The heel (from Latin talus) is the posterior region of the human foot that rests on the ground.

The heel is located behind the foot, it partly constitutes the region of the tarsus. It is formed by the largest bone in this area, the calcaneus. Lying from back to front, it rests on the ground by its rear end. The skin covering the heel is a support zone for the foot; therefore it is thick and contains subcutaneous fat.

The Achilles tendon, the largest tendon in the body, attaches to the posterior surface of the calcaneus. It continues on its way to its underside and the sole of the foot where it joins the plantar fascia (thick ligament that connects the toes to the calcaneus). The Achilles tendon connects the gastrocnemius (calf muscle) to the heel. It allows you to lift it during the exercise of walking and get on your tiptoes.

The heel is the posterior support zone of the foot. The thick skin of the sole of the foot at this point forms a padding zone which provides stability of the support and cushioning with each impact on the ground.

Talalgia (heel pain) : pain under the heel, on the sides or in the back. Most often they are of mechanical origin and are present during walking, prolonged standing or at the first step in the morning. They are found in pathologies such as hollow foot or tendonitis. Heel pain can also be linked to inflammation. In this case, the pain is mostly felt at bedtime or in the morning and tends to subside during the day.

Calcaneal fracture : occurs after a fall from a great height (roof, scaffolding, jumps, etc.) whose landing, and therefore the impact, is on the heel.

Sever’s disease : growth or sports-related pathology manifested by heel pain. It reflects an inflammation of the area where a tendon is inserted. It generally affects temporarily young people (10-16 years) practicing sports activities with repetitive and intense strides and impacts on the ground (football, tennis, running or dancing for example).

Haglund’s disease : called “runner’s disease”, it results in the appearance of a lump behind the heel following repeated friction of the shoe on the calcaneus. It can occur despite the absence of sports activity. It is manifested by pain of varying intensity at the back of the heel. Ankle movements are painful and wearing closed-toe shoes may become impossible.

Achilles tendonitis : inflammation of the Achilles tendon which results mainly in pain, sometimes accompanied by swelling in the tendon. It occurs following trauma to the tendon (shock, repeated forced or poorly coordinated movements during a sporting activity, overweight or even chronic poor hydration).

Achilles tendon rupture : tearing of the tendon which then loses all its effectiveness in the movement of the heel. It can affect the athlete who practice brutal starts (tennis, squash…) or occur in more banal circumstances such as pushing a broken down car for example.

Calcaneal spine (Lenoir spine) : bone growth that forms where the plantar fascia (or plantar fascia) meets the heel bone. This growth is formed because the bone must organize itself to better resist the tendon which “pulls” more. The outgrowth allows it to support this increased tension. This is one of the possible consequences of plantar fasciitis.

Choosing the right shoes is one way to avoid certain heel pain. For example, a shoe counter that is too hard or too tight presses on the heel too aggressively. Conversely, a buttress that is too loose does not hold the heel sufficiently and becomes the site of repeated friction.

For shoes with heels, it is advisable to favor shoes which have a horizontal interior heel plate which allows stable support for the heel and support for the arch of the foot (unlike shoes which are too inclined which give an impression of ” toboggan “). For heel height, 3,5 to 4 cm seems the most appropriate during the day.

Certain medications are known to cause Achilles tendonitis and even ruptures. This concerns in particular fluoroquinolones, antibiotics prescribed for urinary and gynecological infections and certain ENT diseases.

Health professionals do not recommend taking these drugs by the elderly or those with a history of tendonitis or practicing intense sport. It is advisable to stop the treatment in the event of side effects in the Achilles tendon.

Clinical examination: carried out by the doctor, it first includes the questioning (general then focused on the symptoms – pain, swelling, blockage, etc. – which led the patient to consult). It is followed by the physical examination of the heel and ankle: observation, palpation and reaction test of muscle function (plantar flexion of the ankle to compression of the calf).

Additional tests :

• Radiography: a medical imaging technique that uses X-rays. Standard reference examination, the lateral x-ray of the ankle makes it possible, for example, to differentiate a rupture of the Achilles tendon from a bone tearing of the calcaneus.
• Ultrasound: imaging technique that relies on the use of ultrasound to visualize the internal structure of an organ. Ultrasound being stopped by the bone, ultrasound is an examination intended to study the superficial soft tissues.
• Arthrography: X-ray of the heel or ankle with injection of a contrast product. It allows the observation of soft tissues, cartilage, ligaments and their interactions with bone structures, which cannot easily be visualized with a standard x-ray.
• MRI (magnetic resonance imaging): medical examination for diagnostic purposes carried out using a large cylindrical device in which a magnetic field and radio waves are produced. It makes it possible to obtain very precise images of elements of the heel and ankle (muscle, tendon, ligament).
• Scanner: imaging technique which consists in “scanning” a given region of the body in order to create cross-sectional images, thanks to the use of an X-ray beam. We also speak of computed tomography or computed tomography. This exam allows you to clearly visualize the bone, fat, and fibrous tissue.

In Greek mythology, the heel is the only vulnerable area of ​​the character Achilles, hence the expression “Achilles heel” to refer to a person’s weak point. Plunged into the Styx by his mother who wished to make him invulnerable, Achilles was held by the heel; only this part of the body could not be protected. He succumbed during the famous Trojan War, hit by an arrow in the heel.