Interpret heel pain correctly

Interpret heel pain correctly

Heel pain plagues many people of different ages. The reasons for their occurrence are very diverse: They can be caused, for example, by inflammation, foot malpositions or warts. This article presents and briefly explains common causes of heel pain. You will also receive advice on what you can do if you have heel pain and when a visit to the doctor becomes unavoidable.

What are the common causes of heel pain?

Pain in the heel can have different causes. Possible triggers for the symptoms are:

  1. Plantar fasciitis
  2. Achilles tendonitis
  3. Achilles tendon rupture
  4. foot deformities
  5. rheumatism
  6. disc prolapse
  7. Apophysitis of the heel
  8. Calluses and warts

Below, we will introduce you to the various causes in more detail.


  1. Plantar fasciitis: Pain on the bottom of the foot

According to studies, eighty per cent of heel pain is caused by this disease with a complicated name. The plantar fascia becomes irritated by repeated stress, also known as microtrauma. This plate of tendons runs along the bottom of the foot.

Accordingly, the pain manifests below the foot, especially when walking and standing. In addition, the pain can be triggered by pressure on the sole, which the doctor can adjust accordingly. Many sufferers also describe that the pain is strongest when walking in the morning after getting up and that it decreases again over the day until a certain threshold of stress is exceeded, and it ultimately becomes worse again.

Plantar fasciitis mainly occurs in middle age. Risk factors include incorrect loading, excess weight, misaligned feet, and too much and too little physical activity.

Plantar fasciitis is not the same as  heel spurs , even though the terms are often used interchangeably. A heel spur refers to an ossification of the tendons in the heel bone area. Calcaneus is the name of a bone in the heel. A heel spur is often a painless incidental finding. It can develop under the heel or at the top of the back of the heel. Pain only occurs when this ossification of the tendon attachment becomes inflamed.

Plantar fasciitis is usually treated conservatively.  Painkillers  can be taken under medical supervision and only for a limited period of time if the pain is too severe. Otherwise, custom-made insoles, taping (i.e. the use of Kinesio tape) and special night splints, which also protect the foot, help. If plantar fasciitis is very severe, surgery can help relieve the pain.

2. Achilles tendonitis (Achillodynia)

Various diseases can cause inflammation and pain in the area of ​​the Achilles tendon above the heel. Severe pain occurs, especially when walking and running. Those affected often try to only put their front foot on the ground to reduce their pain.

Causes of inflammation of this tendon can be, for example,  gout  or increased blood fats. Both diseases lead to deposits in the Achilles tendon area, causing irritation and ultimately inflammation.

In the case of acute inflammation of the Achilles tendon, immobilizing the foot is particularly important. This can be done with a cast, taping or bandages. Giving painkillers can also help those affected. Exercise should be avoided and the underlying disease should be treated to prevent chronic inflammation.


3. Achilles tendon rupture – tear of the Achilles tendon

An Achilles tendon rupture, i.e. a tear in the Achilles tendon, also leads to pain in the heel. The symptoms of an Achilles tendon rupture are usually very clear. Athletic men between the ages of 30 and 40 are mainly affected. Ruptures occur particularly when starting or braking suddenly during sport. This is manifested by a loud bang, often described as a “whip crack,” and severe pain.

The Achilles tendon rupture must be treated in any case. In general, conservative treatment with a cast or special shoe is possible. However, young patients in particular tend to be advised to undergo  surgery more often  . Physiotherapeutic treatment is then recommended to restore strength and function in the affected leg.

4. Foot misalignments as a cause of heel pain

A number of different foot misalignments can cause heel pain. The pain can either arise from the misalignment itself or from inflammatory processes that occur as a result of the misalignment, such as  bursitis  or the heel spurs already described.

A congenital variation in the shape of the heel bone, the so-called Haglund deformity, particularly often leads to heel pain. This is a bony protrusion above the heel bone in the area of ​​the Achilles tendon. Constant pressure (for example from shoes that are too tight) leads to inflammation and swelling of the surrounding bursa (bursitis) and thus to the clinical picture of Haglund exostosis. This is also known as Haglund’s heel.

At first you try to treat it conservatively, for example with proper shoes that don’t exert too much pressure, immobilization and bandages. If pain occurs permanently and on both sides at this point and the deformity can also be proven by an X-ray, surgical removal of the bone process may make sense.

5. Rheumatism can cause heel pain

Rheumatic diseases  can occur in many places in the body and are therefore also a possible trigger for heel pain. Many people who suffer from rheumatism experience severe heel pain, especially in the area of ​​the Achilles tendon and heel bone, which often affects the entire foot. However, rheumatic complaints usually begin in the finger and toe joints. They occur on both sides and intensify at rest, for example in the second half of the night.

If the cause of heel pain is rheumatic in nature, this can be determined using an X-ray. In patients with rheumatism, x-rays show narrowing of the joint space and changes in the surrounding bone in the affected joint.

Once the diagnosis has been confirmed, the therapy for rheumatism consists of two components, as the disease is divided into flare-free phases and flare-ups, during which the disease progresses. First, rheumatism, a disease that affects the whole body, must be treated with medication. If there is a flare-up, people with rheumatism are given medication to suppress or mitigate this flare-up. If there is no flare-up of the disease, the patient is given essential therapy to stop the next flare-up and, thus, the progression of the disease.

In addition, complaints such as heel pain should also be treated in a targeted manner. In rheumatism, a so-called rheumatic foot with severe deformation of the toes is not uncommon. To prevent this, the affected person should receive insoles that relieve the foot in places where it hurts. In addition, physical therapy can help position the foot correctly. In the case of an acute flare-up with pain, cold therapy can also be a valuable supplement to drug therapy.


6. Herniated disc: Pain radiates to the heel

A herniated disc can also cause pain that radiates to the heel. If a herniated disc is the cause of the heel pain, it is doubtful that this will occur in isolation. Instead, many sufferers describe their pain as an electrifying pain that pulls down the leg. In addition, back pain occurs in the area of ​​the lumbar spine.

7. Apophysitis calcanei: heel pain in childhood

There is another cause of heel pain in growing children that rarely occurs in adulthood. Calcaneal apophysitis is a disease of the heel bone. The apophysis of the heel bone softens as a result of increased stress. The apophysis is a bony process that attaches to the Achilles tendon on the heel bone. The softening causes pain.

The disease most commonly affects children between the ages of eight and sixteen. Calcaneal apophysitis usually occurs on both sides and requires rest for several weeks. Fortunately, calcaneal apophysitis heals well in most cases without any consequential damage.

8. Calluses and warts on the heel

Heel pain can not only have orthopaedic causes. Plantar warts appear on the soles of the feet and, thus, also in the heel area. Walking, running, and jogging can be painful under the heel. If the warts are on the side, narrowing shoes can cause pain. In addition to warts, simple calluses or blisters can also be painful when pressure is applied.

The therapy to get rid of warts is often quite lengthy. Various ointments, tinctures and ice creams are available in pharmacies. A visit to a dermatologist can also help.


How do you find the cause of heel pain?

If you notice increased pain in the heel area, you should pay close attention to when it occurs. This can be the case, for example, after jogging, at night, when bending over or stretching.

An exact localization of the pain can also be helpful for the doctor treating you to make a diagnosis. So pay attention to whether the pain occurs more under the heel, on the outside, on the inside or, as with Achilles tendonitis, for example, more on the back.

When should you see a doctor for heel pain, and which doctor is responsible?

If the observed pain occurs repeatedly over several weeks or if there is sudden severe heel pain, it is advisable to consult your family doctor. If the diagnosis is unclear, he can decide which doctor can best help, for example, an orthopaedist, rheumatologist or dermatologist.

What can you do about heel pain?

If the pain’s origin is unclear, the affected foot should first be immobilized. In addition to rest, many sufferers also find the cooling or warming of their heels pleasant. Foot baths, such as apple cider vinegar or simple foot massages, are often recommended as home remedies.

Stretching exercises can also help reduce the pain, depending on the cause. There are numerous instructions on the Internet to find the right exercises for the respective disease. Physiotherapists can also put together individually adapted and targeted exercises for each affected person and explain the correct execution.


Which medications help with heel pain?

In general, the so-called non-steroidal anti-inflammatory drugs, or NSAIDs for short, can be used to treat heel pain. These are painkillers such as Aspirin®, Diclofenac or Ibuprofen. The advantage of these painkillers is that they are both pain-relieving and anti-inflammatory. This helps very well, for example, if the heel hurts due to plantar fasciitis or other inflammation.

It is also essential to refrain from using these over-the-counter tablets permanently, i.e. not over several weeks. Because they also have side effects if used for a long time – for example, stomach ulcers can occur.

Ointments containing painkillers also help alleviate heel pain for many patients.

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