Heel pain

The conditions of survival in the modern world force many people to spend a lot of time in motion and "on their feet", sometimes for whole days without the opportunity to fully rest. Such workaholism creates strong loads on the legs, which can ultimately lead to a heel injury. Heel pain creates a lot of discomfort, but many are used to enduring it.

Doctors do not advise to perform such feats and, if possible, do not delay and contact a doctor as soon as possible, because a sore heel is no joke, and you need to approach the treatment of this pain responsibly and not delay until the pain gets worse.

The heel, consisting of the heel bone and a soft fat layer, performs a very important shock-absorbing 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 a very vulnerable place, in fact, an Achilles heel.

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Causes of Heel Pain

1. Diseases of the heel bone.
2. Arthritis of the joint located below the talus.
3. Achilles tendon rupture.
4. Calcaneal paratendinitis (pain is felt deep in the Achilles tendon).
5. Retrocalcaneal bursitis (thickening of the bursa over the roughness of the calcaneus, on the back of the heel).
6. Pain in the heel (sub-heel) pad (in this case, pain is felt in the lower part of the heel).
7. Plantar fasciitis (pain under the front of the heel bone).

As statistics show, patients most often complain of plantar fasciitis - inflammation or rupture of the fibrous connective tissue strip that covers the entire sole from the heel to the toes. The sources of fasciitis can be both uncomfortable shoes and a violation of the bone structure due to heavy loads, flat feet and other mechanical problems with the feet. Heel pain can also be caused by inflammation of the tendon tissue, which is accompanied by a sensation of "needles in the heel". Rheumatoid arthritis is another source of heel pain. In such a situation, doctors recommend wearing shoes with an open heel.

Most often, people who are prone to obesity, have problems with the spine, flat feet have problems with heels. Athletes, especially athletes, often have problems with heel pain. Fasciitis mainly affects older people, but recently this disease has become much “younger” due to poor ecology, poor-quality food, and a stressful lifestyle. All these factors disrupt the body's metabolism and calcium metabolism, which makes bones and joints more vulnerable.

Trauma to the tendon, its overload due to flat feet, as well as a bruise of the heel bone can lead to heel pain. There are also infectious prerequisites for the appearance of a “nail in the heel”: gonorrhea, chlamydia and other sexually transmitted diseases can cause heel pain even at rest and during sleep. Doctors have also found that the cause of pain in the heel bone can be chronic joint diseases, such as Bechterew's disease, psoriatic arthritis, gout.

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Fasciitis and its symptoms

The first symptom of fasciitis or “heel spur” is pain in the heel when walking immediately after sleep or rest. The pain is so unbearable that victims of fasciitis try to step on their heels as little as possible. After some time, the pain may subside, but it can also return at the most unexpected moment or at the moment of sudden stress on the legs. Such a painful effect occurs because while a person is motionless, micro-tears of the edematous, chronically overloaded aponeurosis grow together. However, as soon as a person takes a few steps, the fascia ruptures again.

Doctors note that most often patients complain of a dull aching pain in the middle of the heel bone. Such pain can torment the whole day without a break. It is especially difficult for overweight people and those who are forced to be “on their feet” for a long time during the day “due to work”. Such pain can move along the foot in the distal direction to the heads of the metatarsal bones. There are cases when heel pain becomes the cause of pathologies in the area of the Achilles tendon, but this phenomenon is quite rare. Medical observations allow us to conclude that fasciitis most often occurs with long-term daily loads, which a person, due to habit, may not even pay attention to. Athletes are more susceptible to the disease, especially those who decide to increase the systematic load on their legs, for example, when running.

There is a theory that frequent changes in athletic shoes can lead to fasciitis, but in practice, such cases are not so common. Overuse injuries in athletes, such as tendinitis or paratendinitis of the Achilles tendon, and in combination with plantar fasciitis, which is common in athletes, make it difficult to make a more accurate diagnosis in a short time.

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Neurological Causes of Heel Pain

Mechanical damage to the heel can lead to pinching of the posterior and lateral tibial nerve, which can also turn a healthy person's foot into an "Achilles heel." Such pain mainly manifests itself at rest. It can cause the development of decreased or increased sensitivity (hypo- or hyperesthesia) in the distal parts of the foot. This complicates the diagnostic process, since problems with nerve conductivity do not allow us to establish the exact causes of the disease. Pinching of the branches of the lateral calcaneal nerve makes the muscles adjacent to the bones completely insensitive, which makes it difficult for doctors to determine the diagnosis.

The Impact of Systemic Diseases on Heel Pain

The sensation of a “nail in the heel” may 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 swelling in the heel or joint below the ankle is visually visible, it is worth sounding the alarm and urgently going to the doctor. X-ray will not help in this case. More in-depth diagnostic methods are necessary, such as magnetic resonance imaging and if “heel” pathologies associated with systemic diseases are detected, treatment should be started with the main disease, and only if the patient does not improve, it is worth starting treatment directly for heel pain.

Heel Pain Treatment

At the first symptoms of fasciitis or other pathologies associated with heel pain, in no case should you self-medicate, otherwise you can only harm yourself. And it is not recommended to delay going to the doctor. To establish a diagnosis, you need to contact an arthrologist, rheumatologist or orthopedist. Usually, patients are first sent for X-ray diagnostics, general and biochemical blood tests, and only after that a course of treatment is prescribed.

If we do not take into account diseases of the heel bone and rupture of the Achilles tendon, then conservative treatment is usually used: the patient is advised to change shoes (so that they do not rub the feet).

Local steroid injections may help with calcaneal paratendinitis and plantar fasciitis. If conservative treatments do not relieve the pain of retrocalcaneal bursitis, the bursa may be surgically removed.

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

1. Alternate ice massage with warming. Doctors recommend doing ice massage 3-4 times a day for the first two days after acute pain appears. Continue the procedure for 5-7 minutes until the heel goes numb. It is also recommended to apply ice to the sore spot for 15 minutes once a day, then take a 15-minute break and immediately apply a hot water bottle to the sore spot. Warm the heel for about 15 minutes.
2. Take pills. Nonsteroidal anti-inflammatory drugs, such as ibuprofen or its more effective analogue, will help reduce inflammation. Consult a doctor first.
3. Use insoles and heel pads. In pharmacies, you can buy special insoles and heel pads that reduce the body load on the sore heel and protect it from impacts. Since there are many types of heel pads, an orthopedist can help you choose the right “model”. Insoles and orthopedic inserts - special orthopedic insoles - will also help relieve not only the symptoms, but will also directly contribute to the treatment of heel pain, especially if they are associated with injuries, flat feet and other mechanical damage to the foot.
4. Increase the heel lift in your shoes. The gist of the advice is that you need to raise and fix the position of your heel in your shoes to reduce the load on it. A heel pad, which is inserted into everyday shoes, will help with this. It will increase the heel lift by 0.3 - 0.6 cm and significantly relieve pain.
5. Knead your heel with a massage. Poor elasticity of the connective tissues in the heel area can cause painful sensations. To relieve pain, you need to regularly knead the tendons. Sometimes doctors prescribe massages as the main treatment.
6. Do exercises for your feet. Stand at arm's length near a wall, lean your palms on it, and place your hands shoulder-width apart. Step back with your right foot, bend your left leg at the knee. Now you need to lean toward the wall, touching the floor with your right heel and holding your leg in this position for 10 seconds. You will immediately feel how the muscles of your right calf stretch. As you do the exercise, you can move closer to the wall, moving your right leg. The exercise is performed in 10 approaches for each leg. Note that the load on the heel should be balanced, without excessive pressure when touching the floor. Do not make sudden movements.
7. Choose your shoes carefully. Comfortable and correct shoes are the key to a healthy heel. When buying shoes, first of all, consider that your foot should feel comfortable. Pay attention to the line from the middle of the heel to the toe. If this line does not divide the rise 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, the shoes should have a heel or a high rise of the foot, for greater stability. However, the heel should not exceed 0.8 -1.2 cm, and the outsole should be sufficiently elastic. Shoes should not be rigid. Shoes should also not be worn out, since the shock-absorbing properties of such shoes are significantly worsened, which can increase heel pain. As soon as you notice that the sole is worn out by more than 50%, it is worth going to a shoe store for a new pair.