Definition
Pain can occur in many places around the ankle and heel. Although the pain is often located in the lateral heel, its cause may be in the upper or lower ankle, calf, arch of the foot, ankle or metatarsus. The heel itself is a bony protrusion of the foot on which the person carries a large part of the body weight.
It is padded with firm fatty tissue to cushion the appearance in front of the heel bone. In technical terminology, the heel is called the “calcaneus”. Among other things, it has the important function of forming the base and origin for the Achilles tendon and the longitudinal arch of the foot as a link between the calf and the metatarsus. Pain can be caused by many of the musculoskeletal characteristics. Important aids to differentiation are the type of pain and the time of occurrence.
Causes
Pain in the lateral heel is mostly caused by the calf muscles and the metatarsus. This area contains important anatomical and filigree structures that enable complex movements in the ankle and foot and at the same time have to bear a high weight load throughout the body. The ankle joints are formed by the fibula and shinbone in the area of the lower leg and by the ankle and heel bone in the area of the foot attachment.
Pain in the lateral heel can be attributed to damage to the bony structures of these bones. Tendon and ligament structures can also be damaged and painful as a result of injuries or wear and tear. Probably the most common cause of lateral heel pain is the peroneal tendon syndrome.
It occurs in very different degrees and is a common disease in endurance athletes. It can also occur quickly in newly started sports or with poor footwear. The tendons behind the outer ankle that belong to the calf muscles are irritated.
Through overstrain or permanent friction and irritation of the bone, the tendons can become inflamed and hurt with every movement. Another very common disease is the heel spur. Here, bony outgrowths, the so-called “spur”, form at the base of the Achilles tendon or the plantar tendon of the foot surface, which can lead to severe pain in the heel with every occurrence.
This can be accompanied by so-called “bursitis subachillea”, an inflammation of the bursa, which can also lead to severe movement-related pain. Less frequent causes of pain in the lateral heel can be a torn outer ligament or tarsal tunnel syndrome. The latter is a nerve entrapment in the area of the inner ankle.
Bursitis subachillea means translated “inflammation of the bursa and the Achilles tendon“. Bursae are parts of the joint capsule that are filled with synovial fluid. They do not exist in all people, but represent a variant of the joint capsule in which a small pouch has formed after an injury or without cause.
The bursa can become inflamed by bacterial or viral pathogens, but especially by mechanical friction and irritation. This leads to severe pain when pressure and movement are applied, since the bursa is located below the Achilles tendon. A frequent cause of mechanical irritation is the upper heel spur.
The bony spur can cause pain and irritation of the tendon and bursa with every movement of the Achilles tendon. In some cases, the inflamed bursa can tear. Often an operation is necessary to remove the bursa and eliminate the inflammation.
The posterior heel spur is much more common than the upper heel spur. It is a very common disease, which more than every third person suffers from in the course of life. The spur can often be seen in an x-ray on the sole of the foot as a small bony protrusion.
However, the x-ray cannot give any information about the pain. There can also be severe pain, although the x-ray does not show any abnormalities. The heel spur is more a disease of old age, but it also occurs more frequently in athletes.
The pain can often be very severe, since the heel spur is often accompanied by local inflammation. In these cases the foot must first be relieved. Padding in the shoe can also initially relieve the pain until the local inflammation has subsided.
In the long term, physiotherapy in particular helps to improve the symptoms of heel spurs. New therapy methods, such as shock wave therapy or radiation, are also being researched. In rare cases, surgery can also relieve the symptoms.The peroneal muscles are located in the calf and are especially stressed during endurance sports such as jogging.
In the area of the ankle joint, the muscle with its tendon pulls around the outer ankle and then starts at the foot. During this process, the tendon can become irritated and become painfully inflamed due to overuse and incorrect strain. Since the tendon takes part in every movement in the ankle joint and rubs against the outer ankle, the pain occurs with every step.
Experienced and inexperienced joggers are particularly at risk for peroneal tendon syndrome. If the tendon is severely overstressed during frequent jogging, the tendon irritation can occur in the same way as in inexperienced, new, unaccustomed sporting activities. The latter often leads to incorrect strain, for example due to incorrect footwear.
The most important first therapeutic measure is a period of rest from sport. The tendon needs time to regenerate itself. Even after the pain has subsided, the tendon must be given further rest in order to allow it to recover.
A torn outer ligament is a typical consequence of an injury to the upper ankle joint. The most common cause of an outer ligament rupture is the so-called “supination trauma”. This means nothing more than a twisting inwards.
As a result, the outer ankle often swells up due to a bruise. The first measures to be taken after the ankle has been bent consist of cooling, gentle elevation and compression. In most cases, the subsequent treatment consists merely of resting and immobilization.
Tarsal tunnel syndrome is a very rare disease that can be accompanied by pain in the heel. Several nerves, which are responsible for muscle supply and sensitive perception at the calf and foot, move through the ankle joint to their supply areas in the foot. The so-called “tibialis nerve” runs through the tarsal tunnel in the area of the inner ankle close to the bone.
In very rare cases, compression of the nerve can occur in the context of a fracture, bruise or without an obvious cause. As a result, the toes begin to tingle, then become painful and numb. A loss of the foot muscles can also occur. The nerve must be relieved promptly so that the restrictions do not remain permanently.
