A condition in which heels hurt may occur due to a variety of reasons, which requires detailed examination and treatment of various specialists (traumatologist, surgeon, rheumatologist, oncologist, infectious diseases specialist, and even a TB doctor). The following are the main diseases that may cause pain in this anatomical region.
Causes of heel pain not related to any disease
- Wearing a high heel for a long time leads to an overstressing of the foot tissues;
- With an increase in motor activity;
- Rapid increase in body weight.
In a separate group, it is necessary to endure such a common disease as dry corns (see how to get rid of dry corns). It not only causes a lot of inconvenience, but also causes severe pain with walking over time.
Plantar fasciitis (heel spur)
It is characterized by pain of inflammatory genesis, in the projection of the heels, due to stretching or long-term damage by the growth of the plantar fascia of the calcaneus. This pathology occurs due to prolonged standing on the legs, injury to the bones of the foot or flatfoot. The course of this disease forms a pathological circle, that is, the inflamed fascia is involved in the formation of bone growth (osteophyte) on the heel, and the latter is constantly traumatizing it does not allow this process to subside. Due to this, the heels of such patients constantly hurt and without remission phases. The pain syndrome subsides only after the heel spur treatment has been undertaken and then only briefly. Heel pain is especially pronounced immediately after sleep, as well as after walking or running.
Achillitis (inflammation of the Achilles tendon)
The inflammatory process in this anatomical formation occurs due to constant loads on the calf muscles (climbing the mountain, jumping), wearing uncomfortable squeezing shoes and walking on high heels. The disease is characterized by pain in the projection of the tendon, and throughout its length. In addition, pain necessarily occurs above the heels of the average intensity and swelling of the tendon itself. In the absence of treatment and reduced immunity, purulent inflammation of the Achilles tendon may occur, then the pain over the heel becomes more intense, to the extent that a person cannot step and step. In addition to this, inflammation can reach such a level that a tendon rupture can occur. This condition requires emergency medical care.
Osteochondropathy heel bone
The essence of this pathology is that for unknown reasons, sterile necrosis begins to develop in those areas of the spongy substance of the calcaneus, to which the greatest burden falls. A characteristic symptom is pain that occurs in the heel at the slightest load. Walking with such an illness brings severe pain to the patient, which is almost not relieved by anything. Patients move only with crutches or walking sticks, while advancing only on the forefoot. The skin over the heel is almost all the time swollen and with symptoms of malnutrition (atrophy). Over time, an atrophy of the muscles of the leg.
Bursitis in the calcaneus
This pathological condition is manifested by classic symptoms of inflammation, namely: edema, pain, impaired function, local temperature increase, redness.
This disease is characterized by inflammation of the periosteum due to excessive loads. Often this pathology occurs in athletes and weightlifters. Heel pain and inflammation of the periosteum ceases several weeks after the cessation of stress.
Sarcoma of the calcaneus
It is characterized by the fact that the pain syndrome is at first less pronounced and is easily removed with the help of analgesics, but after some time it becomes more intense. Along the way, symptoms of cancer intoxication appear (weight loss, exhaustion, anemia). With the progression of tumor growth, pathological fractures of the calcaneus can be observed.
Peripheral nervous system diseases
Neuropathy of the tibial nerve, namely its median branches
Manifested by a violation of the flexion function of the foot and trophic disorders in the skin above the heel. A feature of this pathology is that the pain in the heel area is replaced by a complete numbness. Long-existing neuropathy leads to the appearance of trophic ulcers in the heel area.
Heel bone fracture
It occurs with a strong blow in the projection of the heel. Characterized by the fact that the victim can not focus on the heel, and even more so to take steps. Movement in the ankle sharply limited due to the resulting hematoma and pronounced pain syndrome.
Depending on the extent of the injury, the clinical picture is similar to the fracture of the calcaneus and the integrity of the heel can be diagnosed only by X-ray. Even a few weeks later there is pain in the heel when walking.
It is a separation of cartilage tissue between two points of ossification. This condition occurs only in children from 7 to 16 years with a heel injury or increased physical exertion. It should be noted that often there is pain in the heel after sleep, that is, without any physical exertion.
Diseases caused by infection
Tuberculosis of the skeletal system
This infectious disease also affects the calcaneus, which leads not only to severe pain syndrome, but also to caseous necrosis of the bone tissue inside the heel. In the absence of adequate treatment, a fistula is formed, which tends to periodic remission and re-inflammation with the release of purulent contents from the bone (see how tuberculosis is transmitted).
This pathological condition is characterized by the fact that inside the bone there is necrosis caused by purulent fusion of tissues, due to the multiplication of microorganisms. The disease is characterized as common (body temperature up to 39 degrees, general weakness, weight loss) and local symptoms (fistula in the calcaneus, which releases a significant amount of pus to the outside). The heel is swollen, and the venous vessels above it are sharply dilated due to compression by pasty tissues. Read more about the symptoms and treatment of osteomyelitis.
Pathology caused by metabolic or systemic diseases
Clinical manifestations are very similar to rheumatoid arthritis, but due to external manifestations on the skin, it is possible to distinguish them. One of the first symptoms will be the sudden onset of pain in the heels at rest, sometimes an increase in the joint due to the accumulation of pathological fluid in it. Patients usually do not associate pain with the underlying disease, as a result of which the wrong treatment tactics are chosen.
Gout is a pathological condition characterized by the deposition of urates, that is, uric acid salts. Already at the beginning of the disease there is a sharp pain in the joints, in this case in the heels, big toes, redness and swelling of the skin over them. Often these symptoms occur at night. During palpation, there is an increase in the temperature of local tissues and their pain. Without the treatment of gout (including folk methods), such symptoms last several days or weeks, depending on the stage of the disease. In addition to the pain in the heels, pains in the area of the joint of the big toe, as well as the ankle, knee and hip joints are more common. The inflammatory process may involve the fingers and the Achilles tendon.
It refers to inflammatory and degenerative diseases of the spine and joints. The essence of ankylosing spondylitis is that the body produces antibodies to its own ligaments and joints. As a result of such processes, the ligamentous-articular apparatus of the spine begins to ossify, the vertebrae fuse together, the flexibility and mobility of the spinal column completely disappear. One of the first manifestations of this disease is severe pain in the heels, as a result of which the patient cannot stand on the floor.
This disease is considered to be one of the most severe of its kind, as evidenced by the rapid onset and persistent complications of almost all joints of the human skeleton. At the beginning, pains of moderate intensity, swelling and decreased mobility in the joints appear. It should be noted that heel pains are a rare symptom in this disease, but if they started, this indicates involvement of all joints of the foot in the process. Pain occurs both at rest and at the slightest load on the leg.
Diagnosis of pain in the heel area
- Patient complaints and clinical examination
- Complete blood count for the detection of anemia or leukocytosis
- Blood chemistry
- Oncological markers
- X-ray of the ankle and foot bones on both sides
- Radiography of the chest and abdomen
- Spiral computed tomography
- Osteoscintigraphy (bone scan, mainly used to detect metastases, necrosis, or fistulas)
- Densitometry (study of bone density)
- Ultrasound of the ankle
How to treat heel pain
It is important to understand that heel pain should be treated immediately after making a preliminary diagnosis. Until that time, all activities should be aimed only at relief of pain, since the latter significantly impairs the quality of life.
In order to reduce pain, the following measures should be used:
- Daily steaming of the feet in warm water followed by rubbing non-steroidal anti-inflammatory ointments (diclofenac 1 and 5%, diprilif, fastum gel, etc.);
- According to the indications and pain syndrome of medium intensity, this series of drugs can be used inside and is administered intramuscularly, but if there is no disease of the stomach and duodenum. Such drugs include: dicloberl, ibuprofen, movalis, nimesil, fanigan, dexalgin and ketans;
- Also, in case of severe pain, blockade is performed (diprospan with lidocaine 2% injected at the point of greatest pain), this method is most justified for heel spurs or arthritis;
- Trophic disorders in the heel area are treated with drugs that improve blood rheology and enhance blood circulation (tivortin, actovegin);
- In the presence of dry corn, treatment consists of the use of special patches that erode it or the use of a solution of lactic acid in the preparation of kolomak;
- Various types of surgery (removal of part of the bone, sequestration or spur);
- For all types of pain in the heel area, the use of foot massage, exercise therapy exercises (walking on the toes, on the edge of the foot) and wearing orthopedic insoles is shown;
- An important therapeutic and preventive measure in almost all pathologies that cause pain in the heel area is to reduce body weight and wear comfortable shoes.