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Pain in the heel
Heel pain is a discomfort in the back of the foot that is usually very uncomfortable because walking alone can be very difficult. The heel carries most of the body weight and is therefore heavily loaded anyway. In the event of physical overload, the heel reacts quickly with pain, whereby the stress can spread to the foot, knee and hip joints as well as to the lumbar and neck spine. Pain in the heel area is a common foot problem, which in most cases is caused by inflammation of the Achilles tendon, a heel spur or bursitis, but can usually be relieved quickly and effectively with relatively simple measures.
Symptoms and discomfort
Pain in the heel occurs in different forms. Typical is the so-called “start-up pain”, which occurs in the morning or after lying or sitting for a long time after the foot has not been moved for a while. This form of heel pain often subsides initially during the movement, but returns after another period of rest.
In some cases the pain is so severe that it is almost impossible to walk for the first time and a walking aid is required. In addition, heel pain manifests itself, for example, as severe pressure pain on the tendon attachments or as a stabbing pain inside to the center of the sole area of the heel. Other sufferers report rather dull foot pain in the heel area, which can also occur when at rest.
Functional causes of heel pain
The most common reason for pain in the heel is overloading the Achilles tendon. This can be caused, for example, by muscle imbalance, weak ligaments at the ankles or deformation of the foot. If there is a permanent overload, in many cases there is chronic inflammation (tendinitis), which can result in tissue damage and partial tears. In severe cases, this can even lead to a tendon tear.
The trigger for a permanent overloading of the tendon is mostly sporting activities that involve running or jumping. Because the muscles work e.g. not compensated for by tension or shortening, this results in a one-sided and therefore unfavorable load on the Achilles tendon. In addition - especially in sports - there are other factors that can favor Achilles tendon pain. These include poorly fitting shoes, a lack of warm-up exercises and incorrect technique when practicing the sport.
In the event of inflammation of the tendon, sharp pain and visible swelling in the area of the tendon occur in connection with physical stress (walking, running, jumping etc.), which usually become more intense during the activity. If there is already a permanent inflammation, the symptoms usually appear when you get up, then become fewer to return to after the next rest phase. In this case, the tendon is already thickened in some places and extremely sensitive to pressure in the affected areas.
Inflammation at the base of the Achilles tendon
Another cause can be an inflamed Achilles tendon insertion, which often occurs in combination with bursitis and a bone outgrowth, a so-called "heel spur".
Inflammation at the base of the tendon also causes pain when starting, especially when climbing. Here, a pressing pain appears more selectively inside, outside or behind in the middle of the heel. With bursitis, however, strong local pain is usually reported.
Inflammation of the tendon plate
Inflammation of the tendon plate on the sole of the foot (also called "plantar fasciitis") is often responsible for pain in the heel. This type of inflammation shows changes in the connective tissue of the tendon, fine tears, calcifications and swelling.
The cause of plantar fasciitis has not yet been clarified. Experts agree, however, that running sports can promote inflammation of the tendon plate. On the other hand, misalignments of the foot (e.g., lowering or kinking-lowering foot, spreading-lowering foot), shortened calf muscles, rheumatic complaints, obesity or professions in which there is a lot of walking or standing are considered risk factors.
Here, too, a heel spur can develop in parallel, which applies to every second affected person. In comparison to the heel spurs that can occur in the course of inflammation of the insertion of the Achilles tendon, this is a lower or front spur on the sole of the foot, which occurs more frequently than an upper spur.
Characteristic of plantar fasciitis are heel pain in the heel area, which in most cases occurs in the morning when you get up in the morning and intensify as you move. The pain can radiate not only in the whole foot, but also in the lower leg. Often these also occur on the inner edge of the foot, the frequently occurring heel spurs also cause a stabbing pain in the heel when walking and standing.
Other causes of heel pain
The cause of the symptoms can be a so-called over-leg, as well as genetic predisposition and wear or a deteriorating tissue quality. Some of the injuries that occurred years ago are the reason for the pain in the heel. Other possible reasons include rheumatic complaints and certain metabolic and circulatory disorders such as diabetes or gout.
Weak ligaments on the foot or an ankle arthrosis, misaligned feet (kink-flat foot or spreading foot etc.) as well as misalignments of the legs in the form of so-called X-legs and bow legs can lead to heel pain. The same applies to incorrect, unsuitable footwear. Overweight can also be used as a trigger, since the feet are exposed to a permanently higher load in this case.
In the event of inflammation of the tendon or tendon sheath, pressure pain can usually be triggered in the lower part of the Achilles tendon (approx. Two to seven centimeters above the tendon insertion), and pain also appears when the foot is moved. When the foot is moved, thickening can be felt on the tendon, and in some cases there is even a slight crunching sound.
If the tendon attachment is inflamed, pressure is exerted on the tendon base, which occurs when the forceps grip the tendon edge between the tendon and the heel bone. Stretching the tendon, for example by pulling the foot upwards, intensifies the pain significantly.
With the use of ultrasound, tendon complaints, calcification, inflammatory compaction or cracks appear in many cases. With the help of so-called magnetic resonance tomography, even minimal defects in the tendon can be detected. Further information on the clinical picture can be given by X-rays of the foot (heel, upper ankle), whereby a heel spur would also be recognized here.
If an inflamed sole plate is responsible for the discomfort, pressure on the affected areas causes pain, which increases when the affected person pulls their toes up and tightens the tendon plate. Ultrasound can make thickening in the tendon plate visible and heel spurs can be detected.
Treatment options for heel pain
Heel pain caused by acute overload can in most cases be treated effectively with simple, non-surgical measures. This primarily includes consistent protection of the foot by avoiding long and demanding activities such as running, jogging or sport and wearing “healthy”, i.e. not too small or too high shoes.
Other sensible measures include treating the heel with cold by placing cooling pads or ice cubes wrapped in a towel on the painful area for about five minutes. In the case of overweight, consistent weight loss is advisable.
The classic therapy measures include, on the one hand, wearing individually adapted insoles, which have a supportive effect by correcting incorrect foot functions and thereby relieving pain. On the other hand, regular, daily training in the form of stretching exercises is recommended in order to stretch calf muscles and Achilles tendons, thereby minimizing and effectively preventing heel pain.
- Sit on the floor and stretch out your legs
- Place a cloth or towel around the affected foot
- Use it to pull your foot back towards your body
- Hold the stretch for about 15 seconds
- Then loosen your foot
- Repeat the exercise 10 times
Tip: Alternatively, the exercise can be done with the knee bent to stretch the Achilles tendon.
If there are complaints, it is important to do the exercises regularly, i.e. to be carried out at least twice a day and over a longer period of time. If the pain is severe or has persisted for a long time, you should first consult a doctor.Stair exercise for heel complaints:
- Stand with the balls of your feet on a step
- Slowly lower one or both of your heels down into the void until you feel a stretch in your calf muscles
- Hold this position for 10 seconds
- Repeat the exercise 20 times
Heel cushions or heel pads provide additional support, through which effective pressure relief can be achieved. Alternatively, so-called foot cuffs are suitable, which relieve not only the heel, but the entire foot.
Orthopedic aids for the foot and consistent physiotherapy are particularly important for chronic complaints. There are various offers here, from special connective tissue massages, foot and calf exercises, special insoles and shoe corrections (e.g. a heel increase), which can compensate for different leg lengths.
If major damage has already occurred, surgery cannot be avoided in some cases. This removes the affected tissue and, if necessary, an endogenous tendon graft is used for stabilization. After the operation, the "normal function" of the foot is restored step by step and usually for weeks, using physiotherapy exercises and an orthopedic special shoe with a raised heel.
Naturopathy for heel pain
In addition to the conventional medical approach, naturopathy offers help for heel pain: With transcutaneous electrical nerve stimulation (TENS), for example, electrical impulses are generated by a device and transmitted through the skin to the nerves, these impulses stimulating the body's pain-relieving systems and the irritated nervous system again calm down. As a result, the pain loses intensity and less medication is usually required for treatment. The TENS device is practically no risk for the person concerned and can be used from home after instruction by the practitioner.
In addition to transcutaneous electrical nerve stimulation, homeopathy offers various means for the natural treatment of the symptoms. Arnica is recommended for general overuse, sensitivity to touch and pain (also for external use). Ruta graveolens (garden rhombus) comes into consideration after physical overuse (also for external use), however, with boring, periodic pain or numbness, Hekla lava (volcanic ash from the Hekla volcano) can be the method of choice.
Osteopathy is often used by patients with heel pain as an alternative or supplement to conventional medical treatment methods. In this concept of manual diagnosis and treatment, it is usually considered beyond the heel what the general body tension and the statics of the person concerned are like. Based on this, the Rolfing method is then used, for example, to loosen bonded connective tissue structures by applying gentle but targeted pressure, thereby providing an overall better, more upright posture.
In osteopathy it is assumed that irritation of the supplying nerves on the spine or on the way to the heel can also cause pain. Accordingly, the treatment clarifies whether back pain, low back pain, buttock pain or previous illnesses such as vertebral sliding or ankylosing spondylitis exist or have existed. (No)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Social Science Nina Reese, Barbara Schindewolf-Lensch
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