Introduction
Heel pain is pain that is localized in the back of the foot. There can be many different causes for this type of pain. If you take them all together, they occur relatively frequently. Even if it is often not a worrying illness or condition, heel pain can quickly have a very restrictive effect on the daily life of those affected, as the strain on the aching foot and thus standing and walking is often avoided. Most types of heel pain can be treated relatively well, and the pain can be reduced quickly and successfully.
Causes
Probably the most common reason for pain in the heel is simply overstrain. The heel is designed to carry most of the body weight anyway, and is therefore under constant strain both when standing and walking. Particularly when certain accompanying circumstances are present, such as being overweight, wearing the wrong shoes or engaging in a high level of sporting activity, the load-bearing capacity of the heel bone (the bone that forms the heel), the associated joint (between the heel bone and the ankle bone) or structures close to the joint such as tendons or ligaments can quickly be exceeded, resulting in pain.
Irritation of the bursae is often also responsible for the pain caused by overstrain. Frequently, 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 bursae.
Another possible cause of heel pain is a heel spur. This is a bony process that can develop at the site of the heel tendons (at the top of the Achilles tendon or at the bottom of the tendon plate). After some time, this also causes inflammatory reactions.
Other foot problems (warts, calluses, tumors or cysts, complete ruptures of the Achilles tendon, decrease in the fat pad under the heel bone) are less frequently responsible for heel pain, but should not be forgotten in the differential diagnosis. In addition, there are some other diseases that have nothing to do with the heel per se, but which can also be associated with heel pain. These include metabolic diseases, circulatory disorders, rheumatic diseases (for example rheumatoid arthritis), spinal problems and certain malpositions of the leg (for example bow legs or knock-knees) or foot (splayed or buckled flat feet).
Worse injuries such as a fracture of the heel bone also lead to heel pain, but in contrast to stress-related complaints, this pain occurs quite suddenly and can usually be precisely linked to a specific triggering event. The heel pain itself is not a disease but a symptom. The pain manifests itself in the area of the heel, in most cases especially when it occurs or as a pain that increases with every kind of pressure.
Usually the pain occurs after prolonged stress, but sometimes it is more likely to occur after a longer period of rest (for example, in the morning after getting up or after sitting for a long time). For some, the pain is perceived as stabbing and precisely localized, for others it spreads rather dull over a larger area. If the pain is particularly located in the area of the transition from the Achilles tendon to the heel bone, it is also called achillodynia.
As a result of the pain, many people experience reduced mobility in the joint and it becomes difficult or even impossible to reach the affected foot. Depending on why the heel pain occurs, it can occasionally be accompanied by other symptoms. In certain cases, for example, the pain can spread further and then affect other joints in the leg.
Inflammatory changes can lead to swelling, overheating or redness. If certain basic diseases are present, there are of course other disease-specific symptoms. Pain in the heel when it occurs can have various causes.
One possible cause can be the development of a so-called heel spur. This is a bony extension of the heel bone. A distinction is made between a lower (plantar) and an upper (dorsal) heel spur.
In most cases, this calcaneal spur is not noticed at all, as it does not cause any symptoms under normal circumstances.If, however, an inflammation of the Achilles or plantar tendon occurs, the spur becomes noticeable mainly through pain when it occurs. Athletes, very tall people but also obese people develop a heel spur much more often than others. The pain is mainly caused by pressure and strain on the heel and often has a stabbing character. The so-called “plantar fasciitis” (inflammation of the tendon plate on the sole of the foot) can also cause pain in the heel when it occurs. Although its cause has not yet been fully clarified, it appears that the inflammation is favored by malpositioning of the feet, running, obesity, but also professions associated with standing.
