Why do heels hurt?

Pain in the heel is a painful ailment in old age, which causes considerable discomfort and hinders normal movement. In both cases, the pain is greater in people who are active in sports.

Walking pain in the heel can be a signal of illness, fatigue, or an alert for lifestyle changes. Heel pain should not be underestimated not only because of the discomfort, but also because of the overall condition of the body. What are the causes of heel pain and how do I deal with it?

Heel pain when walking can be caused by many conditions, such as plantar fasciitis, Haglund’s disease, tarsal syndrome, and Baxter’s neuropathy.In each of these cases, proper diagnosis is key in the treatment process. In order to avoid degenerative changes, significant intensification of pain symptoms, and possible nerve damage, consult an orthopedist for diagnosis and initiation of an appropriate treatment procedure.

What is a heel spur?

Many patients come to the orthopedist with naggingheel painand ask if the cause of their ailments may be the so-calledheel spur. This common name refers to plantar fasciitis and is found quite often. Patients report to the doctor a sudden and very distressingpain in the back of the heel, in the area of ​​the plantar. In this case, the problem is in the soft tissue (aponeurosis) that extends from the heel tumor to the toes. The concept of the heel spur is derived from the radiological image, where the x-ray shows the appendix, i.e. the heel spike. It is formed as a result of inflammation in the place where the heel bone meets the heel fascia.

What are the symptoms of plantar fasciitis?

The heel spur problem affects both women and men. It occurs more often in the elderly who are working or staying up late as a result of degenerative and overload changes. People who are obese and who have a limited range of motion in the ankle jointare particularly vulnerable to heel pain .Overweight people experience flattening of the longitudinal arch of the foot, causing the calcaneal fascia to stretch even more. This pathology often occurs in athletes, especially runners, whose workouts are too intense. It can also be the result of many years of wearing high-heeled shoes by women. The main symptom is a shooting pain under the heel, felt in the morning as you take the first few steps after getting up. Sometimes the pain in the heel stops at night during the day and comes back in the evening, spreading to the entire heel. Pain that occurs on the medial side of the heel is often accompanied by tension in the plantar fascia with the simultaneous difficulty in dorsiflexion of the foot.

Diagnosis and treatment of plantar fascia

In the diagnosis of heel pain, palpation is recommended as the tenderness of the heel spur is very high. In order to diagnose the heel spur, it is necessary to perform an X-ray examination, which can reveal whether theheel painwe are struggling with is related to the presence of an acute bone growth on the heel. The doctor may additionally order a magnetic resonance imaging test to detect any abnormalities in the plantar fascia. MRI can also show invisible stress fractures causingsevere pain in the back of the heel (the sole of the foot). In the mildest form of plantar fasciitis, it is usually enough to select appropriate footwear, use an insole that absorbs loads on the heel bone, and perform stretching exercises. Of course, we cannot count on the pain to stop immediately. The process of conservative treatment of this type of heel pain, where we try to combat the causes of the pathology, is unfortunately long-lasting. In a more advanced form, pharmacotherapy with non-steroidal anti-inflammatory drugs or injectable steroids may be helpful. In this case, care should be taken as theplantar fascia is injected as it may carry the risk of its interruption, significantly complicating the further treatment process. The mainstay of treatment is physiotherapy. Because this disease is very often accompanied by calf muscle contracture or disturbed foot structure, the treatment is comprehensive.

When is heel spur surgery necessary?

Heel spur surgeryis performed in cases where the sore heel, after non-surgical treatment, for which up to12 monthsis usually allocated , still causes symptoms. Plantar fascia surgery usually involves a partial incision of the fascia itself. In the past, various techniques were used. It was important to sufficiently visualize the operated area. Currently, we most often perform the endoscopic procedure, using two small incisions in the skin that allow the insertion of appropriate tools with the camera. The interference with the structure of the foot is not large. The procedure is associated with a low risk of complications, but the doctor performing the procedure must be careful because he is operating close tothe Baxter’s nerve. After surgery, the patient quickly recovers. Gypsum immobilization is not used. The very next day after the procedure, it is recommended to do exercises so that the foot function returns to its original state. Elbow crutches are used for two weeks so as not to feel pain. The prognosis after plantar fascia surgery is very good.Heel pains should no longer be a problem. Athletes whose pain has subsided can return to their former training program.

What is Haglund’s disease?

The disease was first described in 1927 by Patrick Haglund. The condition has been described as idiopathic, meaning there is no apparent cause, although doctors have linked it to several factors.Haglund’s heel, otherwise known as Haglund deformation, is a condition in which an extra portion of the heel bone protrudes, causing irritation and inflammation. This is clearly shown by the X-ray picture of the patient before the surgery. Just as human noses can have different sizes and shapes, there can be variations in the size and shape of these bones. The protruding bone may rub against the overlying Achilles tendon and cause tendon pain.Back heel painin this case, it is not the result of a single injury, and depends more on physical activity and strenuous training (especially running, as well as related sports such as football). However, this is not a rule, becauseheel painalso occurs in people who have nothing to do with sport.

The soft tissue on the calcaneus, near the Achilles tendon attachment, becomes irritated when the bone rubs against the shoe while walking. This often leads to the painfulinflammation of the Achilles tendon bursa. The heel bone tilts slightly outwards, which increases the likelihood of your heel rubbing against the back of the shoes. The heel painwe feel is getting worse. Contrary to appearances, pain ailments are not accompanied by too tight shoes but by poorly profiled and too stiff heel counters present, for example, in women’s pumps, men’s winter boots, galoshes, or even ice hockey skates or roller skates. Some scientific studies state that it has a Haglund deformity to some extent, heredity (anatomy of the feet-the shape of the calcaneus and the hollow of the foot) and being overweight also play a role.

What are the symptoms of Haglund Deformation?

The first symptom ispain in the back of the heel, i.e., the calcaneus tumor, with no obvious signs of swelling. Initial symptoms are mild, leading only to discomfort when walking. Patients experience pressure on the back of the heel, especially when putting on shoes. Initially, the symptoms are not so painful and bothersome as to make you go to the doctor immediately with pain in the heel. In this way, the deformation process of the calcaneuscontinues to develop. Over time, the aforementioned pain intensifies, causing a marked limp during the walk.Heel painmost often occurs after exercise or in the morning, but rarely occurs at night. Over time, a deformity develops on the heel tumor along with a painful swelling, as clearly shown in the posted photo. The heel bone in such an advanced stage of disease is very painful. It is especially felt during the dorsiflexion movement of the foot. The next stage may be an inflammatory process within the Achilles tendon attachment to the calcaneus.

Diagnosis and treatment of Haglund’s disease

Haglund’s deformitycan be confirmed on the basis of a physical examination, however, in order to be absolutely sure and to exclude other causes of heel pain, e.g. to assess the structure of the heel bone, X-rays must be performed in the diagnosis.A aching heel in the case of Haglund deformity, with a properly diagnosed and started conservative treatment at an early stage,gives a good prognosis for the patient. Non-surgical treatment of Haglund’s deformity, which begins with rest and a significant reduction in physical activity, is aimed at reducing the inflammation of the bursa. To reduce the swelling, apply ice packs to the place of inflammation (cool the heel for 20 minutes, then repeat the process after a break of at least 40 minutes). Your doctor may give you oral non-steroidal anti-inflammatory drugs (e.g. ibuprofen) to reduce pain and inflammation.

Your doctor may also recommend an ultrasound-guided injection of corticosteroids into your bursa, which can help with diagnosis and treatment. In contrast, steroid injections directly into the Achilles tendon are not recommended as they can weaken the tendon, which can lead to tendon rupture. Lower limb stretching exercises are also important to help relieve tension in the Achilles tendon. Another element is the modification of shoes in order to reduce the irritating factor of the sick bursa. You can think about the selection of orthopedic insoles (full or lifting the heel) that allow you to relieve the longitudinal arch of the foot or special shoes with a soft heel counter or even with an open heel. Conservative treatment can reduceheel painand minimize inflammation, but will not reduce the deformity on the calcaneus itself.

When is Haglund’s heel surgery needed?

In the absence of clear effects of conservative treatment and advanced changes in heel tumor deformation, the orthopedic surgeon decides to perform a surgical procedure. Surgical treatment removes the protruding bone,the deep bursa of the Achilles tendon, which is the main source of pain, and the front part of the Achilles tendon (attachment to the heel bone) is cleaned. The operation can be performed using the traditional open surgical technique (with a scar of 4-5 cm) or a minimally invasive endoscopic technique using two small incisions. The endoscopic technique causes fewer complications in the healing of the wound after surgery, allows you to stand on the diseased foot faster and may allow for a shorter rehabilitation time as well as a faster return to wearing shoes, full health, physical activity and sports. During the operation, the orthopedist may additionally inject the Achilles tendon with high-platelet plasma. The entire procedure takes about 40 minutes. After surgery to minimize heel pain, the patient has a plaster splint in place, which he wears for a week after the operation. He can start rehabilitation after this period, but he can move for the next two weeks with the help of a walker (orthopedic shoe). It is important that you follow the instructions of the orthopedist and physical therapist after surgery. Usually, a return to sports and running occurs approximately 12 weeks after surgery, depending on how rehabilitation is going. To prevent the recurrence ofHaglund Deformation, to prevent the sore heel from bothering you, you should: wear appropriate footwear – avoid stiff heel shoes, do stretching exercises, avoid running on hard ground and climbing up during training.

Causes of the tibial nerve neuropathy

Pain in the foot, located in the heel area, can also be the result ofneuropathy in the tibial nerve. This condition is often referred to as tarsal syndrome (mysterious foot burning –heel pain )). Tibial neuropathy, although a common cause of foot ailments, is rarely diagnosed correctly and, therefore, is not treated properly. The tibial nerve and blood vessels (posterior tibial artery and vein), as well as the muscle tendons (finger flexor, toe flexor, and posterior tibia) pass through the narrow tarsal canal below the medial ankle, where compression is common. Nerve hypoxia, caused by venous stasis, causes fibrosis of the nerve fibers. The causes of posterior tibial nerve neuralgia are often: inflammation of the tendon sheaths of the tarsal canal, as well as chronic irritation of the tibial nerve by bone elements when the foot is incorrectly positioned while walking and running.

What are the symptoms of tarsal canal syndrome?

Tibial neuropathymanifests itself as burning pain in the plantar surface of the foot. Back heel pain can radiate all the way to the medial part of the calf. Venous stagnation (sometimes also varicose veins), which we mentioned earlier, causes an increase in pain at night.Heel painovernight often stops on its own after you start walking. Sometimes there may be swelling or thickening around the ankle and heel. The following factors predispose to the appearance of the syndrome: ankle injuries, edema, rheumatic diseases and obesity. In athletes, especially runners, the cause of pressure may be an overload condition of the foot in pronation, too tight lacing of shoes or an anatomical disorder after a bone fracture in the heel. Of course, beforethe typical symptoms of tarsal canal syndrome develop, athletes subject their feet to many hours of overload, e.g. while running (increased training volume – the number of kilometers run) or in the gym (increasing the weight of weights). The severity of symptoms increases during physical activity, especially while running. At this point, it is worth emphasizing the importance of biomechanics of movement, because disturbed foot placement results in its poor work during each running step.

Diagnosis of neuropathy of the tibial nerve

Correct diagnosis is essential in the treatment of tibial neuropathy. While there is no problem with the diagnosis of this condition when there is an obvious injury, it is asore heelin chronic overload injuries it can be a problem. In a clinical examination, the doctor finds a positive Tinel symptom (a neurological symptom, it is induced by tapping the trunk of the examined peripheral nerve) on the course of the tibial nerve in the steppe canal. A positive result is indicated by a feeling of pain and numbness in the foot. In diagnostics, valuable information can be provided by the following examinations: X-ray (performed with a loaded foot excludes fractures, osteoliths and joint conflicts), ultrasound ultrasound (detects e.g. synovitis) or MRI magnetic resonance imaging (visualizes pathological changes in the tarsal canal, redundant tissue masses) . In diagnostics, EMG can also be used – a nerve conduction test, which can directly confirm dysfunction at the nerve level. Unfortunately, nerve conduction is quite often negative, which does not rule out diagnosis. This is because the examined foot with the EMG method is immobilized and the symptoms occur under load.

How to treat tarsal canal syndrome?

Conservative treatment is essential. It mainly consists of limiting physical activity (you should stop irritating the nerve), the use of anti-inflammatory and analgesic drugs, as well as the use of special insoles or a complete change of shoes. If conservative treatment turns out to be ineffective andheel painis still felt , surgical treatment is started. The procedure involves decompressing the tarsal canal (the operation takes up to 45 minutes), which, unfortunately, does not always turn out to be effective. Occasionally, in the presence of irreversible changes in the tibial nerve, the neuropathy may recur after an initial pain relief period.Tarsal canal syndromeit is an irritating overload, the first symptoms of which can be ignored and later misdiagnosed. This can result in permanent damage to the tibial nerve. Treatment of this condition within three months of the first symptoms appearing can be very hard, and sometimes even impossible to cure completely. Therefore, any discomfort in the medial ankle area or a burning sensation in the heel area should encourage us to contact an orthopedist.

What is Baxter’s neuropathy?

Another condition associated with heel pain, also associated with the tibial nerve (formerly called the tibialnerve) is Baxter’s neuropathy. Anatomically, the Baxter nerve is the first branch of the tibial nerve that passes on the medial side of the calcaneus to the plantar side of the foot. The situation of this ailment is very similar to the tibial nerve. Statistically, it is a rare condition in the heel area. On the other hand, it is said that this may be due to difficulties in correct diagnosis, which results in the overlooking of Baxter’s neuropathy. Symptoms such asa sore heel, are often similar to plantar fasciitis and it happens that both pathologies occur simultaneously. However, an experienced orthopedic surgeon is able to pick out the distinctive features that distinguish these two diseases. In Baxter’s neuropathy, there is a burning pain on the medial side of the calcaneus radiating towards the calcaneus, giving a feeling of numbness. Pain often gets worse with physical activity.

How to Recognize Baxter’s Neuropathy?

The key to successful treatment is a correct diagnosis, and this is not easy withBaxter’s neuropathy , as we have already mentioned.Diagnostics is based mainly on a clinical examination, during which the orthopedist conducts an interview and palpation. The following may be helpful in the diagnosis: MRI (showing the atrophy of the little finger abductor) and ultrasound ultrasound. To confirm the diagnosis, the orthopedic surgeon may inject the area of ​​the lateral plantar nerve or the entire tibial nerve trunk with a steroid at the level of the flexor retinaculum. If the discomfort subsides andthe pain in the heelwears off , we are confident in the correct diagnosis of Baxter’s neuropathy.

Treatment of Baxter’s nerve

We start the treatment of this condition with physiotherapy, which mainly consists of relaxing the tissue directly surrounding the nerve (plantar fascia and muscles: toe abductor, trapezius sole). The calf triceps muscle and the ischio-shin group are also relaxed, the increased tension of which affects the tension of the plantar fascia and, of course, the pressure on the nerve. Additionally, also for home use, you should do some stretching exercises and also roll the posterior myofascial tape to relieve tension. Physiotherapy and exercise alonemay not be enough or even ineffective against heel pain. This is especially true in chronic conditions when the patient reports to the doctor too late or when the therapy is carried out incorrectly (physical therapy may exacerbate the symptoms). In the case of increased pain, the orthopedic surgeon may supplement the treatment with painkillers. If manual therapy does not bring a marked improvement and the sore heel still causes troublesome ailments, a surgical procedure performed by an orthopedist is recommended. The procedure is technically quite difficult and involves the release of the lateral plantar nerve, but when done well, it produces very good results.

Home remedy for heel pain

Heel pain is often caused by too much body weight. It turns out thatoverweight peopleare more likely to suffer from heel spurs. Therefore, in their case, it is recommended to reduce weight in the first place and change the lifestyle to a healthier one. Being overweight puts more pressure on the heels which causes pain. Before starting physical activity, it is worth considering this decision and choosing a sport that is fun and harmless to your health.

Massages and strengthening exercises are helpful in the treatment of aching heels. For this purpose, a point massage is recommended where there is a pain source. Ice cubes can also be used to massage the heels – it is recommended when the pain is extremely severe. To do this, wrap the ice cube in a cloth, e.g. a cotton cloth and massage the heel with it for about 3 minutes.

To improve the comfort of walking, it is worth buying Socks with a gel cover on the heels , which effectively cushions the foot while walking and helps to relieve pain. It is also worth reaching for compression bands that improve microcirculation. These bands are also recommended in the case of Achilles tendonitis or heel pains.

A home remedy for heel pain isolive oilcombined withclove oil. It is a natural remedy that relaxes the foot muscles with anti-inflammatory properties and provides immediate relief. To prepare the liquid, mix 2 tablespoons of olive oil and 1 tablespoon of clove oil, heat it in a microwave and rub the warm liquid into your heels and wait for it to soak in.

Heel pain can also be treated withapple cider vinegar. The fluid has anti-inflammatory and analgesic properties. 1/2 cup of apple cider vinegar and 2 cups of water are enough to prepare it. Pour boiled water into a scalded vessel and mix with vinegar. Soak the diseased foot in the resulting solution for about 20 minutes. To feel relieved, repeat the treatment every day until it brings the desired result.