Heel pain is an unpleasant or painful sensation that occurs during pathological processes in the calcaneus, surrounding soft tissues. They can be aching, stabbing, pulling, bursting, dull, sharp, long-term, short-term. Most often provoked by support on the heel, they appear after standing and walking, less often they are noted at the beginning of movements. The causes of pain in the heel are established using the results of a survey, examination, radiography, CT, ultrasound, and other studies. Before making a diagnosis, it is recommended to unload the foot, sometimes taking analgesics is acceptable.
The most common physiological causes of heel pain are:
The pains are usually aching or burning, associated with being on the legs, may be accompanied by heaviness, swelling of the feet and legs, disappear after rest.
A heel bruise is more often detected in children after jumping from a small height. When landing, there is a moderate, gradually subsiding pain. The pains are superficial, localized along the plantar surface, acquire a aching character, subside when the limb is elevated, disturb when resting on the heel, because of which the victim steps “on the toe” when walking. Swelling is slight to moderate, bruising is rare. All symptoms disappear within 1 or 2 weeks.
Rupture of the Achilles tendon is the result of a sharp contraction of the muscles, occurs during overload, the beginning of a workout without a previous warm-up. Less often it is determined after a direct blow to the tendon. It manifests itself as a sudden sharp pain along the back of the heel, sometimes in combination with the characteristic crackle of torn fibers. A "failure" is formed at the rupture site, edema rapidly increases. With complete damage, lifting the heel is impossible, with a partial rupture, movements are preserved, moderately limited due to pain.
A calcaneal fracture is diagnosed after a fall from a height of 2 or more floors, and is more often found in young men. It is manifested by a sharp, explosive, unbearable pain. Then the intensity of the pain decreases slightly, but after a while it may increase again due to increasing swelling. The pain is diffuse, sharp, sometimes throbbing. The heel is enlarged, cyanotic, covered with bruises. Support is impossible, palpation is sharply painful, in some patients a bone crunch is heard during palpation.
A pathological heel fracture occurs in older women with osteoporosis and in people with diseases that reduce bone strength. It develops with a minor injury, characterized by moderate or non-intense pain. In the future, there are long-lasting aching pain, aggravated by walking, difficulty resting on the heel. When probing, the edema is insignificant or absent, palpation is moderately painful, sometimes a crunch of fragments is heard.
Damage to the ligaments of the ankle joint is determined by turning the leg inward or outward. It manifests itself as a sharp pain in the area of the outer or inner surface of the heel (in the projection of the location of the corresponding ligaments). Subsequently, the pain becomes aching, arching, a rapidly growing edema is revealed, and bruising is often found. The support is limited, palpation of the ligament is sharply painful, pain increases when you try to deviate the foot in the direction opposite to the damaged ligament.
Heel pain
Tendonitis of the Achilles tendon occurs due to constant overload of the Achilles, diagnosed in athletes, usually accompanied by the development of Achilles bursitis (inflammation of the superficial bursa). Initially, it is characterized by short-term, non-intense, superficial aching pains in the back of the heel and just above it in the first minutes of training.
Within a few months, the pain intensifies, their duration increases. Subsequently, the pain syndrome does not disappear, but increases after a warm-up, and remains at rest for a long time. Patients often complain of pain when going up and down stairs. Edema, hyperemia, local hyperthermia are noted, Achilles palpation is painful.
Haglund's deformity is more often determined in women 20-3 years old. The pain syndrome is caused by the development of tendonitis and bursitis of the deep bag of the Achilles tendon, which is compressed between the bone outgrowth and the hard heel of the shoe. Patients complain of pressing, drawing pains behind the heel while walking. With an increase in the load, the pain intensifies, becomes sharp, cutting, burning. In the affected area, a small dense "bump" (exostosis) is palpated, over which calluses often form.
Heel bursitis is provoked by the appearance of a heel spur, diagnosed in patients older than 4 years, more often in women. It is manifested by pain, most pronounced at the beginning of the movement. In some people, pain is not intense, pressing, aching, and disappears after a few steps. In others, pains are burning, shooting, baking, persist throughout the entire period of walking, disrupt gait. In especially severe cases, support on the heel becomes impossible, patients are forced to use crutches.
Sever's disease (calcaneal apophysitis) develops in children 10-15 years old, more often in boys. Accompanied by a gradually growing first pulling, aching, and then burning, bursting pain below the Achilles, aggravated by running and rising on tiptoe. The pain decreases at rest, especially when bending the knee, turning the foot on the outer edge. External changes are absent or expressed slightly. On palpation, the maximum pain is determined by the posterior and posterior surfaces of the heel.
Pain in the heel region can be provoked by arthritis of the subtalar or talocalcaneal-navicular joint. Inflammation of these joints sometimes occurs with rheumatoid, infectious arthritis. Rheumatoid arthritis is characterized by a chronic course, a combination with damage to the toes. Infectious arthritis develops after acute infections. Common symptoms are morning stiffness, pain, worse when standing and walking, subsides after rest.
Arthrosis of these joints is detected after injuries or is idiopathic in nature. Accompanied by "starting pain", crunching, minor or moderate pain, aggravated by movement. Then the intensity of pain gradually increases, the pain begins to disturb before the weather changes, at night. The course of the pathology is undulating, during periods of exacerbations, swelling of the foot is possible. Over time, there are deformations, restrictions of movement.
Hematogenous osteomyelitis of the calcaneus is rare, found in children and adolescents, occurs as a result of infection from a distant focus. It is characterized by a rapid onset, an increase in temperature to 39-40 ° C, a pronounced intoxication syndrome, localized bursting, boring, tearing intense pain in the heel.
To reduce pain, the child lies absolutely still, screaming in pain at the slightest movement. Within 2 days, local manifestations increase: edema, hyperthermia, hyperemia. By the end of 1-2 weeks, the severity of pain decreases, the condition improves somewhat, fluctuation can be determined in the affected area.
Exogenous osteomyelitis can be post-traumatic (with open fractures, deep wounds) or contact (usually with trophic ulcers in patients with diabetes mellitus). Accompanied by an increase in existing symptoms: worsening of the general condition, fever, increased edema. Pain in the post-traumatic form is intense, tearing, boring, with contact - moderate, pulling, arching. In the first case, a large amount of pus is released from the wound, in the second, fistulas form.
Shinz's disease is diagnosed in adolescents, mostly girls. It is manifested by acute or gradually increasing pain in the heel. Pain occurs during exercise (running, jumping), then with any attempt to lean on the heel region. The intensity of the pain syndrome at the height of the disease varies, in some patients the pain remains moderate, in others it reaches the degree of unbearable, excludes the possibility of full support on the foot. At rest and at night, pain is absent. There is swelling without signs of inflammation.
Water calluses often form on the back of the heel, associated with rubbing with tight or uncomfortable shoes. At the initial stage, the pain is insignificant, accompanied by local swelling, redness. After the appearance of the bubble, the pain sharply intensifies, becomes burning. When the bladder is opened, a painful wound remains on the skin.
When the corn is infected, a corn abscess develops, characterized by pulsating, jerking pains, an increase in edema and hyperemia, clouding of the contents of the bladder, and an increase in body temperature to subfebrile numbers. The process of formation of an abscess takes place against the background of night pains that deprive you of sleep. After opening the abscess, the condition improves, with a breakthrough of pus into the surrounding tissues, the pain intensifies, becomes diffuse, the general condition worsens.
A plantar wart is a slightly protruding zone of compaction up to 1-2 cm in diameter, located on the plantar surface of the heel. Initially, the wart is painless, but due to pressure and friction, it is constantly injured, which causes discomfort, pressure, stabbing, burning pain in the foot, especially after a long walk.
With hyperkeratosis of the feet, hemorrhages, calluses and cracks form on the heels. All of these conditions are accompanied by pain. With corns, burning, twitching predominate, with cracks - stabbing, cutting pain, which is aggravated by walking, using uncomfortable shoes. The general condition does not suffer, however, the chronic course of the pathology negatively affects the quality of life.
A trophic ulcer is determined in patients with diabetes mellitus with diabetic foot syndrome, it is formed with severe varicose veins, post-thrombophlebitic disease. The patient complains of jerking, pressing, pulling pain in the heel against the background of rapid fatigue, intermittent claudication, and swelling of the feet. The pain syndrome is usually moderate or non-intense, sometimes the appearance of ulcerative necrotic defects is accompanied only by vague minor pain sensations or indefinite discomfort.
Burning pains, combined with hypersensitivity, numbness or paresthesias, are characteristic of calcanodynia - neuropathy of the calcaneal branches of the tibial nerve. Pain syndrome appears after prolonged walking barefoot, using shoes with too thin soles, jumping from a height. In some cases, the pain is so intense that the patient walks "on the toe", not leaning on the heel.
Sometimes complaints of pain in the heels are presented by patients with mental disorders - neurosis, depression, hypochondria, schizophrenia. In case of violations of the neurotic level, pains have a “rich” set of shades, they are emotionally described as shooting, twisting, burning, aching, etc. In severe psychopathology, the pain syndrome becomes pretentious, unusual, sometimes clearly delusional interpretations.
Traumatologists are engaged in finding out the causes of pain in the heel. If there are indications, patients are referred to dermatologists, surgeons, neurologists, and other specialists. The diagnosis is made on the basis of data from a survey, examination, and additional studies. The following diagnostic procedures may be prescribed:
Therapeutic exercise for heel pain
In case of heel injuries, immobilization is carried out with a splint, cold is applied, and an anesthetic is given. In case of inflammation of the tendon-ligamentous apparatus, arthrosis of the joints, the tarsals limit the load, apply local anesthetics and anti-inflammatory drugs. Sharp pains, worsening of the general condition, hyperthermia, local signs of inflammation and suppuration are indications for immediate referral to a specialist.
Conservative treatment for heel pain is usually a combination of medical therapy and non-pharmacological methods. The following techniques may be applied:
The tactics of surgical interventions are chosen taking into account the nature of the pathology. It is possible to carry out the following open manipulations:
Sometimes operations are performed for Haglund's deformity, Schinz's disease, arthrosis of the tarsal joints, and other diseases of the heel region. In the postoperative period, rehabilitation is carried out, including exercise therapy and physiotherapy.