Biomechanical Aetiology
 As shearing and tractional forces are placed on the achilles tendon, at the back of the heel inflammation can occur. The calf muscles assist inversion of the calcaneus at the heel lift, however when the foot accelerates into an excessively pronated position and the calcaneus is everted, increased medial tendo-achilles traction can result in transverse shearing of the tendon and sheath leading to inflammation and pain. As the rear foot pronates and a calcaneal valgus occurs, it causes misalignment and abnormal stresses on the tendon, lumpy scar tissue may occur, commonly called "pump bumps".
The same biomechanical mechanism has been linked to Restless Leg Syndrome, Sever's Disease and "growing pains".
 The achilles tendon fans out at its insertion to the calcaneus and is sandwiched between the superficial achilles bursa and the retro-calcaneal bursa. Sometimes an abnormal prominence of the postero-superior process of the calcaneus, known as Haglund's deformity, may be present, causing irritation of the bursa or tendon. Often many patients with this condition are supinators which causes lateral lower limb pressure whilst making the foot less efficient in energy absorption, transferring this stress to the achilles tendon region. Superficial bursitis may cause tenderness posterior to the tendon. Retrocalcaneal bursitis usually exhibits tenderness while squeezing the area deep to the tendon.
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The patient presents with a sharp and nagging pain above the heel. Limited ankle flexibility and inflammation over the affected area are often present.