Heel pain

Any pain, including in the foot, is a signal from the body that makes you pay attention to this area. The feet experience tremendous stress on a daily basis, and it is not surprising that we can experience pain in the calcaneus. This is the largest bone in the foot, the plantar fascia is attached to it from below, and the Achilles tendon, which connects to the gastrocnemius and soleus muscles of the lower leg, is attached to it from above.

Most of the load in a standing position falls on the heel. The heel cushions shock when walking, jumping and running. When shooting, burning, aching pain occurs in the heel, a person can hardly step on his foot and lead an active lifestyle. This is an occasion to consult a doctor and deal with the causes of heel pain.

Causes of heel pain

As a rule, heel pain is caused by an inflammatory process caused by various factors. This includes injuries, endocrine disorders, infections, and even autoimmune diseases. Let’s take a closer look at each reason. 

Most often, heel pain is provoked by trauma to the calcaneus itself and inflammation of the tendons and ligaments attached to it. All of the above can be summarized in one list: 

• cracks and fractures of the calcaneus;
• inflammation of tendons and ligaments;
• deformities of the calcaneus;
• inflammatory and degenerative diseases of the joints.

Also, heel pain can be caused by various infections. Even previously transferred infectious diseases can cause heel pain, for example, if the infection provoked the development of reactive arthritis. 

Complications caused by diabetes cannot be ruled out. Heel pain can be the result of a trophic ulcer in diabetic foot syndrome and thrombophlebitis. 

As we can see, there are many causes of heel pain, and its nature and intensity differ with each diagnosis. Let’s try to understand in more detail. 

Fractures and cracks 

According to statistics, fractures and fissures of the calcaneus account for up to 6% of all skeletal fractures, and in more than 60% of cases they are part of a combined injury, for example, with damage to the lower extremities¹. As a rule, they are caused by excessive stress on the feet. This may be a fall from a height with a landing on the heels. A pathological fracture is also possible with minor trauma, which is observed in people with osteoporosis. The pain during a fracture is usually very strong, so the victims do not delay a visit to the traumatologist. But even not too intense pain and swelling in the heel area is a reason to see a doctor.

Plantar fasciitis

A wide, elastic plantar fascia connects the heel bone to the toes. Fasciitis is an inflammation of the fascia that can occur against the background of flat feet, diseases of the joints of the lower extremities and increased stress on the foot. The inflammatory process usually develops at the site of attachment of the fascia to the calcaneus. If you are worried about severe pain, especially when taking your first steps in the morning, you should consult your doctor.

Haglund disease

The deformity of the calcaneus was first described by the Swedish surgeon P. Haglund, so the disease got its name. A bony protrusion forms on the back of the calcaneus, which causes pain to the patient when wearing shoes. There may also be swelling, lameness, difficulty in bending and unbending the foot. The reason for the growth of bone tissue in this area can be flat feet, inflammation of the Achilles tendon, high arch of the foot. With Haglund’s deformity, you should contact an orthopedic traumatologist. 

Achilles bursitis and other lesions in the Achilles tendon 

Due to the contraction of the posterior muscles of the lower leg, the Achilles tendon “pulls” the calcaneus and provides flexion of the foot. Thanks to this feature, we can run, jump and stand on our toes. Between the protrusion of the calcaneus and the Achilles tendon, there is a joint bag that allows the tendon to slide freely during foot movements. Inflammation of this bag and the Achilles tendon is called Achilles bursitis. It is caused by regular microtraumas, pathologies of the foot and joints of the lower extremities. Foot movements during the period of illness are limited, when palpated, acute pain occurs, which forces the patient to go to the doctor.

Reactive arthritis

Sometimes, after an infection, inflammation of the joint, called arthritis, can develop. Often with reactive arthritis, it is the heel area that suffers. With untimely treatment, the disease can sometimes drag on for several years. It is important not to self-medicate to prevent reactive arthritis from becoming chronic. 

diabetic foot syndrome

In diabetes mellitus, peripheral circulation is often disturbed, against which the diabetic foot syndrome can develop. It is accompanied by frequent swelling, decreased sensitivity of the feet, pressing and pulling pain in the heel. Diabetic foot syndrome requires treatment, otherwise the process will develop and may even lead to amputation of the foot. 

Heel pain treatment

Before you see a doctor, it is important to limit the load on the affected leg. If the person is able to walk, shoes that are spacious and comfortable should be chosen that will not put extra pressure on the heel. Orthopedic insoles will help reduce the load on the affected area. It is not worth postponing a visit to a specialist, treatment in most cases is conservative: anti-inflammatory drugs, orthoses (fixing devices) and other devices to restrict movement, therapeutic exercises, physiotherapy.

Surgical treatment may be required for some diagnoses, such as Achilles tendon rupture and calcaneal fracture. To determine the tactics of treatment, a thorough diagnosis of heel pain is necessary. 

Diagnostics

When you see an orthopedic traumatologist for heel pain, you will most likely get a referral for imaging studies such as x-rays, ultrasound, CT or MRI to confirm the diagnosis after examination. With a fracture, the diagnosis is confirmed by x-ray, but the diagnosis of plantar fasciitis is most often based on the clinical picture. Blood tests are often required to diagnose pain and confirm systemic inflammatory diseases. Computed tomography is necessary to determine the exact shape and position of the bones, while MRI is suitable for visualizing soft tissues and determining the condition of the bone.

Modern treatments

Medical science does not stand still, and there are many modern methods of both surgical and conservative treatment.

In most cases, foot pain occurs due to deformities of the foot, such as flat feet. In this case, therapeutic exercises and wearing individual orthopedic insoles will help, which will help stop the progression of the disease.

For the treatment of inflammatory diseases of the tendons of the foot, conservative treatment methods are very effective: shock wave therapy or injection of platelet-rich plasma.

For surgical treatment, new methods of operations and modern metal fixators have been developed.

Prevention of heel pain at home

To reduce the risk of foot injury, you should properly dose physical activity, follow the technique of playing sports, be sure to resort to stretching and warm-up exercises. It is extremely important to select shoes according to the size, observing the features of the foot.

Strengthening the immune system, hardening and good nutrition will help to resist infectious diseases. Since the entire body weight is on the feet, excess weight can contribute to various pathologies of the feet, so it is necessary to keep your weight normal.

Popular questions and answers

Popular questions and answers regarding the treatment of heel pain answered orthopedist-traumatologist Alexander Karandin.

Sources:

1. Minimally invasive osteosynthesis of closed fractures of the calcaneus. Dmitriev O.A. Moscow, 2015. https://sechenov.ru/upload/222270.pdf