Pain in the heel

The conditions of survival in the modern world compel many people to spend a lot of time on the move and on their feet, sometimes for whole days without having the opportunity to fully relax. Such workaholism creates strong stress on the legs, which in the end can lead to a trauma to the heel. Pain in the heel creates a lot of uncomfortable sensations, but many are accustomed to endure it.

Doctors do not advise to perform such feats and, if possible, do not pull and go to the doctor as early as possible, because the patient's heel is not a joke, and it is necessary to approach the treatment of this pain responsibly and do not delay until the pain worsens.

The heel, consisting of calcaneus and soft fat layer, performs a very important damping function when walking and running. In addition, a large number of capillaries and nerve endings are concentrated in the heel. All this makes the heel very vulnerable, in fact an Achilles heel.

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Causes of pain in the heel

1. Diseases of the calcaneus.
2. Arthritis of the joint under the talus bone.
3. Rupture of the calcaneal tendon.
4. Heel paratendinitis (pain is noted deep in the calcaneal tendon).
5. Back-to-back bursitis (thickening of the bursa over the roughness of the calcaneus, on the back of the heel).
6. Soreness of the calcaneal (pad) lining (with pain noted in the lower part of the heel).
7. Plantar fasciitis (pain under the anterior part of the calcaneus).

As the statistics show, most patients complain of plantar fasciitis - inflammation or tearing of a strip of fibrous connective tissue that covers the entire sole from the very heel to the toes. The source of fasciitis can be either uncomfortable shoes, or a violation of the structure of the bones due to heavy loads, flat feet and other mechanical problems with the legs. Pain and heel can also form due to inflammation of the tendon tissue, which is accompanied by a feeling of "needle in the heel." Rheumatoid arthritis is another source of heel pain. In this situation, doctors recommend wearing shoes with an open heel.

The most common problems with the heels are people prone to fatness, having problems with the spine, flat feet. Athletes, especially athletes, often have problems with heel pain. Basically, fasciitis affects people aged, but recently this disease has significantly "rejuvenated" due to poor ecology, poor-quality food, stressful lifestyle. All these factors disrupt the metabolism in the body and calcium metabolism, which makes the bones and joints more vulnerable.

Injury of the tendon, its overload due to flatfoot, and also the bruise of the calcaneus can lead to pain in the heel. There are also infectious prerequisites for the appearance of a "nail in the heel": gonorrhea, chlamydia and other sexually transmitted diseases can cause pain in the heel, even at rest and during sleep. Physicians also found that the cause of pain in the calcaneus can be chronic joint diseases, such as Bekhterev's disease, psoriatic arthritis, gout. 

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Fasciitis and its symptoms

The first symptom of fasciitis or "calcaneal spur" is pain in the heel when walking immediately after sleep or rest. Pain feels so unbearable that the victims of fasciitis try to tread as little as possible on their heels. After a while, the pain can subside, as it can return at the most unexpected moment or at the time of a sharp load on the legs. Such a painful effect arises due to the fact that while the person is in a stationary state, microfractures of the edematous chronically overloaded aponeurosis are cleared. However, it is worthwhile for a person to take several steps, as the fascia breaks again.

Doctors say that most patients complain about the dull aching pain in the middle part of the calcaneus. Such pain can torment the whole day without interruption. Particularly hard for people full and those who "on duty" is forced for a long time during the day is "on his feet." Such pain can move along the foot in the distal direction to the heads of metatarsal bones. There are cases when pain in the heel causes pathologies in the Achilles tendon region, but this phenomenon is rare. Medical observations suggest that most fasciitis occurs with prolonged daily loads, which a person, by force of habit, may not even pay attention. Athletes are more prone to the disease, especially those who decided to increase the systematic burden on their feet, for example, when running.

There is a theory that frequent changing of athletic shoes can lead to fasciitis, but in practice there are not so many such cases. Fatigue injuries in athletes, such as tendonitis or parenchymitis of the Achilles tendon, also in combination with plantar fasciitis, which is common in athletes, makes it difficult to deliver a more accurate diagnosis in a short time.  

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Neurological causes of pain in the heel

Mechanical damage to the heel can lead to the entrapment of the posterior and lateral tibial nerve, which can also turn a healthy man's foot into an Achilles heel. Such pain is mainly manifested in a state of rest. It can cause the development of low or hypersensitivity (hypo- or hypersthesia) in the distal parts of the foot. This complicates the process of diagnosis, since problems with nerve patency do not provide an opportunity to establish the exact causes of the disease. The pinching of the branches of the lateral calcaneal nerve and completely make the muscles adjacent to the bones insensitive, which makes it difficult for physicians to determine the diagnosis.  

The impact of systemic diseases on heel pain

The sensation of a "nail in the heel" can arise as a consequence of systemic diseases of connective tissues, such as Reiter's syndrome (arthritis, urethritis and conjunctivitis), Bechterew's disease ( ankylosing spondylitis ), systemic lupus erythematosus and others. If visually visible swelling in the area of the heel or joint below the ankle - it is necessary to beat the alarm and immediately go to the doctor. X-ray in this case does not help. Deeper diagnostic methods, such as magnetic resonance imaging, are necessary, and if heel pathologies associated with systemic diseases are detected, treatment should begin with the underlying disease, and only if the patient does not have any improvement is it necessary to begin treatment directly for heel pain. 

Treatment of pain in the heel

At the first symptoms of fasciitis or other pathologies associated with pain in the heel, in no case should one engage in self-medication, otherwise you can only hurt yourself. And it is not recommended to delay with a visit to a doctor. To establish a diagnosis, you need to consult an arthrologist, a rheumatologist or an orthopedist. Usually patients are preliminarily sent X-ray diagnostics, a general and biochemical blood test, and only after that they prescribe a course of treatment.

If you do not take into account the calcaneal disease and the rupture of the Achilles tendon, then usually resort to conservative treatment: the patient is advised to change shoes (so she does not rub her feet).

Local injections of steroids can help with calcaneal paratendinitis and plantar fasciitis. If conservative treatment methods do not alleviate pain in the posterior cortex bursa, then this bursa can be surgically removed.

Treating a sore heel is a long process. And to relieve pain, doctors advise to follow the following tips. 

1. Ice massage alternate with warming. The first two days after the appearance of acute pain, doctors advise to do an ice massage 3-4 times a day. The procedure continues for 5 to 7 minutes until the heel is numb. It is also recommended to apply ice once a day to the sore spot for 15 minutes, then take a 15-minute pause and immediately put a hot water bottle on the sore spot. Warm up the heel for about 15 minutes. 
2. Drink tablets. Weaken the inflammatory processes will help non-steroidal anti-inflammatory drugs, for example, ibuprofen or its more effective analogue. Preliminary consultation with a doctor is necessary. 
3. Use insteps and thrusts. In pharmacies, you can buy special insteps and thrusts, which weaken the body's load on the aching heel, protect against blows. Since there are many types of thrusts, the orthopedist will help in choosing the necessary "model". Supinators and orthopedic inserts - special orthopedic insoles - will also help to weaken not only the symptoms, but also contribute directly to the treatment of pain in the heel, especially if they are associated with injuries, flat feet and other mechanical injuries of the foot.
4. Increase the heel in the shoes. The essence of the advice is that you need to raise and fix the position of the heel in the shoes to reduce the load on it. This will help the heel insert, which is inserted into everyday shoes. It will increase the heel lift by 0.3 - 0.6 cm and greatly alleviate the pain. 
5. Stretch the heel with a massage. Poor elasticity of connective tissues in the area of the heel can cause painful sensations. To relieve pain, it is necessary to flex the tendons regularly. Sometimes doctors prescribe massages as the main treatment.
6. Do exercises for the feet. At arm's length, take a position near the wall, lean on it with your hands, put your hands on the width of your shoulders. Make a right foot step back, bend the left leg in the knee. Now you need to make a slope towards the wall, while you need to touch the right heel of the floor and keep your foot in this position for 10 seconds. You immediately feel how the muscles of the right calf will stretch. In the course of the exercise, you can approach the wall, while moving the right leg. Exercise is performed in 10 sets of the proportion of each leg. Pay attention to the fact that the load on the heel should be balanced, without excessive pressure at the moment of touching the floor. Do not make sudden movements.
7. Carefully choose the shoes in which you go. Comfortable and proper footwear is the guarantee of a healthy heel. When buying shoes, first of all, consider that the leg should feel comfortable. Pay attention to the line from the middle of the heel to the sock. If this line does not divide the lifting of the arch of the foot into two approximately equal parts, then in such shoes the load on the heel will be much stronger. In addition, shoes should be with a heel or an over-inflated foot, for greater stability. However, the heel should not exceed 0.8-1.2 cm, and the marking should be sufficiently elastic. Shoes should not be rigid. Shoes should also not be worn, as the damping properties of such shoes deteriorate significantly, which can exacerbate the pain in the heel. As soon as you notice that the sole is worn out more than 50%, you should go to the shoe store for a new thing.