Definition
Pain in the feet and especially in the heels is a common complaint. The reason is mainly the weight that our feet carry every day. Rear heel pain is usually caused by overloading or wrong shoes and should not be confused with lower heel pain. In most cases, the pain can be relieved by taking it easy on the feet, changing their behaviour or using orthopaedic insoles. More rarely, other causes such as “apophysitis calcanei“, rheumatic or genetic diseases may also be possible.
Cause
The causes of pain in the back of the heel are usually the following: Rear heel spur, Haglund’s heel, Achilles tendon irritation, inflammation or tear, blisters or pressure sores, peroneal tendon syndrome, bursitis, bruises or apophysitis calcanei. 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 prolonged pain, since pain in the feet can lead to limited walking ability and thus possibly to occupational and everyday disability.
Heel spurs are a type of calcification on a tendon that is subject to severe mechanical stress. A distinction is made between a lower (plantar) and an upper (posterior) heel spur. Heel spurs are usually formed at the points where tendons attach to bones, since this is where the movement of the muscles is transferred to the skeleton.
A rear heel spur is caused by the pull of the Achilles tendon on the heel bone (os calcaneus). Heel spur complaints are described as stabbing, pressing pain, which occurs mainly in connection with tight shoes. A Haglund’s heel or Haglund’s exostosis is a bony bulge at the level of the base of the Achilles tendon.
It is often caused by unsuitable footwear with a hard and flat trailing edge. Women are particularly affected, as they often wear high shoes with an unsuitable and hard frame, which exert continuous pressure on the bone. As a result, the protrusion leads to irritation or inflammation of the bursa, which lies under the insertion of the Achilles tendon.
This leads to swelling and usually also to a change in the overlying skin. The Haglund’s heel becomes visible through a raised area at the back of the heel, which usually also has a cornea. Pain occurs mainly under stress and when wearing tight shoes and is usually caused by irritation of the bursa.
Achilles tendon inflammation or “achyllodynia” is actually an inflammation or irritation of the Achilles tendon. Frequently, however, pain in the Achilles tendon caused by other causes (e.g. Haglund’s heel) are also summarized under this term. The exact cause of an Achilles tendon inflammation is not yet known with certainty.
A very regular or intensive running training, especially if it is started after long breaks, seems to be a common trigger. Malpositioning of the foot, minor injuries or tendon tears are also named as causes. The most important therapy in case of an inflammation is to take it easy and should be followed in any case until there is no more pain.
If the pain is very severe and restrictive, painkillers such as ibuprofen can be taken in rare cases after consulting a doctor. Peroneal tendon syndrome is a, usually 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 transmits 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 pernoneurosis tendon syndrome is usually an overload of the muscles of the lower leg, which is transferred to the tendon. Also frequent are malpositions (e.g. bow legs) and poorly fitted shoes.
In apophysitis calcanei, similar to heel spur and Haglund’s heel, mechanical irritation occurs at the tendon attachment. Apophysis refers to the area of the bone where one or more tendons are attached. Apophysitis calcanei occurs during the growth phase and therefore mainly affects young people. It leads to a softening of the bony attachment point with subsequent painful swelling. The cause is often an excessive load due to training, overweight or malpositioning.
