Therapy
The therapeutic approach to heel pain depends on the respective diagnosis and ranges from simple conservative measures (i.e. not surgical) to various operations. Plantar fasciitis In plantar fasciitis, stretching exercises of the thigh and calf muscles, as well as the sole of the foot, are suitable and should be learned at the beginning with professional support. Cold and heat applications and anti-inflammatory or pain-relieving medication can also be used for heel pain caused by plantar fasciitis.
Intensive sporting activities should be avoided during the period of acute irritation. In addition, a silicone cushion, which is incorporated into an insole, can also provide relief by cushioning the heel. However, conservative treatment of plantar fasciitis requires patience, as it can last for one or two years.
Only in exceptional cases can surgical therapy be considered. Foot anomalies In the case of foot anomalies, corrective insoles, shoe adjustments and foot gymnastics are possible. Here too, surgery may be necessary as a therapeutic approach.
This can be considered if the complaints do not improve with the measures just listed, if there is a surplus of foot bone or in children with a limited range of motion. Atrophy of the heel fat pad If the heel fat pad, which causes heel pain, shrinks, an anti-inflammatory and pain-relieving ointment can be used. Soft heel cushions can also provide relief for those affected.
Heel spur The heel spur, a frequent cause of heel pain, is mainly treated conservatively. Conservative treatment includes an arsenal of physical therapy options, such as local application of heat or cold, as well as the application of sound stimuli. In addition, the training should be adjusted or the strain should be reduced and physiotherapeutic exercises should be performed.
A further decisive component of therapy are insoles and special shoe fittings, which reduce local overloading. In most cases, the conservative therapy measures can achieve a resounding success with heel spurs.Haglund exostosis In case of a heel with a projection, i.e. a Haglund exostosis, heel cushions with perforated inserts are an option. Special shoe finishes are one possibility.
Physical protection should be maintained for some time. In addition, anti-inflammatory drugs and cooling measures can also help, as they can reduce the inflammation and swelling of the tissue. Physiotherapeutic exercises are also advisable, which should help to stretch the calf muscles.
Treatment methods of physical therapy, such as shock wave treatment, can also be tested. However, the therapy costs for shock wave treatment are not covered by health insurance. If there is no improvement of the symptoms within months due to the conservative measures, the bone protrusion can also be removed in the course of an operation.
The inflamed bursa is either removed at the same time (so-called bursectomy) or it is preserved and can recover after damage after removal of the excess bone. After the operation is completed, the foot must be carefully accustomed to the strain again with the help of a functional treatment. Orthopedic footwear and physiotherapy are also used postoperatively.
Bone cyst There are many different approaches to a bone cyst. The therapeutic decision should take into account the possible risk of a bone fracture. If there is an increased risk of a bone fracture, it may be necessary to stabilize the bone by means of a surgical procedure.
Bone tumors In the presence of a bone tumor, the shape of the tumor is decisive, since there are various therapy concepts for this. Fatigue fracture of the calcaneus Compared to fractures caused by injury alone, surgical measures are rarely used in the case of fatigue fractures of the calcaneus. In the case of a fatigue fracture, an extended break from stress is unavoidable.
The complaints can be reduced with pain-relieving medication. In case of fatigue fractures of the calcaneus, conservative measures such as physical therapy or physiotherapy play a role. Apophysitis calcanei This disease, which occurs in childhood, is also treated conservatively.
The therapeutic concept here includes a reduction in sporting activity for a limited period of about four to six weeks and relieving measures such as shoe heel elevation or heel padding. Accompanying treatment with an anti-inflammatory ointment can be soothing. If the symptoms do not improve, a temporary immobilization of the cast may be necessary for four to six weeks.
With completion of the growth phase, the complaints usually disappear completely. Pathological changes of the Achilles tendon In the acute situation, it is advisable to rest for several weeks. Therapeutic measures from the spectrum of physical therapy, such as electrotherapy or cold and heat applications are also considered beneficial.
In addition, a soft bedding of the heel, a slight increase in heel height and/or an anti-inflammatory ointment can also contribute to a decrease in symptoms. Light stretching exercises under professional supervision are also advisable. Chronic complaints in the area of the Achilles tendon can be improved by physiotherapy and orthopedic aids for the foot.
If the damage is more extensive, usually only a surgical approach can provide relief. During surgery, inflamed tendon tissue is removed and, if necessary, replaced with a piece of the body’s own tendon. Postoperatively, the load is increased in small steps up to normal load.
Achilles tendon rupture An Achilles tendon rupture can also be treated conservatively or surgically. The therapeutic approach for an Achilles tendon rupture also depends on how close the two divergent tendon ends are to each other. The distance between the two tendon ends is determined by ultrasound.
If there is good contact between the tendon ends, a rupture of the Achilles tendon can be treated without surgery. The focus is then on a so-called “conservative-functional” therapy, in which the foot is immobilized with a firm bandage. After a short phase of pure immobilization, the functional treatment begins, in which the injured limb is first moved passively and then actively under professional supervision.
There are various options for surgery. There is, for example, the possibility of suturing, possibly with additional bonding or the body’s own tendon transplant.Competitive athletes who need to be ready for action again quickly are recommended to have an operation. Skin changes In case of corneal calluses, which cause heel pain, medical foot care can be helpful.
Warts can recede on their own after a certain time. In addition, various preparations for self-treatment, such as icing or softening the area, can be purchased from the pharmacy. In most cases a repeated application is necessary.
In the absence of success or even if the appearance of the wart has changed, a doctor should be consulted to make sure that it is really a wart. It may be necessary to obtain a tissue sample for this purpose. The physician also has a large repertoire in the treatment of warts, such as scraping with a scalpel or sharp spoon under local anesthesia. Under no circumstances should you touch warts yourself, as they are infectious and the device or fingernail used can cause a new wart to appear in another area.