Heel pain( heel hurts) - Causes, symptoms and treatment. MF.

Heel pain is a common symptom that has many possible causes.

Reasons for heel pain

The cause is not caused by the disease:

1. To "heel pain syndrome" can result in permanent overstrain of the foot structures, which is manifested by pain in the heel when walking. It can be caused by shoes with an unusually high heel.
2. In addition, heel pain can occur as a result of thinning of subcutaneous fat on the plantar surface of the foot in the heel area with a sharp increase in motor activity.
3. Long stay on legs during the day.
4. Recent rapid weight gain, obesity.

Pain in the heels should not be underestimated. In addition, that they bring significant suffering and worsen the quality of life of the patient, heel pain can be one of the first symptoms of serious diseases.

Diseases accompanied by pain in the heels

1. Systemic diseases:

Bechterew disease( ankylosing spondylitis) is a chronic inflammatory disease of the spine and joints. The cause of Bekhterev's disease is the aggressiveness of the immune system to own tissues of joints and ligaments. With this disease, "ossification" of the ligaments of the spine, its intervertebral joints and discs occurs. There is a gradual process of "fusion" of vertebrae with each other, the spine loses its flexibility and mobility. In some cases, the very first symptoms of Bechterew's disease are pains in the heels, which make it very unpleasant to stand on a hard floor. Without proper treatment, a complete immobility of the spine may occur in a few years, when virtually all the vertebrae are fused into one unbending bone structure.

Rheumatoid arthritis is one of the most severe joint diseases, taking place with many complications. The main symptoms of rheumatoid arthritis are pain, edema and, as a result, the limitation of joint mobility( including the joints of the foot, although this is an atypical localization of the lesion).Pain can manifest first only when moving. In the case of severe inflammation, pain can also be at rest, they can even awaken the patient. In addition to joint pain, the patient complains of general weakness, fatigue, and loss of appetite.

Gout is a joint disease that is caused by the deposition of uric acid salts( urates).There is acute pain, swelling and redness of the joint( usually one or two).A gout attack can last for several days or weeks( if no treatment is given).It often occurs at night, the joint becomes hot to the touch and very sensitive even to light touches. Very often the joints of the thumb on the foot are affected, but other joints( ankle, knee, joints of the foot, fingers and hands) may be involved. In some cases, joint tendons become inflamed at the same time.

2. Infectious diseases , including urogenital( such as chlamydia, gonorrhea, ureaplasmosis, etc.) and intestinal( dysentery, yersineosis, salmonellosis), proceeding secretly, can lead to reactive arthritis( including the calcaneus joints).In this case, heel pains often occur not only when walking. In patients with reactive arthritis, the heels can even hurt at rest, at night. And sometimes at night they hurt the most.

In addition, the inflammation of the heels with reactive arthritis is often accompanied by inflammation of a number of joints and eyes, as well as unpleasant sensations in the genital area. Patients may note the association of arthritis with an anterior urogenital or intestinal infection.

Bone tuberculosis ( including calcaneus).The disease begins either with the melting of the bone substance of the bone, or with the necrosis of significant areas of the skin, and this process eventually spreads to an ever larger and larger area. Regardless of the initial manifestations, tuberculosis of bones and joints causes the formation of a purulent fistula or a cavity that opens outward. It should be noted that after a few weeks the inflammatory process can stabilize, and the patient has a persistent remission.

The calcaneus osteomyelitis is a purulent-necrotic process that develops in the bone and bone marrow, as well as in the surrounding soft tissue caused by bacteria. At the beginning of the disease a person can complain of weakness, pain in the muscles. Then the temperature rises sharply to 39-40 degrees. Pain, clearly localized in the affected area of ​​the bone, occurs almost immediately. Sharp, boring or bursting from within, intensifying with the slightest movement - such pain is difficult with anything to mix up. The heel is edematous, the skin acquires a stagnant red color, the veins are enlarged.

3. Injury to

Tension or rupture of tendons .The causes may be a direct injury( impact on the tendon with a solid object) and an indirect effect of a sharp contraction of the calf muscles. Usually, at first, there is a sharp pain in the Achilles tendon. In the field of the tendon there is edema. When feeling, you can determine the defect of the tendon integrity. Active plantar flexion is difficult or even impossible.

Bruised bone injury of with further inflammation of adjacent tissues( for example, as a result of landing on the heels after a jump from a height).Such patients, as a rule, complain of burning pains under the heel, "as if there was a nail stuck," with the load on the heel, the pain increases.

For calcaneus fractures are characterized by pain in the area of ​​damage and the inability to load on the foot. The heel is deformed to the outer or inner sides, the heel area is enlarged, the foot is edematous, there are bruises in the calcaneal region and on the plantar surface of the foot. The arches of the foot are flattened. Active movements in the ankle joint due to soft tissue edema and tension of the calcaneal tendon are severely limited, and in the subtalar joint are impossible.

Disease of the North, or epiphysitic calcaneus of the , represents a painful gap between the apophysis of the calcaneus and the calcaneus. This condition usually develops at a time when the full ossification of the calcaneus has not yet been completed. Usually the manifestations of this disease are found in people actively engaged in sports, at the age of 9 - 14 years. Pain in the heel is enhanced by running, fast walking. It's painful to get up on toes. In addition, there is a restriction of movements in the gastrocnemius of the calf. Often in the area of ​​separation there is some edema and a local increase in temperature.

4. Inflammatory diseases

Plantar fasciitis( sometimes referred to as the calcaneal spur) is a painful inflammation of the plantar fascia( a fibrous ligament on the sole of the foot that helps support the arch of the foot).Plantar fasciitis occurs when the plantar fascia is overloaded or overextended. The leading symptom is pain in the calcaneal region, which arises or worsens with exercise. Painful sensations are more pronounced in the morning hours. The diagnosis of plantar fasciitis is established after the analysis of patient complaints and physical examination. Radiography allows you to exclude the stress fracture of the calcaneus, as well as to identify the presence of calcaneal spurs.

Heel spur

Osteochondropathy of calcaneus calcaneus ( Gaglund-Shinz disease).At the heart of the diseases is aseptic( sterile) necrosis( necrosis) of the parts of the spongy bone under the conditions of the greatest mechanical load. Pain in the heel appears with the patient's vertical position immediately or a few minutes after the support on the hillock of the calcaneus, walking with the support of the calcaneus because of the intolerable nature of the pain becomes impossible. Patients are forced to walk, loading the front and middle parts of the foot, using a cane or crutches. Most patients have skin atrophy, moderate soft tissue edema, and increased tactile sensitivity. Often there is an atrophy of the muscles of the shin.

Bursitis is characterized by all the classic symptoms of inflammation. On the back of the heel there is swelling, redness, soreness. To the touch, the skin in this place becomes warm. Gradually, the swelling is increased. In case of chronic inflammation, swelling behind the heel may become condensed.

Tendonitis of the Achilles tendon is its inflammation. It can occur due to excessive stress on the Achilles tendon( strained muscles of the calf, frequent running uphill or from the mountain, a sudden increase in the number of physical exertions, for example, running for long distances);wearing uncomfortable shoes, frequent wearing of shoes with high heels and a nightly heel change to a flat sole. With tendinitis, pain occurs along the tendon, usually closer to the heel;swelling in the tendon area with a local increase in the temperature of the skin, their redness and increased sensitivity;pain when getting up on toes and jumping toes. Following a stressful condition, the inflamed Achilles tendon may burst, which is often accompanied by a characteristic bursting sound. With a torn tendon it is almost impossible to walk. If you can not stand on the toes, you may have a tendon rupture. This requires urgent medical attention.

5. Malignant tumors. As with other primary malignant tumors of the bones, the earliest symptom is pain in the area of ​​the affected bone, first passing, then constant with increasing intensity. As the disease develops, this zone becomes more and more noticeable, swelling. Depending on the tumor subtype, the soft tissue component of the tumor may be hard or soft. With the rapid growth of the tumor( which is observed in children), cachexia and progressive anemia can develop. Pathological fractures are possible. Above the tumor, there is sometimes a network of dilated blood vessels.

6. Neuropathy of medial calcaneal branches of the tibial nerve. Manifestations of the disease are composed of a failure of plantar flexion of the foot and fingers, as well as turning the foot inside. Violated sensitivity in the heel and sole. With a long-term lesion of the tibial nerve, trophic ulcers develop in the heel and deformities of the foot.

Examination for heel pain

When examining patients with pain in the heel, complaints are important. In addition to pain in the heel of the patient, pain in the joints of different localization, pain and inability of full-fledged movements in the back, pain in the 1st toe, reddening and swelling, etc., can be disturbed. Pay attention to the history of the disease( for example, previous foot trauma, previous chlamydial infection, morning stiffness, etc.) and objective examination( eg, redness, edema, dysfunction, fistula, etc.).These data together can lead to the identification of the cause of pain in the heel. If the diagnosis is not clear or requires confirmation, a laboratory and instrumental examination is carried out.

Laboratory and instrumental examination for heel pain

1. General blood test( possible anemia, leukocytosis, increased ESR in rheumatoid arthritis, Bekhterev's disease);
2. Biochemical blood test: increase in uric acid with gout;
3. Microbiological examination( eg scraping from the urethra on Chlamydia if suspected of reactive arthritis);
4. X-ray examination - one of the main methods of examination for pain in the area of ​​the heel. Specific changes specific to a specific pathology will be seen.
5. Study for oncologic markers in case of suspected malignant neoplasm;
6. Serological analysis: rheumatoid factor in rheumatoid arthritis.
7. Puncture bone biopsy for suspected bone tuberculosis and osteomyelitis: a sowing material is obtained by aspiration of pus from bone or soft tissues, or bone biopsies are performed.
The plan for further examination depends on the patient's age and clinical manifestations. Especially careful it should be if pain in the calcaneal region is noted for a long time.

Treatment for heel pain

Because the pain in the heel is a symptom, the method of treatment depends on the cause or underlying disease. However, to reduce pain and prevent its appearance, regardless of the causes, it is necessary to follow certain recommendations:

1. Fighting overweight. Excess weight increases the load on the muscles of the foot.
2. Wearing orthopedic insoles. Especially with flat feet.
3. Wear comfortable shoes with a heel not more than 5 cm. Shoes without heels are also not recommended.
4. Therapeutic gymnastics for the feet daily.

To quickly reduce severe pain in the heel, you can put a piece of ice on the aching place and hold the cold for 20 minutes, the heel itself and the area above it can be rubbed with an anti-inflammatory cream( for example, a gel-paste).

If pains in the heels of torture you for a sufficiently long time, and you yourself do not cope with it, seek professional help from a doctor.

Which doctors should I use for pain in the heel?

Depending on whether there was a trauma, doctors - therapist, traumatologist, orthopedist. It may be necessary to consult doctors of the following specialties: neurologist, surgeon, oncologist, phthisiatrist.

Physician therapist Kletkina Yu. V.