History

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

Prophylaxis

You can do a lot yourself to prevent heel pain. First of all, you should simply make sure that your body is generally in good health.If you regularly take adequate physical exercise, eat a healthy diet and watch your weight, you have already gained a lot. In addition, there are special measures that affect the feet.

One should wear comfortable, suitable and breathable footwear, pay attention to good foot hygiene and treat or have small problems such as warts or calluses treated directly. It is also advisable to go 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 feet, it is always advisable to consult a doctor before they get worse.

Exercises

There are various exercises to stretch heel tendons and prevent or reduce heel pain. Since most pain in the heel is caused by incorrect loading and overloading, strengthening the muscles through gymnastics combined with shoe insoles or special adjustments is often sufficient to alleviate or end the pain. The exercises are helpful for heel pain, especially heel spurs (upper/lower heel spur) and tendon shortening.

All subsequent exercises should be held for about 10 seconds and repeated several times (ideally up to 20 times) to feel improvement. They may be used several times a day and over a long period of time. Often a clear improvement is only noticeable after 6 months.

1st Exercise: To stretch the plantar fascia, you can stand one step away from a wall, facing the wall. Now take a small lunge with the affected leg to the back. The other leg may stand bent closer to the wall.
The heel of the back foot (with the pain) must not lift off the floor. Now lean forward with your upper body and support yourself with your hands against the wall. You should notice a significant stretching of the calf muscles and the Achilles tendon.
2nd Exercise: If you put your feet on a step and go back a bit so that your heels are hanging in the air, you can stretch both heel tendons at once by letting the heel sink down.
If you have balance problems or pain, you can do this exercise one after the other with only one foot over the edge at a time. The calf muscles are also stretched strongly during this exercise.
3rd Exercise: Also leaning against a wall or on a table, stand up and then squat down (leaning forward a bit). Just before your heels lift off the floor, hold the position for 10 seconds and then return to an upright position.
4th Exercise: Sit on the floor with your legs stretched out and wrap a towel around the affected foot and pull it towards your body.
Thereby the toes are pulled tight. When the knee is bent, the Achilles tendon is also stretched. If you are flexible enough, you can also grasp the foot with your hands.
5th exercise: With a spiky/yellow ball you can roll over the sole of your foot, this stimulates the small foot muscles and strengthens them.
6th Exercise: You can lay a cloth on the floor and with the toes of your feet in a claw movement pick up the cloth and drop it again.
7th Exercise: Place the foot on the floor in a sitting position.
Throughout the exercise the heel and toes remain on the floor. Now put more weight on the outer edge of the foot and tighten the sole of the foot in the middle of the foot so that the longitudinal arch of the foot is pulled upwards. A “hollow foot” position is assumed, so to speak.

A possible explanation for heel pain after walking could be a shoe that is too tight and presses on the heel.

Pressure blisters often develop at this point, which are very painful. But even a shoe that is too wide can cause a blister due to friction. It is best to wear sufficiently high socks that cover the predisposed area or even reinforced socks.

A blister plaster can also help. Pressure points and calluses, warts (e.g., thorn warts on the heel) or athlete’s foot can also cause heel pain. Another cause of heel pain is the so-called heel spur.

There is an upper and a lower heel spur. The lower one on the sole of the foot is much more common. It represents a change in the base of the plantar aponeurosis (sole plate) and projects the pain onto the heel on the sole of the foot when it occurs.

The upper heel spur affects the insertion of the Achilles tendon and is also called Haglund’s exostosis.This is located approximately where an ankle-high shoe presses on the heel. Due to pressure loads, the attachment of the tendon ossifies and causes a bony protrusion to develop. This can often also be felt as a knot on the heel.

A heel spur can be promoted by incorrect loading, overweight and foot malpositions. The pain of a heel spur often occurs in the morning after getting up. Both the plantar aponeurosis and the Achilles tendon can become inflamed and cause pain during or after walking.

Incorrect strain on the feet can be caused by overweight, differences in leg length, pelvic obliquity, knock-knees or bow legs and foot malpositions. Heel pain caused by these factors becomes stronger the higher the load is. Foot malpositions include splayfeet, fallen arches and flat feet.

These in turn can also promote heel spurs. With age, the fat pad, which is very pronounced on the heel, among other things, can also shrink. As a result, the weight presses directly on the bone and can in turn trigger a heel spur or bursitis.

Shoes with a thickly padded heel can help here. After sporting activities, the calf muscle, Musculus gastrocnemius, may have suffered small tears in the muscle fibers (colloquially called sore muscles). These micro-injuries are subsequently repaired and reinforced, resulting in muscle growth.

This muscle soreness can extend as far as the Achilles tendon, which is the base of the muscle at the calcaneus, and can cause pulling and pain, especially during stretching exercises. Rheumatic diseases can also affect the heel and ankle joints. Particularly typical is the Achilles tendon attachment inflammation (enthesiopathy) with the Bechterew’s disease, which belongs to the rheumatic diseases.

These pains are often intensified during and after stress, but also occur at rest. There is often a marked swelling, redness and overheating. Also medicines can release tendon attachment inflammations, in addition count also antibiotics such as fluoroquinolones.

In addition, bone fractures must be considered as a possible cause of heel pain. These can be caused by a fall on the heel or by long-term overloading of the heel bone. This latter “fatigue fracture” can occur during sports involving many jumps (basketball, handball) and can lead to small cracks in the bone due to the chronic pressure.

This fracture, which is also called marching fracture (fracture is called bone fracture), can also be caused by running a lot (marathon runs, etc.). In most cases a conservative therapy with protection and relief of the foot is sufficient. Gout is a disease which, due to high concentrations of uric acid in the blood, leads to crystal deposits on joints, almost always the big toe.

However, it can also cause gout nodes in the heel. Haglund’s disease (Apophysitis calcanei) is another possible cause in children who complain of pressure pain in the heels on both sides. In Haglund’s disease there is a delay in the ossification of the heel bone. 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, which can be felt behind the outer ankle.