Symptoms
Due to the different causes that can lead to an inflammation of the heel, the symptoms also differ somewhat, so that variable complaints are possible. The Achilles tendon inflammation manifests itself at the beginning with pinching pain usually 2-6 cm above the heel bone, initially limited to moments after longer periods of rest, such as in the morning after getting up, after sitting for a long time or at the beginning of a running training. In the further course of time, the pain can then persist even during the rest phases.In addition, swelling, redness and overheating in the area of the Achilles tendon may be noticeable, as well as small, palpable bumps (nodules) along the tendon strand.
In the case of an inflammation of the bursa underlying the heel inflammation, pain initially occurs only when walking, during movements in the ankle and when pressure is exerted on the heel, which is particularly concentrated in the rear-upper heel area. Later, the pain is also felt at rest and a swelling in the Achilles tendon heel area is visible. Another characteristic feature is the pain that can be triggered when the calf muscles are stretched, which tenses the Achilles tendon and compresses the surrounding inflamed bursae.
Symptoms of an upper calcaneal spur, are usually symptoms of an Achilles tendon insertion, which is characterized by pressure pain (e.g. by the shoe edge) and load pain (e.g. when walking, running). The skin in the upper-rear heel bone area can also be reddened, swollen and overheated.
Since the upper calcaneal spur can also be accompanied by bursitis, its symptoms may also occur. The lower heel spur usually manifests itself by load-dependent, stabbing pain in the lower heel area near the sole of the foot, which occurs particularly intensively in the morning after getting up or after sitting for a long time (so-called tarnishing pain). In some cases, the pain may improve somewhat after some time of exertion, although it usually increases again with prolonged and increasing strain.
If the lower heel spur is accompanied by inflammation of the tendon plate under the sole of the foot (plantar fasciitis), typical signs of inflammation can also occur on the underside of the heel. In both the upper and lower heel spur, in some cases even the bony outgrowth of the heel bone under the skin can be palpated. The Achilles tendon inflammation is usually diagnosed by the description of the symptoms and by a physical examination.
Above all, the painfulness of certain movements in the foot is tested, for example when lifting the tip of the foot with simultaneous stretching of the calf muscles. In addition, an ultrasound examination can confirm an inflammatory event in the Achilles tendon. If the findings are unclear, an additional MRT (magnetic resonance imaging) examination can be performed.
The same examination methods can also be used to diagnose bursitis. To diagnose an upper or lower calcaneal spur, an X-ray of the foot is primarily ordered to show and prove the bony outgrowth on the calcaneus. However, tendon attachment inflammation caused by the heel spur can be diagnosed by ultrasound and/or MRI examination in the same way as Achilles tendon or bursitis. As with most inflammatory processes taking place in the body, certain inflammation parameters can also be conspicuous in blood tests for heel inflammation.
