Possible diseases as a cause

Inflammation of the plantar aponeurosis is one of the most common causes of pain in the heel area. Plantar aponeurosis is a strong ligament that extends from the heel to the toes on the sole of the foot. This ligament becomes tense when standing and walking and thus puts particular strain on the point where the ligament attaches to the heel bone.

Strong friction or excessive strain can cause the site of attachment of the plantar aponeurosis to become inflamed, leading to pain in the heel. Particularly unusually heavy strain, such as an intensive hike without prior training, or unaccustomed new sporting activities, can cause inflammation. Being overweight or foot malpositions (pigeon-toed foot and hollow foot) also increase the risk of inflammation.

In most cases, however, no specific triggering factor can be found. In addition, shortened calf muscles are often found, which lead to a greater strain on the plantar aponeurosis. The calcaneal spur is a bony thorn-shaped extension on the underside of the calcaneus (tuber calcanei).

This bony formation usually occurs at the starting point of overstressed tendons or in the case of inflammation. About 10-20% of patients with heel spurs show no symptoms. In other cases, the causal inflammation can cause pain or pressure pain due to too tight shoes in the area of the heel spur.

Muscular or bony injuries in the heel area are also possible. Although these forms of injury are relatively rare, the heel bone can break in the course of an accident, leading to severe acute pain. In addition, the heel tendon at the heel can be stretched or torn severely, which also causes severe symptoms.

Long-term overloading can also lead to a fatigue fracture of the heel. The disease rheumatism can cause pain in any bone or joint of the body. This also applies to the heel.

It is an autoimmune disease, which is not caused by other causes, but is genetically predisposed. It causes severe pain when moving in the area of the heel. An incorrect loading of the foot and thus of the plantar aponeurosis can also lead to pain in the heel, an inflammation and a heel spur.

In this case, incorrect loading means both overloading due to unaccustomed sporting activities and a poor load distribution due to the wrong footwear. But overweight (BMI> 25) alone can also cause heel pain. Since the entire body weight rests on the feet, this can lead to pain in the heel, especially when walking long distances.

If the heel pain has been present for a long time and does not go away on its own, a doctor should be consulted. The localization, character and duration of the pain are particularly important in the medical history. Also basic diseases such as rheumatism or diabetes mellitus should be mentioned.

The heel is then clinically examined. A heel spur can be felt well here. In addition, when pressure is applied to the heel spur, the patient reports increasing pain in most cases.In order to make a reliable diagnosis of a calcaneal spur, X-ray diagnostics is a meaningful procedure.

On the X-ray image of the foot in two planes, the bony structures, and thus also the heel spur, can be easily assessed. If the heel pain is only moderately severe and there is no palpation, X-ray examination is not necessary. In addition, the clinical examination can identify foot malpositions, which can be the cause of the pain. In order to exclude an inflammatory genesis or an autoimmunological cause such as rheumatism, the inflammation parameters and special antibodies in the blood are determined by laboratory chemistry. An ultrasound examination (sonography) can also provide information about the diagnosis, for example whether an effusion or an abscess is present.