Pain in the back of the heel
definition
Pain in the feet and particularly in the heels is a common complaint. The main reason is the weight our feet carry every day. Rear heel pain is usually caused by excessive strain or incorrect footwear and should not be confused with lower heel pain. In most cases, the pain can be relieved by rest, behavioral changes or orthopedic insoles.
Other causes such as “calcaneal apophysitis”, rheumatic or genetic diseases may also be possible less frequently.
root cause
The causes of rear heel pain are usually the following: posterior heel spur, Haglund's heel, Achilles tendon irritation, inflammation or tear, blisters or pressure points, peroneal tendon syndrome, bursitis, bruises or calcaneal apophysitis. Depending on the cause, different treatments are possible, which is why an exact diagnosis is important.
An orthopedic surgeon should be consulted, especially in the case of persistent pain, as pain in the feet can lead to limited ability to walk and thus possibly to occupational and everyday incapacity.
Posterior heel spur
Heel spurs are a type of calcification on a tendon that is subject to high mechanical stress. A differentiation is made between a lower (plantar) and an upper (rear) heel spur. Spores usually arise at the attachment points of tendons on bones, since this is where the movement of the muscles is transferred to the skeleton.
A posterior heel spur occurs when the Achilles tendon pulls the heel bone (os calcaneus). Heel spurs complaints are described as stabbing, pressing pain, which occurs primarily in connection with tight footwear.
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My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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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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Further information about myself can be found at Dr. Nicolas Gumpert
Haglund's heel
A Haglund heel or Haglund exostosis is a bony protrusion at the level of the insertion of the Achilles tendon. The cause is often unsuitable footwear with a hard and flat rear edge. Women are particularly affected, as they often wear high shoes with an unsuitable and hard frame, which exert continuous pressure on the bones. The protrusion leads to irritation or inflammation of the bursa, which lies under the attachment of the Achilles tendon. This leads to swelling and usually also to a change in the overlying skin.
The Haglund heel is visible through a protrusion on the back of the heel, which usually also has a callus. Pain occurs mainly when the patient is under strain and when wearing tight shoes and is usually caused by irritation of the bursa.
You can find more information on the topic here: Therapy of Haglund's heel
Achilles tendonitis
Achilles tendonitis or “achyllodynia” is actually an inflammation or irritation of the Achilles tendon. Often, however, other pain in the Achilles tendon (e.g. Haglund's heel) is also included.
The exact cause of Achilles tendonitis has not yet been clarified with certainty. Very regular or intense running training, especially when started after long breaks, seems to be a common trigger. Misalignments of the foot, minor injuries or torn tendons are also named as causes.
The most important therapy for inflammation is rest and should be followed in any case until there is no more pain. In the case of very severe and restrictive pain, pain relievers such as ibuprofen can in rare cases, after consulting a doctor, be taken.
Peroneal tendon syndrome
Peroneal tendon syndrome is a mostly chronic, painful irritation of the peroneal tendon, which is particularly associated with pain and swelling in the area of the outer ankle and the outer part of the heel. The peroneal tendon (or "fibularis tendon") connects the muscles of the fibula with the sole of the foot, where it transfers the movements to the skeleton. The tendon begins on the outside of the lower leg, passes the outer ankle under the foot and attaches to the bone.
The cause of a painful pernicious tendon syndrome is usually an overload of the muscles of the lower leg, which is transferred to the tendon. Misalignments (e.g. bow legs) and poorly fitted shoes are also common.
Calcaneal apophysitis
In calcaneal apophysitis, similar to the heel spur and Haglund's heel, mechanical irritation occurs at the tendon insertion. Apophysis refers to the area on the bone where one or more tendons attach.
Calcaneal apophysitis occurs during the growth phase and therefore mainly affects young people. There is a softening of the bony attachment point with a subsequent painful swelling. The cause is often excessive exercise, obesity or misalignment.
According to the localization
On the inside
Pain on the inside of the heel is less common than pain on the back of the heel. The cause can be a so-called flat arched foot, which is caused by a weakness in the ankle ligaments and usually has existed since childhood. Inflammation / irritation of the tendons of the soles of the feet, such as "plantar fasciitis" (inflammation of the fascia of the soles of the feet), is also possible. A painful pressure point on the inside of the heel from unsuitable shoes is also a possible cause.
On the outside
Pain on the outside of the heel is rare. Possible causes here are pain in the back of the heel, which radiates outwards. Ankle ligament injuries are significantly more common on the outside than on the inside, which is why a ligament injury to the rear outer ligament is an option. This typically results in swelling and a bruise at the same time. If the symptoms are mainly expressed by a tingling sensation, it may be that the large foot nerve that runs along the outer ankle is pinched or irritated.
Concomitant symptoms
Frequent accompanying symptoms of pain in the back of the heel are changes in the skin (e.g. callus), pressure points, blisters, swellings, bulges, hobbling, redness and the pain radiating to the calf or sole of the foot. If the pain is due to a high level of athletic stress, pain in the other foot usually occurs at the same time.
A hard protrusion at the back of the heel with pressure and strain pain speaks more for a heel spur, a Haglund heel or a calcaneal apophysitis. Swelling usually accompanies inflammation or irritation. In this case, an inflamed or injured Achilles tendon is more likely. Additional pain in the sole of the foot is also possible and can be caused by peroneal tendon syndrome or irritation of the arch of the foot.
diagnosis
In the event of pain in the heel, the family doctor or an orthopedic surgeon is usually the first point of contact. They can usually make a diagnosis with just a few questions and a physical examination. In rare cases, an X-ray or even diagnostic imaging, such as an MRI, is done.
If it is still unclear why the symptoms exist, it may be necessary to wait and see whether the pain will improve on its own while taking care. Depending on the diagnosis, different treatments come into question, which are discussed with the respective doctor after the diagnosis.
Treatment / therapy
Treatment for heel pain depends on the cause of the discomfort. In most cases, this means changing shoes, orthopedic insoles or taking it easy in everyday life. If you have a Haglund heel, heel spur, pressure points or an anatomically different foot position, perfectly adapted shoes or orthopedic insoles are essential. The anatomy and gait of the patient are examined in order to counteract the corresponding weak points with the future shoes.
In the case of inflammation / irritation of the Achilles tendon, calcaneal apophysitis or heel spurs, it is often sufficient to protect the foot for a few weeks. Above all, strenuous sports or long running should be avoided. Cooling the heel at the same time can also provide pain relief.
Surgical therapy may only be necessary in rare cases, for example a ruptured Achilles tendon.
Duration
The duration of the pain depends on many factors and therefore varies between a few days and a chronic (persistent) course. If the cause is overstrain, the pain will usually improve after a few days to weeks if you take it easy.
In addition to daily stress, however, the wearing of inappropriate footwear is often to blame. In this case, the complaints will not stop until a change is made.
Pain is rarely caused by genetic factors. These then usually exist since childhood and only improve with appropriate therapy and can therefore last for a very long time.
After jogging
Heel pain after jogging is a very common problem. Pain in the back of the heel is often caused by pressure points or blisters. This is almost always caused by unsuitable jogging shoes or a bony change (e.g. heel spur). Also, irritation or overloading of the Achilles tendon is not uncommon. In this case you should take it easy for a while or reduce the intensity and frequency of the exercise.
Avoiding vertical meters can also help, as an inclined plane places a particularly high load on the Achilles tendon. In any case, it is advisable to have your jogging shoes adjusted by an expert.
