Also known as heel pain or tallodynia, heel pain has a variety of causes; among these, the most common is plantar fasciitis, followed by conditions such as heel spurs and heel spurs, Achilles' tendon inflammation, calcaneus fractures, bursitis and bruises.
Depending on the causative factor, heelitis can evoke pain on the sole of the foot (under the heel) or behind the heel (back of the heel). this pain can be acute or chronic.
Almost always, a history and physical examination are sufficient for the diagnosis of heelitis and its causes. There are, however, circumstances that require further investigation with diagnostic imaging.
In general, the treatment of heelitis is based on conservative remedies; However, it should be noted that some causes of heel pain require surgery.
constituting 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).
Origin of the name
The word "heel" derives from the "union of the term" heel "and the suffix" ite ", which in the medical field indicates inflammatory processes.
, the heel spur, the heel spur, inflammation of the Achilles tendon (enthesopathy of the Achilles tendon), bursitis (eg: retro-calcaneal bursitis), bruises and fractures (especially those caused by stress).
Then follows a group of less common causes, but still worthy of mention, which includes: rupture of the Achilles tendon, Haglund syndrome, tarsal tunnel syndrome, reactive arthritis (once known as Reiter's syndrome) , rheumatoid arthritis and ankylosing spondylitis.
Additional Causes of Tallonitis
- Osteomyelitis;
- Sarcoidosis;
- Paget's disease of bone.
Plantar fasciitis
Plantar fasciitis deserves special attention as it is the leading cause of heel pain, particularly the lower part of the heel.
It 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 RemediesInflammation and Rupture of the Achilles Tendon
The Achilles tendon is the strong connective-fibrous band 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 degenerative alterations in the tendon structure (functional overload).
The rupture of the Achilles tendon, on the other hand, is the laceration of the tendon structure in question.
This second injury is quite serious, as it severely limits a person's motor skills.
Also, since the Achilles tendon is unable to repair itself, its rupture requires repair surgery.
Stress Fractures of the Calcaneus
Stress fractures are often the consequence of a repetition of mechanical stress 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 bags (or synovial bags) are small sacs filled with synovial fluid, with the task of protecting and reducing the potential friction between the various structures involved in the stabilization and mobility of a "joint (ligaments, tendons, bones, muscles, 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).
It should also be noted that retro-calcaneal bursitis is also often associated with Haglund's syndrome, another cause of heelitis.
Causes of Tallonitis in Young People
Heelitis can also affect young people.
In particular, in these subjects, the disorder may be mainly due to osteochondrosis or Sever's disease, two typical conditions of young age.
Classification of the Causes of Tallonitis
Experts have a habit of distinguishing the causes of heelitis into two categories: the causes of pain under the heel and the causes of pain behind the heel.
The first group includes conditions such as, for example, plantar fasciitis, heel spurs, bruises or fractures; the second group, on the other hand, includes conditions such as, for example, inflammation of the Achilles tendon, rupture of the Achilles tendon, bursitis, Haglund's syndrome or Sever's disease.
Tallonite: the Risk Factors
Factors such as:
- Overweight or obesity;
- Frequent use of uncomfortable footwear for the foot (eg heels, but also excessively worn shoes);
- Lack of planning of training in sports specialties focused on running on hard surfaces (eg: marathon, many athletics specialties, etc.);
- Excessive shortening (retraction) of the calf muscles;
- Primary or secondary postural alterations;
- Presence of forms of arthritis (eg: ankylosing spondylitis, rheumatoid arthritis, etc.).
Finally, it should be noted the possibility of an "association between heelitis and neurological disorders, such as tingling and numbness in the foot; this association is characteristic of a condition such as tarsal tunnel syndrome, which is due to compression of the posterior tibial nerve, nerve intended to reach the sole of the foot.
For further information: Tallonitis: the SymptomsComplications of Tallonitis
If neglected, those causes of heelitis that begin with mild pain, evoked only by specific physical activity, tend to take on a chronic nature, becoming much more difficult to treat.
Furthermore, again with reference to this type of cause of heelitis, those who do not follow any therapy and try to live with the disorder 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.
Tallonitis: When To See Your Doctor?
An individual suffering from heelitis should contact their treating physician 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).
.; these investigations show fractures, hematomas, edema, alterations of the plantar fascia (eg thickening) and other anomalies, which are very useful for diagnostic purposes.The identification of the causes of heelitis is essential 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 pain, a cause identified through appropriate diagnostic investigations;
- The intensity of the symptoms.
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.
Tallonitis Cure: Conservative Remedies
Rest
Rest understood as abstention from all activities that evoke heel pain is essential to recover from inflammatory states (due for example to functional overload), tissue degeneration and fractures.
It is a typically recommended measure when heelitis is in its onset stage.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for Pain
If the pain in the heel is very severe and intolerable, the doctor may recommend an NSAID in order to relieve 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 packs
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).
Usually, 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 onset of heelitis had contributed to the use of shoes that excessively stress the heel or shoes that are not appropriate for certain activities (eg shoes worn for running), it is good to change footwear in favor of something more comfortable and suitable.
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 emphasized that they are a symptomatic remedy, 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 against pain, but with an important limitation: corticosteroids are drugs that can have serious side effects.
In light of this, therefore, a medical consultation is recommended before using them.
Tallonitis Cure: 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 heelitis is that of professional athletes and those who regularly practice running, jogging and similar sports.
from a heelitis depend on the severity of the triggering cause and the timeliness of the diagnosis (a timely diagnosis allows to start an adequate therapy early).Less severe causes of heelitis 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).
