What causes heel pain to shoot up the leg. How can heel pain that radiates up the leg be treated effectively. What are the best prevention methods for heel pain that travels up the leg. How do podiatrists diagnose and manage heel pain that extends into the leg.

Understanding Heel Pain and Its Impact on the Leg

Heel pain that radiates up the leg can be a debilitating condition affecting daily activities and quality of life. This complex issue often stems from the interconnected nature of the lower limb structures. When one part experiences discomfort, it can have a ripple effect on surrounding areas, leading to pain that extends beyond its original source.

The human body’s lower extremities are intricate systems where muscles, tendons, bones, and nerves work in harmony. When this delicate balance is disrupted, it can result in pain that doesn’t remain localized but travels along connected pathways.

Common Causes of Radiating Heel Pain

• Achilles tendinitis
• Nerve inflammation or irritation
• Gait changes due to compensating for heel pain

Understanding these causes is crucial for effective treatment and prevention. Let’s delve deeper into each of these factors to gain a comprehensive understanding of why heel pain may shoot up the leg.

Achilles Tendinitis: A Major Culprit in Radiating Heel Pain

Achilles tendinitis is a common condition that can cause heel pain to radiate up the leg. This inflammation of the Achilles tendon, which connects the calf muscles to the heel bone, can result in pain that extends from the heel up the back of the leg.

Why does Achilles tendinitis cause radiating pain? The Achilles tendon plays a crucial role in walking, running, and jumping. When inflamed, it can create tension and discomfort that travels along its length, affecting not just the heel but also the calf area.

Risk Factors for Achilles Tendinitis

1. Sudden increase in exercise intensity or duration
2. Tight calf muscles
3. Running on hard surfaces
4. Overtraining
5. Improper footwear
6. Sudden foot movements

Recognizing these risk factors can help in preventing Achilles tendinitis and the associated radiating heel pain. It’s essential to approach physical activities with care and proper preparation to avoid overstraining this vital tendon.

Nerve-Related Causes of Heel Pain Shooting Up the Leg

Nerve inflammation or irritation can be another significant cause of heel pain that radiates up the leg. When nerves in the foot or ankle become compressed, inflamed, or damaged, they can send pain signals that extend beyond the initial point of irritation.

How does nerve-related heel pain manifest? The pain may feel like a sharp, burning sensation that travels along the path of the affected nerve. This can result in discomfort that starts in the heel and shoots upwards into the leg, sometimes reaching as far as the lower back.

Common Nerve-Related Conditions

• Tarsal tunnel syndrome
• Peripheral neuropathy
• Sciatica
• Plantar nerve entrapment

These conditions can cause persistent pain that doesn’t respond to typical treatments for muscular or tendon-related heel pain. Proper diagnosis by a podiatrist is crucial for effective management of nerve-related radiating heel pain.

The Impact of Gait Changes on Heel Pain and Leg Discomfort

When experiencing heel pain, it’s natural for individuals to alter their walking pattern to alleviate discomfort. However, these gait changes can inadvertently lead to pain that radiates up the leg. How does this happen? By shifting weight or changing the foot’s position during movement, other structures in the leg may bear unusual stress, resulting in secondary pain.

Gait changes can affect various parts of the lower limb, including:

• Ankle joints
• Calf muscles
• Knee joints
• Hip alignment

Over time, these alterations can create a cycle of pain and compensation, potentially leading to chronic issues if not addressed promptly. Recognizing and correcting gait abnormalities is an essential part of treating radiating heel pain effectively.

Effective Treatments for Heel Pain That Shoots Up the Leg

Addressing heel pain that radiates up the leg requires a comprehensive approach tailored to the underlying cause. In most cases, conservative treatments can provide significant relief without the need for invasive procedures.

Conservative Treatment Options

• Rest and activity modification
• Ice therapy
• Anti-inflammatory medications
• Shoe modifications
• Custom orthotics
• Physical therapy exercises

How effective are these conservative treatments? Many patients experience substantial improvement with a combination of these approaches. However, the key lies in consistency and following the treatment plan as prescribed by a podiatrist.

In rare cases where conservative methods don’t provide adequate relief, surgical intervention may be necessary. Experienced podiatrists like Drs. Joel Brook, Arroyo, and McClurkin can perform advanced surgical procedures to address persistent heel pain issues.

Preventing Heel Pain: Proactive Measures for Foot Health

Prevention is always better than cure when it comes to heel pain that radiates up the leg. By implementing certain lifestyle changes and adopting good foot care habits, individuals can significantly reduce their risk of developing this condition.

Key Prevention Strategies

1. Gradual increase in activity intensity
2. Proper footwear selection
3. Regular stretching exercises
4. Cross-training with low-impact activities
5. Maintaining a healthy weight
6. Using supportive insoles or orthotics

How can one ensure proper footwear selection? Look for shoes that provide adequate arch support, heel cushioning, and a comfortable fit. Avoid worn-out shoes and those that don’t match your foot type or activity level.

Incorporating these preventive measures into daily life can go a long way in maintaining foot health and preventing the onset of radiating heel pain.

When to Seek Professional Help for Radiating Heel Pain

While some cases of heel pain may resolve with home care, persistent or severe pain that radiates up the leg warrants professional attention. Recognizing when to consult a podiatrist is crucial for timely intervention and effective treatment.

Signs That Indicate the Need for Professional Care

• Pain that persists for more than a week despite rest
• Inability to bear weight on the affected foot
• Severe pain or swelling
• Numbness or tingling sensation in the foot or leg
• Pain that interferes with daily activities or sleep

How do podiatrists diagnose the cause of radiating heel pain? They typically begin with a thorough physical examination and review of medical history. Additional diagnostic tools such as X-rays, MRI scans, or nerve conduction studies may be employed to pinpoint the exact cause of the pain.

Seeking professional help early can prevent the condition from worsening and lead to faster recovery. Podiatrists can provide targeted treatments and personalized advice to address the specific causes of radiating heel pain.

Advanced Treatment Options for Persistent Radiating Heel Pain

In cases where conservative treatments don’t provide adequate relief, podiatrists may recommend more advanced interventions. These options are typically considered after thorough evaluation and when other methods have been exhausted.

Advanced Treatment Modalities

• Extracorporeal Shock Wave Therapy (ESWT)
• Platelet-Rich Plasma (PRP) injections
• Custom-made orthotic devices
• Minimally invasive surgical procedures

How effective are these advanced treatments? While success rates can vary depending on the individual case, many patients experience significant improvement with these interventions. For instance, ESWT has shown promising results in treating chronic plantar fasciitis, a common cause of radiating heel pain.

It’s important to note that the choice of advanced treatment depends on various factors, including the specific diagnosis, the patient’s overall health, and their lifestyle needs. A skilled podiatrist will consider all these aspects when recommending the most appropriate treatment plan.

The Role of Physical Therapy in Managing Radiating Heel Pain

Physical therapy plays a crucial role in both the treatment and prevention of heel pain that shoots up the leg. A well-designed physical therapy program can address multiple aspects of the condition, from reducing pain and inflammation to improving strength and flexibility.

Key Components of Physical Therapy for Radiating Heel Pain

1. Stretching exercises for the calf muscles and plantar fascia
2. Strengthening exercises for the foot and ankle
3. Gait analysis and retraining
4. Manual therapy techniques
5. Use of therapeutic modalities (e.g., ultrasound, electrical stimulation)

How does physical therapy contribute to long-term relief? By addressing underlying biomechanical issues and improving overall foot and leg function, physical therapy can help prevent the recurrence of radiating heel pain. It also equips patients with tools and knowledge to maintain their foot health independently.

Collaboration between podiatrists and physical therapists often yields the best outcomes for patients with complex cases of radiating heel pain. This multidisciplinary approach ensures comprehensive care that addresses all aspects of the condition.

Lifestyle Modifications to Support Heel Pain Recovery

While medical treatments are essential, certain lifestyle modifications can significantly support the recovery process and prevent future episodes of radiating heel pain. These changes can complement professional treatments and improve overall foot health.

Beneficial Lifestyle Changes

• Maintaining a healthy weight to reduce stress on the feet
• Choosing appropriate footwear for different activities
• Incorporating low-impact exercises into fitness routines
• Practicing good foot hygiene
• Avoiding prolonged periods of standing or walking on hard surfaces

How can one incorporate these changes effectively? Start by assessing current habits and gradually introducing new practices. For instance, if you typically walk barefoot at home, consider using supportive house slippers to provide better cushioning for your heels.

Remember, consistency is key when it comes to lifestyle modifications. Small, sustained changes can lead to significant improvements in foot health over time.

The Importance of Proper Diagnosis in Treating Radiating Heel Pain

Accurate diagnosis is the cornerstone of effective treatment for heel pain that shoots up the leg. Given the various potential causes of this condition, a thorough diagnostic process is crucial to determine the most appropriate treatment plan.

Diagnostic Procedures for Radiating Heel Pain

1. Comprehensive medical history review
2. Physical examination of the foot and leg
3. Gait analysis
4. Imaging studies (X-rays, MRI, ultrasound)
5. Nerve conduction studies (if nerve involvement is suspected)

Why is a detailed diagnosis so important? Different causes of radiating heel pain require different treatment approaches. For example, treatment for Achilles tendinitis would differ significantly from that for tarsal tunnel syndrome. An accurate diagnosis ensures that the treatment targets the root cause of the pain, leading to more effective and lasting relief.

Podiatrists use their expertise and advanced diagnostic tools to pinpoint the exact source of pain, allowing for tailored treatment plans that address each patient’s unique condition.

Long-Term Management Strategies for Chronic Radiating Heel Pain

For some individuals, radiating heel pain may become a chronic condition requiring ongoing management. In such cases, developing a comprehensive long-term strategy is essential for maintaining quality of life and preventing exacerbations.

Components of Long-Term Management

• Regular podiatric check-ups
• Ongoing physical therapy or home exercise program
• Use of custom orthotics or supportive devices
• Pain management techniques (e.g., mindfulness, stress reduction)
• Periodic reassessment and adjustment of treatment plan

How can patients actively participate in their long-term care? Keeping a pain diary, adhering to prescribed treatments, and communicating regularly with healthcare providers are effective ways to stay proactive in managing chronic radiating heel pain.

It’s important to approach long-term management with patience and persistence. While complete cure may not always be possible in chronic cases, significant improvements in pain levels and functionality can often be achieved with consistent care and attention to foot health.

The Impact of Overall Health on Radiating Heel Pain

Radiating heel pain doesn’t exist in isolation; it can be influenced by and impact overall health. Understanding this connection is crucial for comprehensive management of the condition.

Health Factors That Can Affect Radiating Heel Pain

1. Obesity and excess weight
2. Diabetes and peripheral neuropathy
3. Cardiovascular health
4. Autoimmune conditions
5. Vitamin deficiencies

How do these factors influence heel pain? For instance, excess weight puts additional stress on the feet and legs, potentially exacerbating pain. Diabetes can lead to nerve damage, altering sensation in the feet and complicating pain management.

Addressing these broader health issues in conjunction with specific foot treatments can lead to better outcomes. A holistic approach that considers overall health can enhance the effectiveness of radiating heel pain treatments and improve general well-being.

Emerging Technologies in the Treatment of Radiating Heel Pain

The field of podiatry is continuously evolving, with new technologies and treatment modalities emerging to address complex conditions like radiating heel pain. Staying informed about these advancements can provide patients with additional options for managing their condition.

Innovative Treatment Approaches

• 3D-printed custom orthotics
• Regenerative medicine techniques (e.g., stem cell therapy)
• Advanced imaging technologies for more precise diagnosis
• Wearable devices for gait analysis and monitoring
• Virtual reality for pain management and rehabilitation

How are these technologies changing the landscape of heel pain treatment? For example, 3D-printed orthotics offer a higher level of customization, potentially providing better support and pain relief. Regenerative medicine techniques show promise in promoting tissue healing and reducing inflammation.

While many of these technologies are still in various stages of research and implementation, they represent exciting possibilities for the future of radiating heel pain treatment. Patients should discuss with their podiatrists whether any of these emerging options might be suitable for their specific condition.

In conclusion, heel pain that radiates up the leg is a complex condition that requires a multifaceted approach to diagnosis, treatment, and management. By understanding the various causes, treatment options, and preventive measures, individuals can take proactive steps towards alleviating their pain and improving their overall foot health. Regular consultation with experienced podiatrists, adherence to prescribed treatments, and adoption of foot-friendly lifestyle habits are key to effectively managing and preventing radiating heel pain. As research continues and new technologies emerge, the future holds promising advancements in the field of podiatric care, offering hope for even more effective treatments for this challenging condition.

Podiatrist in Dallas TX Shares Heel Pain Treatment

The human body relies on a coordinated effort by many parts and systems working in conjunction to keep us alive and participate in our favorite activities. This can be seen in various areas, but the lower limbs are clear examples of complex structures that work together and affect one another. In some instances, the effect one part has on another is not necessarily a good thing, and such is the case when heel pain starts radiating up the leg.

Heel Pain Radiating Up the Leg

There are a couple of different potential explanations when pain starts down in the heel and then begins to travel up the leg. These include:

1. When heel pain is caused by Achilles tendinitis, the painful sensation can travel up the tendon and be experienced in the back of the leg.
2. Some cases of heel pain develop from nerve inflammation or irritation. When this happens, the nerve pain may radiate either up or down along the affected nerve. This creates the possibility that heel pain radiates up into the leg.
3. Whenever pain is experienced in a foot, it can lead to either subtle or significant gait changes. The most obvious example of this is limping as the result of an injury. Depending on the nature of the gait change, this can potentially affect how other areas of the foot or even the leg moves. As a patient compensates for the injury, muscles, bones, and nerves can experience abnormal stress loads, and this is then perceived as radiating pain.

Heel Pain Treatment

Naturally, treatment will depend on the specific injury and its severity, but it is important to have heel pain properly addressed to avoid the pain radiating up the leg. In a vast majority of cases, the treatment needed to address the original issue will be conservative in nature. This can include such nonsurgical methods as rest, ice, medication, shoe modifications, and custom orthotics.

Although they are rare, there are heel issues that may require a surgical procedure. When this is the case, though, you can find comfort in the fact that Drs. Joel Brook, Arroyo, and McClurkin are experienced, skilled, and highly knowledgeable when it comes to foot and ankle surgical procedures. Our foot specialists will make sure your issue is properly resolved and you have the post-operative instructions to recover completely.

Preventing Heel Pain

Now that you know how heel pain can travel up the leg and some of the treatment options, let’s take a look at prevention measures you can take on the front end:

• Ease into activity. You can reduce your risk of Achilles tendinitis by starting new activities at low levels of intensity and duration, and then gradually increasing them over time.
• Wear proper footwear. Your shoes should be appropriate for the activities you perform and fit correctly. It’s also important to make sure they offer sufficient cushioning and ample arch support.
• Cross-train. Reduce the amount of physical force your feet face by incorporating low-impact activities into your exercise program. Also, make sure to have rest days so that your body can recover from high-impact exercises.

Professional Heel Care and Treatment in Plano, TX

Whether your heel pain begins to travel up the leg or stays down in the back of the foot, you can benefit from the care and treatment we provide here at Dallas Podiatry Works. Our foot doctors will evaluate your condition, provide an accurate diagnosis, and then create a treatment plan for you to relieve any painful symptoms and allow you to participate in your favorite activities.

Call 972.853.7100 for more information or schedule your appointment at either our Plano or Dallas, TX podiatrist offices online today.

Achilles tendinitis: MedlinePlus Medical Encyclopedia

Achilles tendinitis occurs when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It allows you to push your foot down. You use your Achilles tendon when walking, running, and jumping.

There are two large muscles in the calf. These create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel.

Heel pain is most often due to overuse of the foot. Rarely, it is caused by an injury.

Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes.

Achilles tendinitis may be more likely to occur if:

• There is a sudden increase in the amount or intensity of an activity.
• Your calf muscles are very tight (not stretched out).
• You run on hard surfaces, such as concrete.
• You run too often.
• You jump a lot (such as when playing basketball).
• You do not wear shoes that give your feet proper support.
• Your foot suddenly turns in or out.

Tendinitis from arthritis is more common in middle-aged and older adults. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling. Flat feet will put more tension on the tendon.

Symptoms include pain in the heel and along the length of the tendon when walking or running. The area may feel painful and stiff in the morning.

The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on your toes. You may also have trouble finding shoes that fit comfortably due to pain in the back of your heel.

The health care provider will perform a physical exam. They will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes.

X-rays can help diagnose bone problems.

An MRI scan of the foot may be done if you are considering surgery or there is a chance that you have a tear in the Achilles tendon.

The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.

Try putting ice on the Achilles tendon area for 15 to 20 minutes, 2 to 3 times per day. Remove the ice if the area gets numb.

Changes in activity may help manage the symptoms:

• Decrease or stop any activity that causes pain.
• Run or walk on smoother and softer surfaces.
• Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.

Your provider or physical therapist can show you stretching exercises or eccentric loading exercises for the Achilles tendon.

You may also need to make changes in your footwear, such as:

• Using a brace, boot or cast to keep the heel and tendon still and allow the swelling to go down
• Placing heel lifts in the shoe under the heel
• Wearing shoes that are softer in the areas over and under the heel cushion

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can help ease pain or swelling.

Other treatment include injections, such as platelet rich plasma or steroids, to reduce the inflammation. However, the tendon can become even weaker following injection and should be protected after the injections.

If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. If there is a bone spur irritating the tendon, surgery can be used to remove the spur.

Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.

In most cases, lifestyle changes help improve symptoms. Keep in mind that symptoms may return if you do not limit activities that cause pain, or if you do not maintain the strength and flexibility of the tendon.

Achilles tendinitis may make you more likely to have an Achilles rupture. This condition most often causes a sharp pain that feels as if you have been hit in the back of the heel with a stick. Surgical repair is often necessary. However, the surgery may not be as successful as usual because there is already damage to the tendon.

Contact your provider if:

• You have pain in the heel around the Achilles tendon that is worse with activity.
• You have sharp pain and are unable to walk or push-off without extreme pain or weakness.

Exercises to keep your calf muscles strong and flexible will help reduce the risk for tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.

Tendinitis of the heel; Heel pain – Achilles

• Inflamed Achilles tendon

Biundo JJ. Bursitis, tendinitis, and other periarticular disorders and sports medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 247.

Brotzman SB. Achilles tendinopathy. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 44.

Hogrefe C, Jones EM. Tendinopathy and bursitis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 103.

Waldman SD. Achilles tendinitis. In: Waldman SD, ed. Atlas of Common Pain Syndromes. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 126.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Heel pain – the causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment

Arthritis

Diabetes mellitus

2522

06 April

Heel pain: causes of occurrence, in which diseases it occurs, diagnosis and methods of treatment.

Definition

Pain in the heel region not only causes discomfort, but also deprives a person of the opportunity to stand for a long time and move normally. Pain usually results from inflammatory changes in the tissues surrounding the heel bone and is often long-lasting and recurrent. The calcaneus is the largest of all the bones in the foot and bears the greatest stress when walking.

Types of heel pain

Depending on the disease that is accompanied by pain in the heel, the nature of the pain syndrome will vary. Possible acute pain that occurs when walking and standing. Pain may appear in the morning when a person gets up after sleep, then it decreases or disappears completely. In other cases, heel pain is aching in nature and is not associated with a load on the leg. With a number of diseases, pain bothers not only when walking, but also at night, at rest. Sometimes, along with pain, numbness, tingling and “goosebumps” are felt, the skin may turn red, swelling appears.

The pain may worsen with foot extension and in some cases causes limitation of mobility in the ankle joint.

Possible causes of heel pain

The causes of heel pain can be divided into physiological and pathological. The first includes foot strain due to wearing uncomfortable shoes or shoes with a flat sole and no arch support, due to standing for a long time, due to increased stress on the foot during pregnancy or during rapid weight gain.

Pathological causes are various diseases and injuries.

Achilles tendinitis and plantar fasciitis (heel spur) . During physical exertion and overstretching of the tendons attached to the calcaneus, their inflammation occurs, which is manifested by pain in the heel and in the tendon area during physical exertion, local swelling on the back of the heel, and a feeling of weakness in the ankle joint. Flexion and extension of the foot is painful. Tendinitis of the Achilles tendon (Achilledynia) is often the result of spondyloarthritis (disease of the intervertebral discs), hypermobility of the joints (hereditary disease or predisposition), flat feet, shortening of one of the lower extremities due to a pelvic tilt due to intervertebral hernias.

Plantar fasciitis, or heel spur, is also characterized by inflammation of the plantar ligaments. The consequence of this process is the formation of a heel spur, that is, marginal bone growths (osteophytes). Patients report pain when walking and standing along the entire plantar surface of the foot.

Most often, pain makes itself felt at the first steps after a night’s sleep or prolonged sitting.

Tarsal tunnel syndrome is characterized by damage to the fibers of the tibial nerve due to its compression between the ligaments of the ankle in injuries, bone growths and soft tissue tumors. The syndrome is accompanied by burning pain and tingling in the heel area, and sometimes the entire sole. The pain worsens when the foot is extended. There may be a change in the sensitivity of the skin in the area of ​​​​the sole. In tarsal tunnel syndrome, foot function and gait are often impaired.

Traumatic injuries of the calcaneus (contusion, crack, fracture) . A calcaneal injury is more likely to occur when falling or jumping from a height in an upright position. A strong blow leads to a bruise or violation of the integrity of the bone (often combined with fractures of other bones of the lower extremities) and causes sharp pain, the inability to support the heel, and swelling that covers the foot and lower leg.

Damage to the calcaneus is rarely accompanied by an external violation of the integrity of the soft tissues; hematomas are more often noted on the lateral surfaces of the foot.

Achilles bursitis – the disease is characterized by inflammation of the synovial bursa, which is located between the calcaneal tendon and the calcaneus, and manifests itself as pain at the bottom and behind the heel, at the point of attachment of the Achilles tendon to the calcaneal tuber, redness and swelling in the calcaneal tuberosity, as well as partial limitation of foot mobility. The causes of Achilles bursitis can be traumatic injuries due to wearing tight shoes, excessive physical exertion on the ankle joint, Haglund’s deformity. Less commonly, the disease is caused by metabolic and hormonal disorders, allergic reactions, autoimmune diseases, and infections.

Reactive arthritis – arthritis of the joints of which the calcaneus is a part (the articulation of the calcaneus with the tarsal bones – talus and navicular).

The disease develops as a result of infectious diseases (most often urogenital).

Pain syndrome appears two weeks later – a month after the infection. Severe pain is felt not only during exercise, but also at rest. Both heels may be affected, swelling and redness are noted.

Infectious diseases (tuberculosis, gonococcal infection, osteomyelitis of the calcaneus) is a fairly rare cause of heel pain. Mycobacterium tuberculosis and gonococci can develop in spongy bones and epiphyses of tubular bones, which leads to their local destruction. The process is accompanied by pain, swelling in the ankle joint and redness. The mobility of the foot is impaired.

Haglund’s deformity – ossification of the calcaneus, in which there is an osteo-cartilaginous growth in the area of ​​the calcaneal tuber, accompanied by the appearance of a growth (osteophyte) in the area of ​​attachment of the Achilles tendon. Such a pathology can be caused by a high arch or flat-valgus deformity of the foot (a combination of flat feet and valgus deformity of the foot – deviation of the thumb towards the remaining fingers), a decrease in the elasticity of the tendons.

Valgus deformity of both feet

Constant friction of the Achilles tendon leads to the development of an inflammatory process and changes in the cartilage, sometimes with the formation of sharp spikes. Patients may notice a hard protrusion on the back of the heel. The function of the foot, as a rule, is not disturbed, but inflammation of the joint capsule and tendon sheath leads to pain when walking, and sometimes at rest.

The disease is more common in young women due to wearing uncomfortable shoes with high heels.

Calcaneal epiphysitis – this disease develops in children aged 8-15 years due to a violation of the processes of ossification (ossification) of the calcaneus. Normally, the heel bone is formed as a result of the activity of two centers of ossification. One of them functions from the birth of a child, the other – from about 8 years old. Between the centers of ossification is cartilage tissue, which eventually transforms into bone. In case of cartilage overload between these two areas, cartilage degradation or partial rupture is possible, which is accompanied by inflammation and pain on the back and side of the heel, aggravated by the load. There is a limitation of the amplitude of movement, and with a rupture of the cartilage – swelling and redness.

Osteochondropathy of the calcaneal tuber apophysis, or Haglund-Schinz disease – the disease is characterized by aseptic (non-infectious) necrosis of the calcaneal tuber, which occurs due to injury, wearing uncomfortable shoes, due to hereditary predisposition and hormonal imbalance. Tendons attached to the tubercle during overstrain constantly injure the bone, which causes pain and swelling, which increase after the load and when the foot is extended. A swelling can be seen above the heel tubercle. It is noted that Haglund-Shinz disease is more common in girls aged 12-16 years.

To reduce the severity of pain, patients lean on their toes when walking.

Pain in the heel can be caused by dermatological and vascular pathologies that are diagnosed in patients with diabetes mellitus (trophic ulcers in diabetic foot syndrome), with varicose veins, and thrombophlebitis. Patients experience a slight pulling, pulling pain, fatigue. There are swelling of the feet, intermittent lameness.

Doctors to contact for heel pain

For heel pain, especially in case of injury, it is recommended to consult an orthopedic traumatologist. In some cases, consultation with an infectious disease specialist and other specialists is required to determine the diseases that caused the onset of pain.

Diagnosis and examination of heel pain

When heel pain occurs, a careful history taking and instrumental examinations are necessary. First of all, a clinical blood test is prescribed, as well as tests for infectious diseases – chlamydial and gonococcal infections, tuberculosis.

Clinical blood test: general analysis, leukoformula, ESR (with microscopy of a blood smear in the presence of pathological changes)

Synonyms: Complete blood count, UAC. Full blood count, FBC, Complete blood count (CBC) with differential white blood cell count (CBC with diff), Hemogram.
Brief description of the study CBC: general a…

Up to 1 business day

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RUB 810

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Anti-Chlamydia tr.-IgA

Secretory antibodies that appear 1-2 weeks after infection and protect the mucous membranes from deeper penetration of chlamydia. Sharp marker

Up to 2 working days

Available with home visit

830 RUB

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Gonococcus, determination of DNA (Neisseria gonorrhoeae, DNA) in synovial fluid

Determination of DNA of the causative agent of gonorrhea (Neisseria gonorrhoeae) in synovial fluid by polymerase chain reaction (PCR) with real-time detection…

Up to 1 business day

Available with home visit

RUB 560

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Mycobacterium tuberculosis, detection of DNA (Mycobacterium tuberculosis, DNA) in synovial fluid

Determination of DNA of causative agents of tuberculosis, mycobacteria complex: M. tuberculosis, M. bovis, M. bovis BCG, M. microti, M. africanum in synovial fluid by polymerase chain reaction…

Up to 1 business day

Available with home visit

RUB 570

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Imaging includes radiography of the ankle and calcaneus in two standard views.

X-ray of the bones of the foot

X-ray examination of the foot in two projections allows diagnosing injuries and other pathological changes, including flat feet.

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In some cases, computed tomography and ultrasound of the foot may be needed. With tunnel syndromes, the diagnosis is clarified according to electromyography. Magnetic resonance imaging allows you to assess the state of soft tissue structures.

How to deal with heel pain

It is important to limit the load on the foot as much as possible and choose shoes with a low stable heel.

Orthopedic arch support insoles help to reduce the load on the heel bone, before buying which it is advisable to consult with a specialist in an orthopedic salon.

Heel pain treatment

In most cases, conservative therapy is sufficient. In inflammatory processes, non-steroidal anti-inflammatory drugs are prescribed, in infectious diseases – antibiotics. Trophic ulcers are treated with antiplatelet agents and phlebotonics, and in diabetes mellitus, correction of antidiabetic therapy is required.

Surgical intervention is necessary for torn ligaments, fractures, abscesses. Rarely, operations are performed for arthrosis of the tarsal joints, Haglund’s deformity, Schinz’s disease. Rehabilitation after surgery includes exercise therapy and physiotherapy.

Sources:

1. Clinical guidelines for the diagnosis and surgical treatment of injuries and diseases of the peripheral nervous system // Association of Neurosurgeons of Russia. – Moscow, 2015.
2. Traumatology. Clinical guidelines / Ed. S.P. Mironov. – GEOTAR-Media, 2018.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

Causes of heel pain – symptoms, which doctor to contact

The frequency of heel pain is difficult to determine. Many people, periodically experiencing pain, prefer to endure it or be treated on their own, without going to a doctor.

Causes of heel pain

The cause of heel pain is inflammation. It, in turn, can be caused by various factors.

• Trauma. Most often, heel pain occurs due to inflammation caused by injury to the heel structures – mechanical damage to the heel bone, tendons, synovial bags or ligaments. Because of this, pathologies accompanied by pain can develop – calcaneal fissures, bruises, sprains of the ankle ligaments and Achilles tendon, heel spurs and bursitis.
• The second most common cause of inflammation and pain in the heel region is a metabolic disorder: diabetes mellitus and gout. In diabetes, the walls of blood vessels are affected. Veins in the legs are the first to suffer from diabetic angiopathy. With gout, uric acid salts accumulate in the joints and periarticular structures. Vascular disorders in diabetes and accumulations of uric acid in gout are the causes of pain.
• Sometimes heels can hurt with inflammation caused by autoimmune diseases, such as reactive arthritis. Rarely, pain in the heel can occur due to inflammatory lesions of the heel structures by pathogenic microbes. As a rule, purulent inflammation of the calcaneus is observed in tuberculosis and osteomyelitis.

What can hurt in the heel

Heel bone. Pain in it occurs due to inflammation in reactive arthritis, epiphysitis, osteomyelitis, tuberculosis, osteochondropathy of the tubercle and fractures.

Skin and subcutaneous tissue. Involved in pathological processes when structures under them are affected. Pain with diabetic angiopathy, gout, ankle sprain, heel spur, etc.

Synovial bags. There are two of them in the calcaneal region – retrocalcaneal and superficial Achilles tendon bag. Pain with bursitis.

Ligaments and fasciae. The lateral ligaments of the ankle joint are most commonly affected. They hurt with bruises and sprains on the dorsum of the foot. Plantar – plantar fascia – usually hurts with plantar fasciitis – heel spur.

Achilles tendon. When it is inflamed, the back of the heel hurts.

Nerves and vessels. Nerves, as a rule, become inflamed in any pathology of the heel structures. Vascular damage causes pain in bruises, diabetic angiopathy, osteomyelitis and calcaneal tuberculosis.

Intertarsal joints. The talocalcaneonavicular and calcaneocuboid joints tend to hurt with gout.

Which doctor to go to when your heel hurts

First of all, if you have heel pain, you need to exclude more dangerous diseases that require urgent treatment. Therefore, the first specialist to contact for heel pain is a surgeon.

Diseases in which heel pains are possible:

• heel spur, or plantar fasciitis;
• bursitis;
• Haglund’s deformity;
• tarsal tunnel syndrome;
• tuberculosis of the calcaneus;
• osteomyelitis;
• reactive arthritis;
• osteochondropathy;
• epiphysitis;
• diabetic angiopathy;
• gout;
• contusions;
• stretching;
• inflammation of the tendons;
• cracks.

Common complaints

If you have pain on the inside of your heel, your first step is to rule out a heel spur by doing an x-ray. If there is no spur, the cause of pain on the side can be injuries, foot deformities or excessive loads – excess weight, uncomfortable shoes, hard physical labor.

If the heel hurts when walking and it hurts to step on it, try to reduce the load and consult a doctor. With the symptoms described, first of all, a heel spur, Achilles, osteochondropathy of the heel tuber, bursitis or loading periostitis are suspected. In addition to them, infectious diseases, oncology and injuries are possible. The tactics of individual differential diagnosis is developed by the attending physician.

Most often, the heel hurts when sleeping with a heel spur. The disease is characterized by intense pain in the heels in the morning, in the afternoon it subsides.

Diagnosis of pain in the heel

When contacting a doctor, the examination is carried out according to a specific plan. The doctor asks in detail about complaints, specifying their nature, type and location of pain, and examines the diseased area. If necessary, he prescribes a number of laboratory tests and instrumental examinations. These include:

• Complete blood count. It is necessary to detect an inflammatory process, a decrease in hemoglobin in case of anemia, changes in platelet levels in case of blood clotting problems.
• Biochemistry of blood. The analysis will show the existing shifts in metabolic processes, will help in identifying diabetic lesions, rheumatoid, gouty arthritis, infections caused by pathogenic streptococci.
• Analysis for tumor markers. It is needed if you suspect bone tumor processes.
• Sowing of purulent discharge on flora. It is necessary in the presence of purulent lesions, the selection of antimicrobial drugs.
• X-ray of bones and soft tissues of the foot. It will help in identifying unexplained pain in the heel, including after an injury, against the background of degenerative processes.
• Ultrasound for the detection of arthritis, bursitis, neuroma, carpal tunnel syndrome with the determination of the localization of the focus of inflammation.
• Puncture of bone or bursa for suspected infectious or neoplastic lesions.
• CT or MRI for accurate diagnosis of damage to any structures in the foot and heel.

Methods for the treatment of pain in the heel

Pathologies of the heel region are tried to be treated conservatively, but this is not always possible. If conservative therapy is ineffective, this is an indication for surgery. Surgical treatment quickly and permanently eliminates the cause of pain in the heel area. Modern surgery is based on minimally invasive outpatient techniques with minimal trauma and a short recovery period.

Heel spur

Surgery for heel spur is indicated if conservative therapy fails within 6 months. Types of operations for heel spurs are osteophyte removal and plantar fasciotomy.

Interventions are performed under local anesthesia. Through a small incision, the surgeon inserts an endoscopic probe and microsurgical instruments. Under the control of a microvideo camera, he cuts out the bone growth, and, if necessary, the inflamed area of ​​the fascia. In order not to compress the nerve in the future, the thick part of the adductor muscle of the big toe is dissected.

For more information on diagnosis and removal of heel spurs, click here.

If the pain associated with a heel spur is not caused by an osteophyte, but by excessive tension on the plantar aponeurosis, a tenotomy is performed – partial dissection of the tendon. The operation is performed without incisions – through punctures using a high-frequency electric current (radiofrequency tenotomy).

Bursitis

Bursectomy – surgical removal of the bursa – is indicated when conservative treatment of bursitis fails. The operation is performed without incisions using arthroscopic technique.

Through 2-3 punctures with a diameter of 4-5 mm, microsurgical instruments and a miniature video camera are inserted into the joint. The joint capsule is dissected and removed. A sterile bandage is applied to the incisions. The duration of the procedure is about 30 minutes. The recovery period is 2 days.

Haglund’s deformity

If conservative treatment of Haglund’s deformity fails, surgery is indicated. During the endoscopic operation – without incisions – the bone outgrowth is removed from the surface of the calcaneal tuber, after which the retrocalcaneal bursa is excised. Thus, the mechanical functions of the Achilles tendon are restored and the cause of pain is eliminated.

Tarsal tunnel syndrome

Tarsal tunnel syndrome caused by mass lesions in the tarsal canal, both congenital and acquired as a result of deformity of the foot, requires surgical treatment. During the operation, pathological formations are removed and the normal patency of the canal is restored.