Pain in the inner heel bone
At the inner heel bone run mainly tendons, which are responsible for the flexion of the toes. Overloading there can lead to inflammatory or degenerative changes, which become noticeable through pain. The inner ligaments of the ankle joint also extend into the area of the calcaneus. If the ankle is bent, the ligaments can be overstretched, torn or torn, which in addition to pain, causes severe swelling. You will find more detailed information on this in the following articles:
- Ligament stretching at the ankle joint
- Torn ligament at ankle joint
Pain in the outer heel bone
In the area of the outer heel bone, muscles run mostly to the outside of the foot, which are used to abduct the foot, i.e. to spread the foot outwards. These are guided along the ankle in a long tendon sheath. Excessive strain, especially in athletes, can lead to inflammation or even to adhesions of the tendons in the tendon sheath. If the outer heel bone hurts, the shoes should also be checked to see how much external pressure they exert on the heel bone.
Pain in the heel bone after getting up/after rest
Pain in the heel bone, which occurs at rest or immediately after getting up, tends to speak against a degenerative cause of the complaints. For example, an acute inflammation of a bursa or tendon should be assumed. These complaints usually get worse under stress, but in acute phases they can cause pain even at rest.
This is usually accompanied by swelling, redness and overheating of the area. Rheumatic illnesses can also make themselves felt on the heel bone.Bechterew’s disease, for example, leads to stiffening of the joints, which is most pronounced in the morning. If vascular disease leads to reduced blood flow and thus to poorer supply to the calcaneus, small defects in the bone can develop there.
Over time, these expand, weakening the bony structure. This can also lead to pain in the heel bone. If pain occurs after getting up or at rest, it is not uncommon for disorders of the nerve fibers to be the cause of the complaints.
This results in damage to the nerves, so that they mistakenly transmit pain signals to the brain. At the beginning of the approach to a possible diagnosis, there is always a detailed medical history by questioning the patient (anamnesis). This should be followed by a physical examination of the patient, whereby the examiner pays particular attention to posture, physique and the course of the body axes.
In addition, joint mobility, muscle strength, reflexes, other nerve functions and gait pattern should also be examined. For the function of the Achilles tendon, there are one or two simple but expressive movement tests. Depending on the diagnosis, the examining doctor will arrange for further special examinations.
These include the collection of certain blood values, as well as imaging procedures such as X-rays or ultrasound examinations. Furthermore, in case of special questions or prior to a planned operation, magnetic resonance imaging (MRI) or computer tomography (CT) may also be considered. A nuclear medical examination method (scintigraphy) can also be useful from time to time.
The gait pattern can be examined more closely with the help of a pedography. This is a scientifically recognized method of depicting the forces acting on the foot during standing and movement. The measurements are taken while standing (i.e.
statically), as well as while walking or running (i.e. dynamically). With the help of a video analysis, incorrect loading of the body axes can also be detected. Finally, a joint endoscopy (arthroscopy, or tendoscopy if the Achilles tendon is being endoscoped) can help with the diagnosis and the therapy itself.
