Posterior heel pain is often the result of insertional inflammation and partial tearing of the Achilles. The pain often localizes directly on the posterior heel and can be associated with a spur of varying sizes. Often the pain is worse in the morning and when getting up from a seated position. There may be associated swelling in the area of discomfort. The exact cause of the symptoms is unknown but is not necessarily associated with an injury. Treatment begins with anti-inflammatory medication, stretches, ice, and sometimes physical therapy. Immobilization is also sometimes useful to reduce symptoms and facilitate healing. Non-operative treatment is usually more successful in patients seen earlier in the course of the symptoms and those without a large spur noted on x-ray. For those failing non-operative treatment, surgery is often indicated. In most cases, an MRI will be obtained prior to surgery to evaluate the extent of the Achilles involved in order to better understand whether additional procedures may be required at surgery in order to resolve the problem. Surgery for this problem has a high success rate but the recovery process can take several months.