Heel pain

introduction

Under Heel pain one understands pain that in the back of the foot are localized.
For this type of discomfort it can be great many different causes give. If you take them all together, they appear quite often.
Even if the diseases or conditions are often not of concern, heel pain can still occur for those affected Very restrictive in daily life work, as the strain on the painful foot and thus standing and walking is often avoided. Most types of heel pain are relatively easy to treat, which means that the pain can be reduced quickly and effectively.

causes

Perhaps the most common cause of heel pain is simply overload. The heel is designed in such a way that it basically bears the majority of the body weight anyway and is therefore constantly stressed both when standing and when walking.
Especially if certain circumstances exist, such as being overweight, wearing the wrong shoes or doing a lot of sporting activity, the resilience of the heel bone (the bone that forms the heel) and the associated joint (between the heel bone and the Ankle bone) or structures near the joints such as tendons or ligaments is exceeded and consequently pain occurs. Often, irritation of the bursa is also responsible for the pain caused by overload.

Often, inflammation also leads to heel pain. These inflammations often affect the Achilles tendon, but occasionally also the tendon plate under the sole of the foot or the bursa.
Another possible cause of heel pain is a heel spur. This is understood to be a bony process that can develop at the point of attachment of the tendons of the heel (above on the Achilles tendon or below on the tendon plate). This also causes inflammatory reactions after a while.

Also read our topic: Back heel pain or inflammation of the periosteum of the heel

Figure causes of heel pain

Heel pain

1. Achilles tendon -
   Tendo calcaneus
2. Ankle bone -
   Talus
3. Bursa
   between Achilles tendon and
   Heel bone -
   Bursa subachillea
4. Bursa
   between Achilles tendon and heel bone
5. Heel bone -
   Calcaneus
6. Sole tendon plate -
   Plantar aponeurosis
7. Lower ankle joint -
   Articulatio talocalcaneonavicularis
   Causes:
   A - irritation and inflammation -
   of the bursa (Bursitis),
   Achilles tendon attachment,
   Sole tendon plate
   B - Lower (plantar)
   Heel spur and upper
   (dorsal) heel spur -
   bony outgrowth
   Therapy:
   C - rest -
   Avoid strenuous sports
   D - Transitionally special
   adapted shoes, insoles,
   Heel cushion and pad
   E - cooling -
   Ice cubes or cooling pads
   (wrapped in a towel)
   F - connective tissue massages
   (Physiotherapy),
   physical therapy
   G - TENS
   (Transcutaneous Electrical
   Nerve stimulation),
   Shock wave therapy
   (for heel spurs)
   H - painkillers -
   from the NSAR group
   (e.g. ibuprofen or diclofenac)

You can find an overview of all Dr-Gumpert images at: medical illustrations

Other foot problems (Warts, Calluses, Tumors or cysts, complete avulsions of the Achilles tendon, reduction of the fat pad under the heel bone) are less often responsible for heel pain, but should not be forgotten in the differential diagnosis.

In addition, there are still some diseases that actually nothing with the heel per se have to do, but which can also be associated with heel pain. These include, among other things Metabolic diseases, Circulatory disorders, rheumatic diseases (for example the Rheumatoid arthritis), Spine problems and certain Misalignments of the leg (for example If one or Knock knees) or foot (Spread- or Arched arches).

Worse injuries like a Calcaneal fracture also lead to heel pain, but in contrast to stress-related complaints, these arise suddenly and can usually be linked to a specific triggering event.

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Symptoms

The heel pain in itself is not a disease, but a symptom.
The pain manifests itself in the heel area, in most cases mainly when it occurs or as a pain that increases with any kind of pressure. Most of the time the pain occurs after prolonged exposure on, but sometimes even earlier following a longer period of rest (For example, in the morning after getting up or after sitting for a long time). For some, the pain becomes rather than piercing and precisely localized perceived, with others it spreads rather dull over a larger area out.
If the pain is particularly in the area of ​​the transition from the Achilles tendon to the heel bone, then one speaks of one Achillodynia.
As a result of the pain, for many it is Limited mobility in the joint and stepping on the affected foot becomes difficult or even impossible.

Depending on why the heel pain occurs, it can be occasional accompanied by other symptoms become. The pain can develop in certain cases for example spread further and then affect other joints in the leg as well.
With inflammatory changes it can swelling, overheat or Redness come. If certain underlying diseases are present, there are of course other disease-specific symptoms.

Pain when stepping on

Heel pain when it occurs can be for a number of reasons. One possible cause can be the Formation of a so-called heel spur be. This creates a on the heel bone bony extension. One distinguishes one lower (plantar) and one upper (dorsal) Heel spur. In most cases this will be Lime spur not noticed at all as it does not cause symptoms under normal circumstances. However, if there is an inflammation of the Achilles or Plantar tendon, then the spur is mainly noticeable through pain when it occurs.

athlete, very tall people but also obese people develop a heel spur much more often than others. The pain mainly occurs here Pressure and strain the heel and often have a stinging character. Also the so-called "Plantar Fasciitis" (Inflammation of the tendon plate on the sole of the foot) may cause heel pain when stepping on. Although its cause is not yet fully understood, it appears to be favorable for the occurrence of the inflammation Misalignments of the feet, running, obesity but also Professions that involve standing, to be.

diagnosis

For a diagnosis that explains heel pain is that first Medical history survey of great importance. It is important that any Risk factors and other current or past diseases that could still affect the heel can be queried.
Also one exact description of the complaints (when, where, how often, how strong) should be done.
The doctor then does one physical examination by which he is initially the entire body with a special focus on the legs (are there any misalignments? What is the posture? How is the patient walking?) and then the Muscle strength, the sensitivity and Reflexes checked.
In addition, he should see where exactly is the pain and whether he is for example triggered by pressure can be.
Depending on what the doctor suspects after an initial examination additional diagnostic procedures used. For example imaging procedures (roentgen, Computed Tomography, Magnetic resonance imaging, Scintigraphy), Blood tests or Joint reflections (Arthroscopy or tendoscopy) can be used to arrive at the final diagnosis.

therapy

The therapy for heel pain depends of course on its cause.

Especially if the pain in the heel has arisen due to overloading, it often helps if you have the Gentle on the heel for a while. If available, should Reduced excess weight and stressful sports (for example jogging) be avoided for a while. For effective relief it can be helpful if one at least temporarily, specially adapted shoes or insoles to relieve pressure on the heel when running. For the same purpose there is also Heel cushion and -pad. In worse cases, the patient should consider walking on crutches for a while. Also one Cooling the heel (with ice cubes or cooling pads) many find pain reliever.

For most forms of heel pain, an appropriate one helps physical therapy. Here certain stretching and gymnastics exercises are learned and performed as regularly as possible in order to joint, To relieve tendons and muscles on the one hand and to strengthen them on the other. Specific Connective tissue massages are also used successfully to treat heel pain in physiotherapy.

Other possibilities are the Transcutaneous Electrical Nerve Stimulation (TENS; in this procedure, electrical impulses are transmitted from outside through the skin, which are able to activate the body's pain-relieving system. Also homeopathy or Osteopathy represent therapy options that provide relief in some patients.

This can of course be used in conjunction with severe pain Painkiller, preferably from the group of non-steroidal anti-inflammatory drugs (NSAIDs, for example Ibuprofen or Diclofenac) can be used.

In the case of major damage (for example, tears in the Achilles tendon or broken heel bone), a surgery respectively. In the course of a surgical procedure, for example, tissue can be removed, a break reduced or a tendon transplanted.

Should Underlying diseases (Tumors, circulatory disorders, metabolic disorders, etc.) are present, these must of course adequately treated in order to be able to permanently get rid of the pain in the heel.

course

The course of heel pain is highly dependent on the underlying cause. In most cases, however, they can be treated well and then go away completely and without consequences. For separate clinical pictures see there.

prophylaxis

There are a number of things you can do yourself to prevent heel pain.
First of all, one should just take care that the body is in general in one good health is located.
If you regularly do a reasonable amount of physical activity, eat healthily and watch your weight, you will gain a lot.
In addition, there are special measures that affect the feet. One should comfortable, suitable and breathable footwear wear on one good foot hygiene pay attention and Treat small problems like warts or callouses directly or get treated.
It is also advisable to to run barefoot more often (with the exception of public baths or saunas) as this is good for the feet.

If you are unsure about changes or pain in your foot, it is always recommended to consult a doctor before they worsen.

Exercises

There are different exercises to do Heel tendons to stretch and prevent or reduce heel pain. Since most heel pain is caused by incorrect loading and excessive strain, one is enough Strengthening the muscles through gymnastics, combined with shoe insoles or special adjustments, often to relieve or end the pain.
The exercises are helpful for heel pain, especially for Heel spurs (upper / lower heel spur) and shortened tendons.
All of the following exercises should be held for about 10 seconds and repeated several times (ideally up to 20 times) to feel an improvement. They can be used several times a day and over a long period of time. A significant improvement is often only noticeable after 6 months.

• 1st exercise: To the Plantar fascia To stretch, you can stand a step away from a wall facing the wall. Now you do a little lunge step with the concerned Leg backwards. The other leg can be bent closer to the wall. The heel of the back foot (with the pain) is allowed to move Not lift off the ground. Now you lean forward with your upper body and can support yourself with your hands on the wall. There should be a significant stretching of the calf muscles and the Achilles tendon be noticed.
• Exercise 2: If you put your feet on a step and step back a little so that your heels are in the air, you can do the Heel drop can stretch both heel tendons at once. If you have problems with your balance or are in pain you can also do this exercise one after the other with only one foot over the edge. The calf muscles are also strongly stretched during this exercise.
• 3rd exercise: You stand up against a wall or on a table and then crouch down deep (you can lean forward a little). Shortly before your heels lift off the floor, hold the position for 10 seconds and then go back to an upright position.
• 4th exercise: Sit on the floor with your legs stretched out, wrap a towel around your affected foot and pull it towards your body. The toes are drawn in here. When the knee is bent, the Achilles tendon is also stretched. If you are flexible enough, you can also hold your foot with your hands.
• 5th exercise: You can roll over the sole of the foot with a spiked / hedgehog ball, this stimulates the small foot muscles and strengthens them.
• 6. Exercise: You can put a cloth on the floor and lift the cloth with your toes in a claw movement and let it fall again.
• 7. Exercise: The foot is placed on the floor in a sitting position. Keep your heels and toes on the ground throughout the exercise. Now the outer edge of the foot is more loaded and the sole of the foot is tightened in the middle of the foot so that the longitudinal arch of the foot is pulled up. A “hollow foot” position is assumed, so to speak.

After running

A possible explanation for heel pain after running could be a shoe that is too tight and is pressing on the heel. Pressure sores, which are very painful, often develop at this point. But too wide a shoe can trigger a blister due to the friction. It is best to pay attention to sufficiently high socks that cover the predisposed area or wear reinforced socks. A blister plaster can also help. Pressure points and calluses, warts (e.g. plantar warts on the heel) or Athlete's foot can also trigger heel pain.
Another cause of heel pain is what is known as heel spur. There is an upper and a lower heel spur. Of the lower on the sole of the foot is much more common. He noted a change in approach Plantar fascia dar (sole plate) and projects the pain onto the heel on the sole side when stepping on. Of the upper Heel spur affects the approach of the Achilles tendon and will too Haglund exostosis called. This is located roughly where an ankle-high shoe presses on the heel. Due to pressure loads ossified the insertion of the tendon and creates a protruding bone. This can often be felt as a knot on the heel. A heel spur can be favored by incorrect loading, overweight and foot misalignments. Heel spur pain often occurs in the morning after getting up. Both the plantar fascia and the Achilles tendon can become inflamed and cause pain during or after running.
Incorrect load on the feet can be caused by overweight, leg length differences, pelvic inclination, Knock knees or If one and foot malpositions are triggered. The heel pain caused by this becomes stronger the higher the load. The misaligned feet include Splay feet, Lower- and Flat feet. These in turn can also favor heel spurs.
In addition, the fat pad, which is strongly pronounced on the heel, can dwindle with age. As a result, the weight presses directly on the bone and can turn into a heel spur or a Bursitis (Bursitis). Shoes with a thickly padded heel can help.

After exercise, the calf muscle, Gastrocnemius muscle, little one Ruptured muscle fibers have suffered (in colloquial language aching called). These micro-injuries are subsequently repaired and reinforced, creating a Muscle building he follows. This sore muscles can stretch as far as the Achilles tendon, which is the attachment point of the muscle to the heel bone, and it can be painful, especially during stretching exercises.
You can also rheumatic diseases affect the heel and ankles. The Achilles tendon inflammation (enthesopathy) is particularly typical in the ankylosing spondylitis, which is one of the rheumatic diseases. This pain is often increased during and after exercise, but it also occurs at rest.There is often significant swelling, reddening and overheating.
Medicines can also trigger inflammation of the tendons, including Antibiotics like fluoroquinolones.
Additionally must Broken bones be considered as a possible cause of heel pain. These can arise from a fall on the heel or from long-term overloading of the heel bone. This latter "Fatigue fracture“Can occur in sports with many jumps (basketball, handball) and the chronic pressure can lead to small cracks in the bones. This break can also occur through a lot of running (marathons etc.) March fracture (Fracture means broken bone) is called, arise. In most cases, conservative therapy with protection and relief of the foot is sufficient.

The gout is a disease which, due to high levels of uric acid in the blood, leads to crystal deposits on joints, almost always on the big toe. However, it can also cause gout nodules in the heel.
In children who complain of tenderness on both sides of the heels is the Haglund's disease (Apophysitis calcanei) another possible cause. At M. Haglund there is one delay ossification of the calcaneus.
An additional foot bone, for example the os trigonum, which is present in up to 15% of all adults, is not so rare. It can cause pain, especially in athletes, that can be felt behind the outer ankle.

After the sport

In athletes, the high loads placed on the feet (e.g. when running, jumping) can cause various diseases on the heel. So by the pressure of the The tendon attachment of the Achilles tendon calcify and one upper calcaneal spur cause. The Inflammation of the Achilles tendon and so lead to severe pain under stress. Acute inflammation is usually accompanied by redness, swelling and overheating. If the athlete does not take it easy now, the inflammation can attack the tendon and close small cracks lead or to one chronic inflammation become. Chronic inflammation, on the other hand, leads to pain, especially when you get up in the morning, and decreases as soon as you have taken a few steps. If the tendon is torn, it can lead to loss of muscle strength. The posterior calf muscle (M. gastrocnemius), which is necessary, for example, for standing and walking on the toes.
If the Achilles tendon is completely torn, which can usually not be overheard by a loud noise such as a whip, the calf muscle is usually slack and it is no longer possible to stand on your toes. The tear is accompanied by severe pain and swelling. A partial or complete tear of the tendon can first be checked by clinical examination and touching a notch. Otherwise you can use Ultrasonic or Magnetic resonance imaging (MRI) visualize and assess the tendon (lime, inflammation, crack).
In the case of acute inflammation, the athlete should take it easy and relieve the foot. Pain relievers can reduce inflammation and reduce swelling. This can be taken as a tablet (aspirin, Ibuprofen) or apply locally to the painful area, for example as a Diclofenac (Voltaren-) Ointment bandage. Cooling the heel is usually recommended. It is also advisable to raise the shoe on the heel (raised heel: heel pad) and do physical exercises. Chronically inflamed tendons can lead to long-term problems that require insoles or special shoe designs. Occasionally, the inflamed tendon tissue has to be removed in an operation. Tendon tissue from another tendon in your own body can be used to reconstruct the Achilles tendon (transplant). Likewise, if the tendon is torn, surgical suturing is often required, unless the tendon edges are very close to one another. In order to fully restore the function, rest and physiotherapy for at least 6 weeks are necessary. Cortisone injections to the Achilles tendon should be used sparingly, as cortisone attacks the tendon and tears have been observed more often.

After getting up

Heel pain that occurs after getting up in the morning typically suggests certain diseases. Pain in joints is often common in general rheumatoid arthritis. This rheumatic disease is through Morning stiffness embossed. However, arthritis often affects several joints symmetrically on both sides, so that not only the feet but also the hands and especially their little toe and finger joints hurt. Many rheumatism sufferers need physiotherapy stretching exercises in the morning, which they do at home to overcome the stiffness. Pain relievers and heat therapy may also be necessary to endure the pain in the morning and generally throughout the day.
Rheumatoid arthritis usually progresses in bouts, so there are phases in which the disease gets worse and phases in which the symptoms improve or are no longer noticed.
Arthrosis, which represents joint wear, is also expressed in "Starting pain", that means that, especially after periods of rest, such as the night, pain occurs the first time it occurs. Movement tends to reduce the pain, but strong stress increases it again. Arthrosis in the ankle or directly in the ankle can be physiological, i.e. normal in the Age occurs as a process of wear and tear, this process is favored by incorrect loads (misaligned feet, hips and legs), but it can also arise after a bone fracture.
An inflammation of a tendon (Achilles tendon, plate of the soles of the foot - plantar fasciitis) also leads to "start-up pain", which is noticed with the first steps in the morning. These inflammations often arise at the tendon attachment and can arise together with a heel spur, cf. lower and upper heel spurs. In particular, the lower heel spur on the sole of the heel typically causes pain when taking your first steps in the morning. Relief of the foot, a padded heel bed and cold are usually sufficient to alleviate the symptoms.

pregnancy

Heel pain is common during pregnancy. The reason for this is probably the significant weight gainthat leads to increased stress on the entire foot, but above all also one significant additional stress on the heel represents. It often happens during pregnancy due to weight gain Changes in posture and thus the statics, which ultimately also affect a Change in the arch of the foot affects it, making it a Sinking of the longitudinal arch can come. In addition, it can also become a pronounced edema formations in the area of ​​the lower legs and feet, so that a shoe that is too tight can lead to pain and discomfort. Especially too Water in your feet it happens very often. A Put your legs up can therapeutically reduce the formation of edema and thus help to relieve the heel.

child

Heel pain can be associated with what is known as "Calcaneal apophysitis" stand.
In this disease, there is a disorder in the growth plate of the calcaneus.

The apophysis of this bone, i.e. the bone process to which the Achilles tendon attaches, becomes increasingly softer as the disease progresses. As a result, the affected child feels severe pain in the heel.
Apophysis calcanei is the most common cause of heel pain in children. In general, it can be assumed that especially sporty boys with significant stress on the heel bone are particularly often affected. In addition, being very overweight can lead to excessive stress on the bony foot and, in a child, pain in the heel