Inflammation at the heel

Inflammations of the heel can be caused by a variety of factors and in most cases they occur as part of a permanent overloading or incorrect loading of the foot structures. As a rule, they do not develop suddenly, but rather gradually, so that, if a suitable therapy is initiated early on, they usually disappear again without leaving residues. Although a chronic course may develop in a few cases, it is generally rarely observed.

Cause

The causes that can lead to an inflammation in the heel area are manifold and can originate from various structures of the foot and lower leg area. Based on the localization of the maximum pain point caused by the inflammatory event, lower and upper causes of inflammation can be distinguished. Pain and signs of inflammation in the upper and rear heel are often caused by inflammatory processes in the area of the Achilles tendon and the bursae in the Achilles tendon area and calcaneus or by an inflammation of the Achilles tendon insertion caused by an upper heel spur.

Achilles tendon inflammation (Achilles tendon tendinitis) is a disease of the tendon structure itself, which can be caused by overloading (e.g. in runners) or incorrect loading (e.g. by shortening of the lower leg muscles) as well as by micro injuries in the Achilles tendon tissue. This is not an inflammation in the classic sense, which is characterized by focal points of inflammation and immigrated inflammatory cells in the affected tissue, but rather a pathological, degenerative change in the Achilles tendon (tendopathy), which causes inflammation-like symptoms 2-6 cm above the tendon attachment to the calcaneus due to progressive destruction of the tendon tissue.

The two bursae in the heel area can also become inflamed and lead to characteristic pain problems in the upper-rear heel area. The bursa sacs at the heel are liquid-filled bags that buffer the mechanical load on the tendon, distribute the pressure of the tendon evenly over the bone and enable friction-free movement of the tendon. However, the bursa located between the Achilles tendon and the calcaneus (bursa subachillea) in particular can become inflamed as part of a gouty arthritis or an overload or calcaneal syndrome.

The second bursa between the Achilles tendon and the skin (bursa praeachillea), on the other hand, is more likely to become inflamed as a result of local pressure or rubbing, which is caused, for example, by the permanent wearing of incorrect footwear. An upper calcaneal spur (also known as Haglund’s syndrome) is an acquired (e.g. due to chronic shoe pressure) or congenital enlargement of the upper heel bone end (in the form of a thorn-like bony process) which leads to increased irritation of the immediately surrounding tissue, so that the Achilles tendon attachment or the calcaneal bursa in particular can become inflamed. Pain and signs of inflammation, which are mainly concentrated in the lower heel in the area of the rear sole of the foot, usually have other causes, such as a lower heel spur or inflammation of the tendon plate under the foot (plantar fasciitis).

The lower heel spur, like the upper heel spur, is a bony outgrowth of the calcaneus caused by chronic mispressure, but it tends to form on the underside of the calcaneal bump and exerts chronic irritation on the area where the short foot muscles and the tendon plate of the sole of the foot are located. In the course of the disease, inflammatory reactions can therefore also occur in this area. Plantar fasciitis is a wear-related inflammation of the tendon plate, which extends between the metatarsals and the calcaneus and is involved in the formation of the longitudinal arch of the foot. The inflammation, which is usually concentrated in the area of the tendon plate near the heel bone, is usually caused by overstrain in sports, incorrect strain in everyday life, micro injuries in the tendon plate tissue or irritation in the context of a lower heel spur.