Heel pain

and Sabine Schrör, medical journalist

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

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Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

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Heel pain (medical: tarsalgia) can have different causes. For example, many runners experience heel pain as a result of excessive strain. Bony outgrowths (heel spurs), broken bones and rheumatic diseases can also trigger heel pain. Read everything you need to know about possible causes and treatments for heel pain and learn tips and exercises to get a grip on heel pain.

Brief overview

Causes: tendon plate inflammation of the sole of the foot (plantar fasciitis or plantar fasciitis), heel spur, pathological changes in the Achilles tendon, bursitis, bone fracture, ankylosing spondylitis, S1 syndrome, tarsal tunnel syndrome, congenital fusion of the heel and scaphoid bone
When to the doctor If the heel pain persists for a long time, increases under exertion, restricts walking or is accompanied by other symptoms such as joint swelling.
Diagnosis: Doctor-patient consultation (anamnesis), physical examination, x-rays (e.g. if a bone fracture is suspected), magnetic resonance imaging (e.g. if changes in the Achilles tendon are suspected), electromyography and electroneurography (if tarsal tunnel syndrome is suspected).
Treatment: depending on the cause, e.g. for heel spurs, special shoe insoles, pain relievers, physical therapy and, if necessary, surgery. If there is no underlying disease: tips and exercises for heel pain.
Tips and exercises: Avoid being overweight, correcting misalignments of the feet, avoiding excessive sitting, avoiding tight shoes, warming up before sport, exercising moderately, putting your feet up in the event of acute pain (e.g. when walking), cooling and protecting them.

Heel Pain: Causes

Heel pain can have a variety of causes. Here you can find out which are the most important.

Tendon plate inflammation of the sole of the foot (plantar fasciitis or plantar fasciitis)

Plantar fasciitis is a wear-related (degenerative) disease of the tendon plate attachment on the heel cusps (calcaneus cusps). The tendon plate connects the heel hump with the ball of the foot, together they form the longitudinal arch of the foot. Plantar fasciitis causes tenderness in the heel.

This pressure pain initially only occurs when the foot is loaded, i.e. when it occurs. Later, however, heel pain on the back of the foot can also occur in the morning after getting up and at rest. Sometimes the pain will become so severe that the person can no longer walk. It is also typical of this heel pain that it increases the day after the heel has been put under pressure.

Heel pain due to plantar fasciitis is usually due to an athletic burden, for example from running or jumping. However, the disease can also occur due to age as a result of natural wear and tear.

Heel spur

Heel pain can also indicate a heel spur. This is a thorn-like bone growth on the heel bone, but it does not necessarily hurt.

Depending on the location, doctors differentiate between the lower (plantar) and the upper (rear) heel spur.

The lower (plantar) heel spur (calcaneus spur) arises on the underside of the heel hump, where the short muscles of the foot and the tendon plate of the sole of the foot begin. It causes severe pressure pain at the lower middle end of the calcaneus. If the foot is put under pressure, stabbing pain occurs on the sole of the foot. In extreme cases, those affected can only step on the forefoot.

The upper (rear) heel spur (Haglund exostosis, Haglund heel) occurs less frequently. It develops at the insertion of the Achilles tendon. Those affected feel pressure and pain when they walk or stand in sturdy shoes. The attachment of the Achilles tendon can also be painful.

Heel spur can also occur together with tendon plate inflammation of the sole of the foot (plantar fasciitis).

Pathological changes in the Achilles tendon

If the upper heel area hurts, pathological changes in the Achilles tendon are often behind it. The Achilles tendon is the strongest tendon in the human body. It connects the calf muscle to the heel bone. If the attachment of the Achilles tendon on the heel bone is calcified, local swelling with pressure pain can occur. These complaints can also occur when the attachment of the Achilles tendon is overloaded or inflamed.

Bursitis

There are two bursa in the area of the Achilles tendon attachment and heel bone. When they become infected, there is often heel pain.

One of the bursa is located between the Achilles tendon and the heel bone (Bursa subachillaea). It can become inflamed, for example, by an upper heel spur, by overloading or by certain diseases such as gout.

The second bursa (bursa postachillaea) is located between the Achilles tendon and the skin. It can be inflammatory if you wear poorly fitting, pressing or rubbing shoes.

Broken bone

A broken bone in the heel area, for example a broken calcaneus, can also cause heel pain. Usually a broken bone is caused by an accident. But there are also so-called fatigue fractures (stress fractures). They can occur on heavily stressed bones, for example in professional runners. The shin, metatarsus, and heel are particularly common. In the latter case, heel pain results.

Bechterew's disease (ankylosing spondylitis)

Bechterew's disease is a chronic, inflammatory, rheumatic disease. It can cause the spine to become increasingly ossified and stiff. Other joints and organs can also be affected.

Common symptoms of ankylosing spondylitis include joint inflammation, joint stiffness in the morning and mutual pain in the buttocks. The lumbar spine is often only able to move to a limited extent, and the pain radiates to the thighs, often even to the heels.

S1 syndrome

Heel pain can hide a pinched nerve in the area of the spine. In the so-called S1 syndrome, the nerve root that emerges from the spinal cord at the first sacral vertebra is narrowed. The reason for the narrowing can be, for example, a local herniated disc. The result is unilateral pain that extends over the buttocks and the back of the upper and lower legs and radiates over the heel to the outer edge of the foot (including toes three to five).

Tarsal tunnel syndrome

A nerve is also pinched here, namely the tibial nerve in the tarsal canal. This is a kind of tunnel, formed by the talus, heel bone and inner ankle as well as a ribbon-like structure as a "roof". Symptoms of tarsal tunnel syndrome include tingling, burning and abnormal sensations on the entire sole of the foot, on the flexor tendons of the toes or just on the heel. The heel pain can radiate into the calf. In addition, there is intense pressure pain behind the inner ankle.

Another sign of tarsal tunnel syndrome: the sole of the foot secretes significantly less sweat than normal.

Fusion of the calcaneus and scaphoid bone (coalitio calcaneonaviculare)

In the case of a congenital fusion of the heel and scaphoid bone, the lower ankle joint and the Chopart joint (tarsal joint) have only limited mobility. The first symptoms usually arise at school age: Standing and walking for long periods of time lead to chronic foot pain (including heel pain). In addition, the ankles feel stiff when they move.

Heel Pain: Tips and Exercises

Do you already suffer from heel pain or would you like to prevent heel pain effectively? Then the following tips and exercises can help you.

If you have had heel pain for a long time, you should always consult a doctor (family doctor or orthopedic surgeon) to clarify the causes of your symptoms. You can then carry out the mentioned tips and exercises in addition to the medical treatment by the doctor.

Tips for heel pain

If you follow the tips below, you can often be effective in relieving and preventing heel pain:

Avoid overweight: Every excess kilo puts a strain on the feet and promotes heel spurs and other foot problems. So make sure you have a healthy body weight. If you are overweight, you should try to lose weight.
Correcting misalignments of the feet: Misalignments such as a flat foot can cause heel spurs and thus trigger heel pain. Therefore, you should have malpositions of the feet treated.
Avoid excessive sitting
do without tight shoes
Warm Up Before Exercise: Warm up your muscles, tendons, and ligaments before exercising. Otherwise the Achilles tendon, among other things, can quickly become overloaded. Inflammation with heel pain is often the result.
Exercise moderately: Do not overdo it with your exercise. In this way, painful fractures due to fatigue, for example on the heel, can be avoided.
Apply first aid measures: In the case of acute heel pain, you should elevate the affected foot, cool it and protect it.

Basically, you should always take heel pain seriously. If you have heel pain, refrain from exercising or stop exercising. Against the acute pain, it helps to elevate the affected foot, to cool it and to protect it.

Exercises for heel pain

Experts recommend regular calf training to prevent heel pain and relieve acute discomfort. For example, you can do the following stretching exercises every day:

Exercise 1 for heel pain

Stand at a distance in front of a wall and lean against it with your palms (arms almost stretched out). Move the leg with the heel pain a little further back so that the knee is straightened, but the sole of the foot remains on the ground. The other leg remains in front with the knee slightly bent. It is important that the toes of both feet point towards the wall. Now lean forward a little (i.e. bend your elbows) to increase the stretching of the calf and arch of the foot in the affected (rear) leg. Make sure that the entire sole of your foot is on the ground (do not lift your heel!). Hold this position for about 10 seconds. Then push yourself back into an upright position. Repeat the exercise 20 times.

Exercise 2 for heel pain

Stand with the balls of your feet backwards on a step and hold onto the railing with one hand. Now slowly push your heels down as far as you can. Hold the position for 10 seconds and repeat the exercise 20 times.

The two exercises are also good for your pre-exercise warm-up routine.

Heel pain: description and forms

Heel pain is pain in the heel that occurs at rest or during exercise. Those affected usually feel the pain when stepping on the back of the foot.

Depending on where exactly the pain is localized, a distinction is made:

Lower or Plantar Heel Pain: This is pain under the heel. They are often caused by inflammation of the tendon plate (plantar fasciitis) or a lower heel spur.
Upper or dorsal heel pain: This is where the Achilles tendon attachment hurts. This heel pain usually occurs when the attachment point of the Achilles tendon is overloaded or inflamed or there is an upper heel spur.

Heel pain: when do you need to see a doctor?

A visit to the doctor is indicated in the event of:

prolonged heel pain
Heel pain that increases with exercise
Heel pain that restricts walking
Heel pain that is accompanied by other complaints, for example joint swelling

Heel Pain: What Does the Doctor Do?

The doctor first collects your medical history (anamnesis). To do this, he will question you in detail about your heel pain. For example, it is important to know how long the heel has been hurting, where exactly it hurts and whether you are suffering from other complaints, for example pain in the back of the leg.

In conjunction with the medical history, various examinations can help to identify the cause of the heel pain. The most important investigations include:

Physical examination: Here the doctor tests, for example, whether there is pressure pain or bony swelling in the heel area, which could indicate a heel spur. He also checks, among other things, how flexible your joints are, how strong your muscles are and whether you can walk normally.
X-ray examination: X-rays make broken bones, heel spurs and a fusion of the heel and scaphoid bone visible, for example. An X-ray examination can also provide certainty if ankylosing spondylitis is suspected.
Magnetic resonance imaging (MRI): If the doctor suspects that pathological changes in the Achilles tendon are behind the heel pain, he can investigate this suspicion with the help of magnetic resonance imaging. Ankylosing spondylitis can also be detected with magnetic resonance imaging.
Electromyography (EMG) and electroneurography (ENG): If a tarsal tunnel syndrome is suspected to be the cause, the doctor can measure the electrical activity of muscles and nerves using an EMG or ENG.

Heel pain: treatment

If an underlying condition, such as heel spur, or an injury (such as a broken bone) is causing heel pain, it needs treatment. For example, if you have a heel spur, the doctor can recommend special insoles for your shoes or prescribe physical therapies (e.g. shock wave therapy) and pain reliever medication. A heel spur is usually only operated on if the heel pain persists despite these conservative treatment measures.

Tags: symptoms home remedies anatomy