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The human foot is a unique natural mechanism that allows us to move comfortably, provides high stability, maneuverability and speed, and all this despite the small size compared to the rest of the body. One of the most important parts of the foot is the heel, which performs the function of cushioning in the process of walking and running. This is possible due to the special structure of the calcaneus and the thick layer of subcutaneous fat, which forms a “cushion” on which we gently lean. Often this is accompanied by unpleasant sensations, and then questions arise: what to do if the heel hurts, it hurts to step on and it is impossible to walk normally?
Understanding the causes of such a problem can be difficult, since soreness in the heel region accompanies a number of diseases and injuries. However, most often the symptom is explained by non-pathological factors: a high load on the legs or wearing uncomfortable shoes. In a similar situation, the fair sex, carried away by beautiful high-heeled shoes, is especially often found. But under the signs of banal leg fatigue, serious diseases can be hidden that need to be noticed in time and started to be treated. Therefore, let’s figure it out together why the heels can hurt in the morning or constantly, when walking or at rest, from below, behind or on the sides – in a word, we will discuss all the possible causes of the problem and consider treatment options at home.
Features of the structure of the human heel
The skeleton of the foot is formed by twenty-six bones, which is truly amazing, given its modest dimensions. The calcaneus is the largest in this design, it has a spongy structure and an elongated, laterally flattened body. In front, it articulates with the cuboid bone, above – with the talus, and behind there is a protrusion – the calcaneal tubercle, to which the Achilles tendon, the most powerful in the human body, is attached. In the lower region of the heel there is a cellular fatty layer 1-1,5 cm thick. It contains a whole network of vessels and nerves that can become inflamed, and this is one of the common reasons why the heel hurts and it hurts to step on.
The posterior and lateral surfaces of the calcaneus are practically not protected – the skin here is thin, there is little fatty tissue, and there are many vessels and nerve endings. Therefore, bruises and subluxations that have happened in this area at least once in almost every person bring tangible suffering and do not go away for a long time, not to mention full-fledged dislocations, fractures, sprains and torn ligaments.
So what can hurt in the heel? Here are the main options:
The calcaneus itself serves as a source of pain in reactive arthritis, osteomyelitis, tuberculosis, apophysitis or osteochondropathy of the tubercle, in addition, a crack or even a fracture may occur;
surrounding joints – calcaneocuboid, calcaneotalar-navicular – can become inflamed with some common diseases, for example, with gout;
Ligaments, tendons and fascia – these elements of the foot skeleton are one of the most common culprits in a situation where the heel hurts and it hurts to step on. The three most common diagnoses are plantar fasciitis, inflammation of the lateral ankle ligaments, and Achilles tendon sprain;
Synovial bags, of which there are two in this area. The first is larger and surrounds the lower back of the calcaneus, and the second is very small and is located behind the junction of the calcaneal tuber with the Achilles tendon. Inflammation of the synovial bags is called “bursitis”, in the first case – subheel, and in the second – Achilles bursitis or otherwise Achillodynia;
Nerves and blood vessels they braid the heel bone with a thick net, so if it hurts to step on the heel, the reason is often precisely this. Among the most common neurogenic factors, various polyneuropathies and erythromelalgia can be distinguished, and among vascular factors – diabetic angiopathy;
Skin and subcutaneous fat can be involved in the inflammatory process that occurs in the deeper structures of the heel region, in addition, external traumatic effects are not uncommon – bruises, wounds, burns.
How to assume the cause by the nature of pain in the heel?
We figured out what exactly can become inflamed and hurt in the heels, now let’s move from localization to the nature of unpleasant sensations, because it is this factor that best helps to determine the preliminary diagnosis.
Burning pain, burning in the heels and feet
The feeling of heat, tingling, or burning, unbearable pain in the heel or entire foot is almost certainly neurogenic in nature. This happens with erythromelalgia, Morton’s metatarsal neuralgia, tarsal tunnel syndrome, as well as with some polyneuropathies: diabetic, demyelinating (in particular, with Guillain-Barré and Fabry syndromes).
The state of health of patients deteriorates sharply after a night’s sleep under a warm blanket or simply in hot weather, when the vessels and capillaries further expand. Violent burning sensation in the area of the feet makes one want to put the feet in cold water.
With erythromelalgia, an additional diagnostic sign is redness or even cyanosis of the skin of the lower extremities. Morton’s neuroma is characterized by burning pain in the toes, which is due to thickening of the plantar nerve and often radiates to the heel, which is painful to step on. And with tarsal tunnel syndrome, a person additionally feels numbness and tingling in the area of uXNUMXbuXNUMXbthe inner ankle, which captures the arch of the foot.
Heel pain in the morning
In almost any inflammatory or degenerative-dystrophic disease that affects the foot and the heel region, pain will intensify in the morning, because during the night’s rest the damaged structures have time to partially recover, but the very cause of their trauma does not disappear anywhere. A person begins physical activity, tissues are damaged again, pain occurs. This vicious circle effect is most characteristic of plantar fasciitis, heel spurs, gout, arthritis and arthrosis. The second unifying symptom for this group of diseases is the fact that pain is much less pronounced at rest, but as soon as a person tries to walk, his heels are very sore and normal movement becomes almost impossible.
It hurts to step on the heel, the pain intensifies when walking
It would be strange to consider this symptom important when diagnosing, since with any disease or injury of the heels, stepping on them will be more painful than not stepping on. Therefore, you should pay attention to additional symptoms: general well-being, temperature, the presence of pain in other parts of the body. A more revealing moment is the constant pain in the heels, which does not subside even at rest, but only intensifies while walking. This happens with reactive arthritis, osteomyelitis, bone tuberculosis and other severe inflammatory pathologies. But such diseases are always characterized by vivid symptoms and, in addition to the feet, almost certainly affect other parts of the skeleton. On the other hand, it also happens that at rest, discomfort in the lower extremities is completely absent, but it is painful to step on the heel. The explanation for this is quite surprising.
Another example of irradiation of pain is tarsal tunnel syndrome, which is characterized by compression of the tibial nerve in the medial malleolus canal. Manifestations begin with numbness of the heel, arch of the foot and the area of the inner ankle, then there is a tingling sensation, and finally a burning pain that rises up and radiates to the buttock.
Pain in the back of the heels
The most common causes of pain in this area are rubbing backs of shoes, or, much more seriously, bruises, cracks and fractures of the calcaneus resulting from trauma. Almost everyone at least once in their life has had such an unsuccessful kick with their foot, for example, not calculating the distance to the obstacle located behind them when swinging. Sometimes calcaneal bursitis and Achilles tendon sprains are diagnosed. Among the relatively rare diagnoses, Haglund’s deformity should be mentioned – this is calcaneal exostosis (bone and cartilage growth), which is localized precisely in the posterior upper region of the heel and causes pain when walking, and also significantly complicates the selection of shoes.
Pain in the sides of the heels
The most common cause of pain in the area of the inner surface of the heel is the sprain of the medial ligaments of the ankle, obtained when the foot is turned outward. The opposite situation, when the heel hurts from the outer side, is no less common and indicates that the person has twisted his leg inward. In addition, the case may be a bruise, crack or fracture – in a word, the problem is almost always of a traumatic origin, and it is impossible not to notice such an incident due to severe pain and subsequent swelling.
Diseases that cause heel pain
Now let’s look at the likely causes of the malaise in more detail and figure out what to do if your heel hurts and it hurts to step on your foot – how to treat it, how to get rid of the pain and prevent the problem from recurring.
We will not touch on injuries of the heel zone here, such as bruises, cracks, fractures, dislocations and sprains, since the moment of receiving such injuries cannot go unnoticed, and the injured person probably knows exactly the answer to the question of why his heel hurts and it hurts to attack on foot. If such a misfortune has happened, apply dry cold to the bruised place, immobilize the leg and consult a doctor as soon as possible.
Heel arthritis
This is an inflammatory lesion of the calcaneus, surrounding structures and tissues. It rarely occurs in isolation – as a rule, other joints are also affected.
According to the etiology, calcaneal arthritis is divided into the following categories:
Reactive – begins as a complication a few weeks after the infection, most often respiratory, intestinal or urogenital;
rheumatoid – occurs as a result of an attack of immune cells on the body’s own tissues;
post-traumatic – becomes a response to the resulting bruise, dislocation, sprain, crack or fracture of the calcaneus;
Gouty – due to the high level of uric acid in the blood and the deposition of its salts (urates) on the articular surfaces.
Each of the forms of calcaneal arthritis manifests itself with a different intensity of pain, in addition, swelling and redness of the skin often occur. The treatment program depends entirely on the nature of the disease and may include the appointment of non-steroidal anti-inflammatory drugs, antibiotics, hormones, immunomodulators, chondroprotectors, healing and cellular repair stimulants, physiotherapy, and in severe cases, surgical intervention.
More: Arthritis – causes, symptoms, degrees, types and diagnosis
Arthrosis of the heel
The disease is a degenerative-dystrophic process that leads to thinning of cartilage and the appearance of bone growths (osteophytes) on the articular surfaces. Arthrosis of the heels is very often combined with plantar fasciitis and heel spurs.
Reasons for the development of the disease:
Wearing uncomfortable shoes with high heels;
Heavy loads on the legs;
Endocrine disorders;
Overweight;
Deficiency of vitamins and minerals;
advanced age;
Genetic predisposition.
Arthrosis of the heels begins to manifest itself as increased fatigue of the legs, crunching when walking, then the discomfort gradually intensifies, the feet become deformed, the person has severe heel pain, it hurts to step on his feet, and in the last stages of the disease, movement becomes impossible even with the help of a cane or crutches. It is important not to start heel arthrosis, start taking chondroprotectors as soon as possible, do massage, undergo physiotherapy, and exercise therapy. A radical method of treating heel arthrosis is arthroplasty, that is, the surgical removal of osteophytes and the growth of cartilage tissue.
More: Arthrosis – causes, symptoms, complications and treatment methods
plantar fasciitis
The plantar aponeurosis, or plantar fascia, is an oblong flap of dense connective tissue that is attached to the calcaneal tubercle on one side and to the heads of the metatarsal bones on the other side, forming and supporting the arch of the foot. With increased loads on the aponeurosis, its micro-ruptures occur in the heel region, where the tension is the strongest, which leads to inflammation, and then the heel hurts, it hurts to step on the foot, and more often both limbs suffer at once. Women over 40 who are accustomed to wearing stilettos, as well as professional athletes and people with gout, flat feet, diabetes and overweight, are most at risk of getting sick with plantar fasciitis.
Gouty arthritis is manifested by terrible pains in the heels and feet in the morning, immediately after waking up, because during the night a lot of uric acid salts accumulate in the body, and the joints have time to grow new microscopic osteophytes. Treatment is aimed at reducing inflammation and normalizing disturbed metabolic processes. Allopurinol, Colchicine, Febuxostat, Probenecid, as well as drugs from the NSAID group (Diclofenac, Ibuprofen, Naproxen, Ketorolac) are used. An acute attack of gout, as a rule, is removed in a hospital, it is very difficult to cope with it at home.
More: Gout – causes, symptoms and treatment
Osteoporosis of the calcaneus
This is also a metabolic disease that occurs due to calcium deficiency. On the one hand, in any person, the strength of bone tissue deteriorates with age, and on the other hand, the problem may be a lack of vitamin D, without which calcium is poorly absorbed by the body. The situation worsens significantly during menopause in women, since a decrease in the level of estrogen in the blood leads to an accelerated leaching of calcium from the bones, therefore, to their fragility and the risk of fractures. Therefore, osteoporosis is often and not without reason called a disease of older women.
Video: Dr. Evdokimenko “osteoporosis – treatment of osteoporosis, its symptoms and diagnosis. Need whether drink calcium?»
Diagnosis of such a serious disease, as a rule, is not difficult. Treatment is long, it takes from six months to several years, depending on the severity and stage of pathogenesis. Multistage therapeutic schemes involving several powerful antibacterial drugs are used. After recovery, a course of rehabilitation is carried out, sanatorium treatment, massage, physiotherapy procedures are indicated.
Osteomyelitis of the calcaneus
An extremely dangerous disease, which is a purulent-necrotic process in the bones and surrounding soft tissues, caused by infection with pyogenic bacteria. Such pathogens can enter the heel region through the systemic circulation from other foci, or directly through a wound on the leg. Inflammation begins with swelling, redness and pain in the heel, it is painful to step on the leg, then an ulcer forms on the surface of the skin, through which purulent discharge is expelled. The body temperature rises, the general state of health deteriorates sharply.
Acute osteomyelitis of the heel can lead to gangrene and limb amputation, not to mention blood poisoning and possible death. At the first signs of a purulent abscess, it is urgent to contact a surgical hospital. An injection of antibiotics is carried out, and if necessary, the focus of inflammation is opened and washed. Complications may develop in the diseased limb after recovery: muscle contractures that cause chronic pain and interfere with walking.
Diabetic angiopathy
This term refers to pathological changes in the vascular wall caused by a constant excess of sugar in the blood. The products of glucose metabolism, as well as water, accumulate in the endothelium (inner shell) of blood vessels and capillaries, which leads to edema, increased permeability, ruptures, the formation of aneurysms (dilations), blood clots, and atherosclerotic sites. In addition, the person suffers from high blood pressure.
Video: What is diabetic angiopathy and why is it dangerous for a diabetic?
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