It can be caused by conditions such as, for example, plantar fasciitis, stress fractures of the heel, bursitis of the heel, tarsal tunnel syndrome, heel spur, and inflammation or injury to the Achilles tendon.
Typically, heel pain is a sensation that appears gradually and that worsens, sometimes even severely, if the affected individual walks for a long time, runs, or spends many hours standing.
The identification of the causes of the pain through a scrupulous diagnosis is important for the planning of the therapy: the therapy, in fact, varies according to the triggering factors.
Treatment can be conservative or surgical in nature. Generally, doctors prefer to resort to conservative treatment and reserve the right to surgery only in extreme cases.
or spend many hours on your feet.
Heel pain is a type of disorder that often characterizes the morning awakening and the phases following periods of prolonged inactivity (eg after sitting for a long time).
With the resumption of movement, it tends to diminish and the person concerned feels a noticeable relief.
Where is the heel located?
The heel is the rear end of the foot.
In this region there is the calcaneus, one of the seven bones making up the tarsus; tarsus which represents the hindfoot and acts as a junction point between the foot and the leg (tibia and fibula).
A good part of the weight of the body weighs on the heel, both in the static phase (standing position) and during walking.
Those who suffer from heelitis may experience pain in the lower part of the heel (on the sole of the foot) or in the portion behind (where, so to speak, the shoe horn is put on).
For further information: Foot Bones: Anatomy and FunctionEpidemiology
Heel pain is a very common condition that, according to some statistical surveys, affects one in every 10 people at least once in a lifetime.
There are two categories of individuals most at risk for heel pain: those who run or jog regularly and adults between the ages of 40 and 60.
from heel stress;
Plantar fasciitis
Plantar fasciitis is an orthopedic disorder due to the degeneration of the plantar fascia, a ligament that extends from the heel to the metatarsal heads and which is responsible for redistributing body weight at the breech level during the static and dynamic phases (eg: walking).
Plantar fasciitis is generally a functional overload syndrome, which arises as a result of excessive and protracted stimulation of the plantar fascia; the latter, in fact, in similar circumstances, is the victim of sequential microtraumas which cause a more or less serious degeneration.
Plantar fasciitis mainly affects people addicted to running and athletics, individuals suffering from overweight or obesity, those with shortened or retracted calf muscles and those who use shoes with little cushioning.
For further information: Plantar Fasciitis: Causes, Symptoms and RemediesCalcaneus Stress Fractures
Stress fractures are often the result of repeated mechanical strain to damage the affected bone or bones.
Stress heel fractures typically affect those who regularly play sports such as running or jogging, which continually overload the bones of the feet and lower limbs in general.
Bursitis of the Calcaneus
By "bursitis", doctors mean the "acute or chronic inflammation of a serous bursa of a" joint.
The serous bursae of a joint are small sacs filled with synovial fluid, with the task of protecting and reducing potential friction between the various joint structures (therefore between ligaments, tendons, bones, etc.).
At the level of the heel there are several serous bags; among these, one particularly prone to inflammation is that located near where the Achilles tendon joins the calcaneus (behind the heel).
The inflammation of this serous bursa is called retro-calcaneal bursitis.
One of the most important risk factors for the formation of bursitis at the level of the heel is, without doubt, the use of shoes that tighten the back of the heel (eg shoes with heels).
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is a nerve compression syndrome.
In nerve compression syndromes, symptoms are due to crushing (or compression) of a nerve and surrounding tissues.
Going into the specifics of the tarsal tunnel syndrome, the nerve compression affects the posterior tibial nerve, which, before reaching the sole of the foot, passes through an osteo-ligament structure located at the level of the ankle joint and called the tarsal tunnel.
Generally, a cyst, formed close to the aforementioned osteo-ligament structure, compresses the nerves that pass through the tarsal tunnel.
In addition to causing heel pain, tarsal tunnel syndrome also causes tingling and numbness in the affected foot.
Calcaneal Spine
The calcaneal spine is an osteophyte located at the level of the calcaneus.
Osteophytes are small bone spurs - similar to a rose thorn, a beak or a claw - that form along the joint margins of bones subjected to chronic erosive and irritative processes.
Often associated with plantar fasciitis or problems affecting the Achilles tendon, the heel spur can be of two types, depending on the location of the osteophyte: the posterior heel spur (better known as the heel spur) and the inferior heel spur.
Sever's disease
Sever's disease is the most common cause of heel pain in children.
At its origin there is, very often, the greater speed with which the bones of the legs grow, during a young age, compared to the speed with which the tendons and muscles of the thigh and leg develop.
In fact, this difference in speed leads to a lack of proportions between the size of the skeleton and the muscle-tendon apparatus of the affected areas, with consequent stretching of the heel by the muscles and tendons of the thigh and especially the leg (NB: the tendon d " Achilles groups several muscles of the leg and "inserts right at the level of the calcaneus).
Atrophy of the plantar adipose pad
The atrophy of the plantar fat pad is a condition resulting from the deterioration of the layer of adipose tissue, located below the heel bone, whose task is to absorb the shocks of the impact with the ground during a walk, a run, etc.
The people most at risk of plantar fat pad atrophy are women.
Inflammation and Rupture of the Achilles Tendon
The Achilles tendon is that structure of connective-fibrous tissue that connects the calf muscles (the twins and the soleus) to the heel bone.
It is essential for walking, running and jumping.
Inflammation of the Achilles tendon is a tendonitis; at its origin, there are very often repeated microtraumas and alterations of a degenerative nature, affecting the tendon structure.
The rupture of the Achilles tendon, on the other hand, consists in the laceration of the tendon structure in question. This is a serious injury, as it strongly limits the motor skills of the person; moreover, since the Achilles tendon is not able to self - repair, its rupture requires repair surgery.
Heel Pain: Other Potential Causes
Other possible triggers for heel pain are:
- Osteomyelitis with involvement of the calcaneus. Osteomyelitis is the medical term that indicates the presence of an "infection in the bone;
- Paget's disease of bone. It is a very rare disease that weakens the bones of the human skeleton. A typical symptom of this weakening is bone pain;
- Reactive arthritis. It is an inflammation of the joints of the human body, with a double nature: infectious and autoimmune. In addition to the joints, it can also affect the eyes and urethra;
- Sarcoidosis. It is an autoimmune disease that causes a generalized inflammatory state. It induces the appearance, in various anatomical regions, of proliferating masses, called granulomas;
- Rheumatoid arthritis. It is another type of inflammation in the joints of the human body. It has an "autoimmune origin;
- Haglund syndrome. It is a particular anatomical anomaly, in the presence of which the person concerned presents a sort of protuberance on the heel.
Heel Pain: Risk Factors
- Old age. Aging involves a reduction in the flexibility of the plantar fascia and a thinning of the fat pad located inferior to the calcaneus;
- Diabetes;
- Spending many hours of the day on your feet;
- Inadequate physical activity (ex: over-training, inadequate warm-up, etc.);
- Suffering from flat foot or pes cavus.
Some causes of heel pain are responsible for acute pain (eg: fracture and rupture of the Achilles tendon), while others for a gradual pain, evoked only by physical activity in a first phase and instead chronic in a more advanced moment ( eg: plantar fasciitis and inflammation of the Achilles tendon).
Finally, it should be noted the possibility of an "association between heel pain and neurological disorders, such as tingling and numbness in the foot; this association is characteristic of a condition such as tarsal tunnel syndrome.
For further information: Heel Pain - Causes and SymptomsHeel Pain: Complications
If neglected, those causes of heel pain that begin with mild pain, evoked only by specific physical activity, tend to become chronic ailments, making them much more difficult to treat.
Furthermore, again with reference to this type of causes of pain, those who do not follow any therapy and try to live with the problem implement motor compensations, useful for bearing pain, which however increase the risk of joint problems affecting the ankle, knee. , hip and, even, lumbar area of the back.
Heel Pain: Who To Turn To And When To Do It?
An individual with heel pain should contact their healthcare provider when:
- The affected foot is particularly painful and interferes with the performance of daily activities;
- Pain prevents you from properly carrying out sports activities that involve running, jumping, etc .;
- Symptoms such as tingling and / or numbness in the affected foot are present;
- The affected foot and ankle are stiff and swollen, and bruised.
Very often, it is also essential to consult an orthopedist (a doctor specialized in the diagnosis, treatment and prevention of pathologies of the complex system of muscles, bones, tendons, ligaments and nerves, present in the human body).
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Doctors consider additional diagnostic tests (X-rays, MRI, sometimes ultrasound) when the patient complains of other symptoms in addition to the painful sensation, such as: tingling / numbness in the affected foot, stiffness and / or swelling of the foot and ankle etc.
The identification of the triggering causes is fundamental for planning an adequate therapy.
Anamnesis
Anamnesis is an indispensable investigation to establish a link between present symptoms and potential causal factors.
Through the "anamnesis, the doctor clarifies all the details of the symptoms by asking the patient questions such as" when did the first complaints appear? "," On which occasions does the pain become more intense? "Etc.
In addition, it probes the patient's medical history (diseases and injuries of the more or less recent past, ongoing therapies, etc.) and investigates his / her work activity (type of job), lifestyle (is he sedentary or an active person? If it is active, what activities does it carry out? Etc.) and habits (ex: used shoes).
For the reasons set out in the chapter relating to the causes, the analysis of lifestyle is very important, in particular everything concerning any sporting / motor activities practiced.
Physical examination
The physical examination (or physical exam) consists of the medical evaluation of the patient's general state of health.
It provides for diagnostic maneuvers that are used by the doctor to ascertain the presence or absence of signs indicative of some pathological condition.
In a patient complaining of heel pain, the physical examination includes:
- The observation of the heel, behind and below, and, subsequently, of the plantar arch;
- Palpation of the heel area;
- The analysis of the consequences deriving from the movement of the toes of the painful foot (this is because, for example, in the patient with plantar fasciitis, the dorsiflexion of the toes produces pain);
- Assessment of ankle mobility and calf muscle stretching ability.
- The cause of the symptoms, a cause identified through appropriate diagnostic investigations;
- The intensity of the painful sensation.
The choice of the therapeutic approach is divided between conservative (or non-surgical) therapy and surgical therapy.
Except for particular conditions for which surgery is the only possible cure (eg: rupture of the Achilles tendon), doctors give priority to conservative treatment, which, among other things, is often effective.
Heel Pain Treatment: Conservative Remedies
Rest
Rest understood as abstention from all activities that evoke heel pain is essential to recover from inflammatory states (due to functional overload, for example), tissue degeneration and fractures.
It is a typically recommended measure when heel pain is in its onset (acute phase).
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for Pain
If the heel pain is very severe and intolerable, the doctor may recommend an NSAID in order to mitigate the inflammation and, consequently, the painful sensation.
It is a symptomatic remedy, which does not act on the causes.
The most prescribed NSAID in the case of heelitis is ibuprofen.
Ice
Cryotherapy intended as the application of ice on the painful area is a significant anti-inflammatory remedy, ideal especially during the onset of symptoms.
To get the maximum benefits from the application of ice, it is good to perform 4-5 packs a day, packs lasting no less than 15 minutes and no more than 20.
Physiotherapy
Physiotherapy is essential to heal all those conditions due to functional overload (eg plantar fasciitis); moreover, it is a cornerstone of the recovery programs foreseen after the resolution of fractures and orthopedic surgery (eg: repair of the Achilles tendon).
Typically, physiotherapy is based on exercises of stretching for the calf and plantar fascia, on proprioception exercises and on motor re-education activities; however, it should be noted that the rehabilitation process varies according to the cause of the pain and the characteristics of the patient.
It is strongly recommended to contact a physiotherapist experienced in foot problems.
Change Shoes
If the habitual use of shoes that excessively stress the heel or shoes that are not appropriate for certain activities (eg shoes worn for running) had contributed to the onset of heel pain, it is good to change footwear in favor of something more comfortable and suited.
To find out which shoes are best suited to your foot, it is good to contact an expert in the sector.
Make use of Orthotic Insoles
Plantar orthoses (ex: insoles, heels, etc.) are indicated in the presence of pain under the heel (ex: plantar fasciitis, heel spurs, etc.).
They allow to cushion the load on the heel, which should alleviate the symptoms.
It should be noted that they are a symptomatic treatment, which does not act on the causes.
As in the case of shoes, to find out which orthoses are most suitable against heelitis, it is advisable to ask an expert for advice.
Injection of a Corticosteroid
The local injection of a corticosteroid is a very effective symptomatic remedy for pain, but with an important limitation: corticosteroids are medicines that can have serious side effects.
In light of this, therefore, a medical consultation is recommended before using them.
Heel Pain Treatment: Surgery
The type of surgical treatment varies according to the triggering cause of the heel.
For example, surgical treatment for heel pain due to plantar fasciitis includes interventions such as distension of the plantar fascia and recession of the gastrocnemius muscle.
The surgery is usually carried out by an interventional orthopedist.
Statistics in hand, the category of people who most undergo surgery for heel pain is that of professional athletes and those who regularly practice running, jogging and similar sports.
To know more...
A description of the surgeries for plantar fasciitis can be found here.
heel pain depend on the severity of the triggering cause and the timeliness of diagnosis and treatment.
Less severe causes of heel pain resolve within a few days / weeks; the most serious ones could take several months (eg: from after the repair surgery, the rupture of the Achilles tendon requires 7 to 9 months of rehabilitation).
