Heel pain

Many of us are familiar with heel pain – whether it be while playing sports, running, walking or jumping. Heel pain is one of the most common foot problems.

Symptoms

Causes

Diagnosis

Treatment

FAQs

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Symptoms

These are some of the ways in which heel pain can manifest itself:

pain when stepping on the heel
persistent pain after prolonged exertion
night or rest pain
swelling on the heel

Causes

Three areas of the heel are particularly susceptible to inflammation: the Achilles' tendon, the plantar tendon and the heel hump.

Inflammation is usually triggered by overuse. Overuse may be due to heavy exercise or performing new physical activities that the body is not used to. Pain in the Achilles' tendon area can occur as a result of shortening of the calf muscles.

Diagnosis

At the beginning of the diagnosis, the patient will be asked various questions about previous illnesses and other complaints to determine whether these may be having an effect on the heel.

The doctor pays particularly close attention to the patient’s physique, gait, stance and joint mobility. The nerve functions are also checked.

As there is a variety of different diseases that lead to heel pain, special diagnostic methods are used:

diagnostic manoeuvres of the heel
ultrasound of the foot
X-ray of the heel and foot
MRI scan

The following diseases can be identified in this way:

damage to the Achilles' tendon
Haglund’s deformity/Haglund’s exostosis (deformation of the heel bone)
heel spur
irritation or inflammation of the bursa
damage to the plantar tendon
deterioration of the heel fat pad

Treatments

Conservative therapies

Surgical intervention is rarely necessary for heel pain. The most common conservative therapies include:

use of insoles
stretching exercises (e.g. the calf muscles)
wearing orthopaedic shoes
regular physiotherapy

Anti-inflammatory drugs or other measures (e.g. ultrasound) may also be used.

Surgical treatment

There are certain heel conditions that do require surgical treatment.

If it is not possible to treat the heel spur with conservative therapy, there is a surgical procedure that can relieve pressure on the plantar fascia. During this procedure, the tendon of the flexor muscle in the lower leg is loosened. This provides greater mobility in the ankle joint and relieves stress on the plantar fascia in the sole of the foot. The heel spur may also be removed through endoscopic surgery.

When the rear upper corner of the heel bone irritates the Achilles' tendon attachment, causing severe pain, surgical intervention is necessary. In this minimally invasive procedure, pressure on the Achilles' tendon is relieved by removing the upper corner of the heel bone. The reduced pressure allows the inflammation to heal.

In the case of Achilles' tendonitis (achillodynia), an operation is carried out to remove the inflamed sheath of the tendon. Heel surgery is also carried out to sew up tears in the Achilles' tendon.

FAQs

Can I do sports again after ankle surgery?

Daily calf-stretching exercises can have a preventative effect on heel conditions. If heavy foot strain is foreseeable, it is important to practise specific exercises designed to gradually prepare the foot for the strain.

How do I prevent ankle osteoarthritis?

A deformation of the heel bone is referred to as Haglund’s deformity (or Haglund’s exostosis). With this condition, part of the heel bone is heavily protruded and forms a bony bump. This causes calcification at the base of the Achilles' heel.

Can osteoarthritis be detected through blood tests?

If all previous treatment attempts have been unsuccessful or insufficient, surgical intervention may be necessary. This may be the case, for example, with a heel spur or Haglund’s deformity.