Heel pain has many possible causes. It is important for successful treatment to see a doctor early and start treatment as soon as possible.
What is heel pain?
Possible causes of heel pain are very diverse. In many cases, the pain is due to impairment of the Achilles tendon. Heel pain can affect different areas of the human heel. In most cases, heel pain manifests itself in a comparatively characteristic manner: The corresponding pain occurs primarily as so-called tingling pain. A pain in the heel is characterized by the fact that it is most pronounced when the foot is loaded after longer periods of rest, for example, when getting up in the morning. Athletes in particular are affected by heel pain from time to time. Depending on the period of time for which heel pain is already present in an affected person, a distinction can be made between acute and chronic heel pain: chronic heel pain is pain that has already been present for several months.
Causes
Possible causes of heel pain are very diverse. In many cases, the pain is due to impairment of the Achilles tendon (the end tendon of the calf muscle and also the strongest human tendon). For example, inflammation, but also overuse or tears of the Achilles tendon can lead to heel pain. Other possible causes of heel pain are also inflammatory processes of the bursa in the heel. A so-called fatigue fracture (a fracture caused by long-term overuse) of the calcaneus can also underlie heel pain. Furthermore, heel pain can be caused by a strong reduction of the heel fat cushion; the bony structures of the heel are now no longer sufficiently protected against shocks. If a patient has a so-called heel spur (i.e. a thorn-like bone outgrowth), this can also cause heel pain. Degenerative processes (often age-related) in the heel can also have a painful effect. In some cases, heel pain is also considered an early symptom of chronic diseases, such as ankylosing spondylitis (an autoimmune disease that can lead to spinal curvature over time).
Diseases with this symptom
- Achillodynia
- Ankylosing spondylitis
- Heel spur
- Fatigue fracture
- Gout
- Achilles tendon rupture
- Rheumatism
- Tarsal Tunnel Syndrome
- Achilles tendinitis
- Spinal curvature
- Bursitis
- Circulatory disorders
Diagnosis and course
To diagnose causes of heel pain, a physician usually first asks about a patient’s medical history. This medical history includes, for example, previous diseases or injuries with possible effects on structures of the heel. During a subsequent physical examination for heel pain, factors such as posture, joint mobility, reflexes, muscle strength or gait pattern are often assessed. If necessary, diagnostic procedures such as ultrasound or X-ray are performed to provide images of the internal heel structures in heel pain. The course of heel pain is mainly dependent on the cause of corresponding pain. If the causes of heel pain can be eliminated medically or by the body’s self-healing powers, the pain usually subsides. If heel pain is based on long-term diseases, the course of pain is usually related to the course of the underlying disease.
Complications
When heel pain occurs, limitations in daily mobility may occur, resulting in a severe reduction in personal range of motion. The way of walking may also change. This subsequently leads to a loss of balance and an increased risk of falls and accidents. It is also known that heel pain is one of the most common causes of hindfoot complaints, which not infrequently pose a particular therapeutic challenge. Accompanying complaints are also reported due to restricted dorsiflexion of the foot. Especially when this is reduced to less than 10 degrees. If plantar fasciitis (tendon plate of the sole of the foot is inflamed) is present due to overuse, heel pain occurs with weight bearing and pressure.If this inflammation is not treated in time, it can become chronic. If the heel pain exists due to a heel spur, inflammation of the adjacent soft tissue may occur. If the treatment is performed with a surgically performed open notch, the pain may persist afterwards, recur after a short period of freedom from symptoms (recurrent pain), or extend to the midfoot. In addition, there are the normal surgical risks such as infections, painful scars or venous thrombosis. Embolisms and nerve injuries are also very rare but cannot generally be ruled out. That there is over- or undercorrection or, in the final analysis, a lack of attachment of the Achilles tendon insertion after reconstruction has been performed cannot be ruled out as a complication but is extremely rare.
When should you go to the doctor?
With heel pain, doctors refer to a potpourri of different forms of pain in the heel. These include, among other things, in addition to malpositions of the feet still bone and nerve problems as well as the heel spur and defects in the Achilles tendon or bursa. The way sufferers deal with heel pain is as varied as its causes. Some initially regard it as a trifle, others are already afraid of surgical intervention. Neither is the best attitude toward heel pain. Visiting a doctor, on the other hand, is an excellent idea. Heel pain belongs in the treatment of a specialist, preferably an orthopedist. He will ask exactly the right questions when investigating the cause and expertly scan the foot for pressure pain and swelling. In this way, foot malpositions, ill-fitting shoes, one-sided stress, but also overweight can be unmasked as possible causes of heel pain. Many orthopedists complain that their patients often see them late, when the heel pain is already advanced. The longer it will take to treat the heel pain. This test of patience and unnecessarily long suffering time is saved by those who consult a doctor immediately in case of heel pain. A surgeon rarely has to be consulted in case of heel pain, even more so if the visit to the doctor is made at an early stage. A foot is a complicated structure with a demanding task. A healthy heel is an important part of its foundation.
Treatment and therapy
Therapeutic measures for heel pain can take two forms: While a causal treatment fights the causes of corresponding pain, a symptomatic therapy serves, for example, to relieve acute pain. Often, both forms of therapy are combined in the treatment of heel pain. The causal therapy of heel pain is always based on the individual cause: If heel pain is caused by a heel spur, for example, treatment is usually conservative (without surgical procedures). For example, the influence of vibrating tuning forks on the affected heel can cause calcium deposits of a heel spur to loosen and the spur to regress. Parallel pain treatment of heel pain in the case of a heel spur can be carried out, for example, by local cold applications, shock wave treatments or pain-relieving medications that are injected (injected) locally. In the case of a partial or complete rupture of the Achilles tendon as the cause of heel pain, healing can be supported, for example, by a special shoe that slightly elevates and immobilizes the affected foot. In some cases, surgical treatment of the cause of heel pain may also be necessary. If underlying diseases are present, consistent treatment of this disease often also has a positive effect on caused heel pain.
Outlook and prognosis
The outlook or an accurate prognosis for heel pain is relatively difficult to make, because first the cause of this pain must be clarified. If it is a heel spur, very unpleasant pain when walking and also standing is to be expected. If it comes to a physical or unaccustomed overload, such a heel spur develops. When starting and also with other loads, persistent pain occurs, which is perceived very intensely by the affected person. If this clinical picture remains untreated, a heel spur will continue to exist. Especially if the overloading continues, no improvement is to be expected. Only with appropriate treatment and a longer period of rest can a heel spur be completely cured.However, if the heel pain is caused by a fracture, medical treatment is essential. If a fracture remains completely without care, there is a risk of severe inflammation, which in the worst case can even cause blood poisoning. Of course, with proper treatment and care, a fracture can be completely healed within a few weeks. Immobilization of the respective foot accelerates the entire healing process.
Prevention
Heel pain as a result of a long-term condition can be prevented primarily by consistent therapy of the underlying condition. Heel pain as a result of physical overload, for example, can be prevented by warming up before sports and an individually tailored exercise program. Heel pain as a result of acute injuries can only be prevented to a limited extent.
What you can do yourself
Various measures help to relieve heel pain and prevent further pain. If patients with heel pain are overweight, they should reduce their body weight. A body weight in the normal range and a healthy metabolism will protect the joints. Good blood circulation is important. A healthy and balanced diet, abstaining from nicotine and regular physical activity promote blood circulation and thus relieve heel pain. The feet should be cared for regularly. This includes appropriate footwear in everyday life and sports and at any time of year. Shoes and socks should be changed daily. Breathable textiles are also recommended. Calluses from calluses can cause heel pain. If calluses are present, they should be rubbed off with a suitable file or pumice stone. A nourishing cream is also helpful. To make the skin more supple, a lukewarm foot bath with a little salt is helpful. Diabetics should never remove calluses themselves, but should seek professional foot care. Walking barefoot is healthy and can relieve heel pain, provided there are no foot problems that speak against it or increased risks, for example for diabetics. However, barefoot walking is not recommended in gymnasiums, swimming pools and saunas. Gymnastics is recommended for patients with heel pain. Special foot exercises help strengthen the arch of the foot and stretch tendons and muscles.
