage.
Easy stationary cycling (Gentle Stationary Cycling)
Choose easy, tolerable pedaling to maintain general activity. Stop if sharp pain behind the heel or a clear increase in symptoms occurs.
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Before you start: This activity replaces irritating running and does not replace Achilles strengthening. Use a stationary bike and comfortable shoes that do not press behind the heel; choose another activity if getting on the bike and pedaling without sharp pain is not possible.
How to do it:
- Sit comfortably on the bike and keep your feet in steady contact with the pedals.
- Pedal gently with low resistance; do not stand to pedal or push hard through the forefoot.
- When you get tired or symptoms increase, reduce resistance or finish the session.
Movement tips: Let the ankle move within a comfortable range and avoid irritating shoe pressure behind the heel. Breathe normally while pedaling and pause whenever needed. Keep your pelvis on the saddle and move smoothly; the aim is tolerable activity, not severe calf fatigue.
Amount, repetitions and progression: No fixed duration suits everyone; start short and easy. Gradually increase either duration or resistance only when you are no worse during the activity, afterward or the next morning. If symptoms are worse the next morning, reduce the duration or resistance and return to the previously tolerable amount.
Stop immediately if: Sharp pain behind the heel or a clear increase in symptoms occurs.
Common mistakes: Standing to pedal; high resistance or shoes that press behind the heel.
Easier version: Reduce duration and resistance; if you cannot tolerate it, choose an alternative with your therapist.
4🏟️ Gym training with Haglund’s and insertional Achilles pain
Warm up without extra compression
Start with lower-load activity such as easy cycling only if tolerable. Warming up on an inclined treadmill or with deep calf stretching may irritate the Achilles attachment. At the end, gradually reduce movement intensity; lowering the heel below a step edge is not a suitable cool-down for this condition.
Form and range before added weight
Start strengthening at the stage appropriate for you on a level floor. On returning, the heel reaches only the floor; more range is not necessarily better. Prefer therapist guidance for weights, single-leg work and return to running. Do not add a harder stage while the easier one still increases pain and stiffness the next morning.
Breathing and session order
Do not hold your breath, and raise and lower the heel slowly. After warming up, perform your chosen strengthening option while you still have adequate control and balance. Do not combine all the seated and standing holds and movements; the cards are stages and alternatives, rather than a complete list for 1 session.
Irritating patterns and alternatives
- Replace heel lowering below a step and deep calf stretching with strengthening through a comfortable range on a level floor.
- During irritation, replace inclined running and jumping with tolerable lower-load activity; return requires tendon readiness.
- Replace shoes with a stiff edge pressing on the prominence with a comfortable, secure style; a soft sole alone does not remove pressure from the shoe’s back.
Managing a worse day
If stiffness, pain or limping increases the next morning, do not consider the previous session’s load appropriate. Reduce the amount, range or difficulty and return to an easier option. Mild, tolerable pain may occur, but do not push through sharp pain to reach the card’s target. Persistent worsening despite reduced load requires the plan to be reviewed.
Weekly consistency and when to stop
Throughout the week, combine selected strengthening with tolerable general activity and record the next-morning response. Rehabilitation progresses gradually; 1 good session does not mean you are ready to jump or run. Sharp pain, instability or loss of control during movement is a reason to stop that exercise. Physiotherapy helps if you are unsure about technique or increasing load; do not postpone your initial assessment until rehabilitation ends.
5⚠️ When should you seek medical care?
Arrange an appointment if improvement has not started after two weeks of home care. Seek care sooner for severe or worsening pain or difficulty with daily activities. Seek care sooner for numbness in your foot as well. If you have diabetes and foot pain, seek care sooner.
- If you hear a snap, a grinding noise or a pop at the time of an injury, or suddenly become weak when pushing off with the foot, seek urgent medical assessment. A pop with sudden pain at the back of the calf or heel can indicate an Achilles injury.
- If you cannot walk, your foot or ankle has become misshapen, you have severe heel pain after an injury, you feel faint, dizzy or nauseated because of the pain, you cannot walk on tiptoes, you cannot walk up stairs, or your calf and ankle are swollen and bruised, seek urgent medical advice and assessment.
6✅ What is your next step?
Reducing contact from the back of the shoe, adjusting activity and gradual strengthening on a level floor form the basis of care. The goal is to improve tendon tolerance and daily activity; exercise does not remove Haglund’s bony prominence. If regular active treatment does not produce an adequate response, the diagnosis and plan are reviewed before adjunct treatments are considered case by case.
Platelet-rich plasma, prepared from your own blood, is called PRP. Its effectiveness for insertional Achilles pain with Haglund’s has not yet been established; findings for plantar heel pain cannot be generalized to this condition. Shockwave therapy is also not an established routine treatment for insertional Achilles pain. Adjunct treatment should be selected with an explanation of this uncertainty and should not replace gradual strengthening. Corticosteroid injection into the Achilles tendon is not recommended because of the risk of rupture.
To assess the cause of your heel pain and plan your care, call Dr Jalil Emad’s clinic on 0913 782 5207, or book an appointment online. In an emergency, do not wait for the clinic to reply; follow the instructions in the warning signs section.
Learn about the clinic’s services: Orthopedic services
This article is for education and does not replace a medical examination or diagnosis.
7📚 Scientific references
View references
- AAOS OrthoInfo. Achilles Tendinitis. https://orthoinfo.aaos.org/en/diseases--conditions/achilles-tendinitis/
- Kent Community Health NHS Foundation Trust. Achilles insertional tendinopathy. https://www.kentcht.nhs.uk/leaflet/achilles-insertional-tendinopathy/
- NHS. Heel pain. https://www.nhs.uk/symptoms/foot-pain/heel-pain/
- Pringels L, Capelleman R, Van den Abeele A, Burssens A, Planckaert G, Wezenbeek E, Vanden Bossche L. Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial. British journal of sports medicine. 2025. PMID:40011018. doi:10.1136/bjsports-2024-109138
- de Vos RJ, van der Vlist AC, Zwerver J, Meuffels DE, Smithuis F, van Ingen R, van der Giesen F, Visser E, Balemans A, Pols M, Veen N, den Ouden M, Weir A. Dutch multidisciplinary guideline on Achilles tendinopathy. British journal of sports medicine. 2021. PMID:34187784. doi:10.1136/bjsports-2020-103867
- Korakakis V, Kotsifaki R, Sotiralis Y, Malliaras P. Shockwave Therapy for Midportion and Insertional Achilles Tendinopathy: A Nail in the Coffin? A Systematic Review With Meta-Analysis. The Journal of orthopaedic and sports physical therapy. 2026. PMID:42063301. doi:10.2519/jospt.2026.13985
- BNSSG NHS. Achilles tendinopathy: Insertional Achilles Tendinopathy Loading. https://myjointhealthhub.bnssg.nhs.uk/foot-ankle-pain/achilles-tendinopathy/
- Dorset NHS MSK. Achilles tendon pain. https://www.mskdorset.nhs.uk/ankle-pain/ankle-pain-achilles-tendon-pain/
- Assi A, Hamyeh A, Mohanna R, Boutros M, Boueri W, Sebaaly A. Platelet-rich plasma vs. placebo injections in achilles tendinopathy: A systematic review and meta-analysis of randomized controlled trials. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 2026. PMID:41997478. doi:10.1053/j.jfas.2026.04.005
- Erroi et al. Conservative treatment for Insertional Achilles Tendinopathy: platelet-rich plasma and focused shock waves. A retrospective study. Muscle, Ligaments and Tendons Journal. 2017. doi:10.11138/mltj/2017.7.1.098
- Sleeswijk Visser T, Brul S, Deng J, Bonsel J, van Es E, Eygendaal D, de Vos RJ. Low socioeconomic status is associated with worse treatment outcomes in patients with Achilles tendinopathy. British Journal of Sports Medicine. 2024;58:579–585. Supplementary material 2: Insertional Achilles tendinopathy, pages 7–8. PMID:38569849. doi:10.1136/bjsports-2023-107633
- Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund’s deformity. Foot & Ankle International. 2012;33(6):487–491. PMID:22735321. doi:10.3113/FAI.2012.0487
