Heels hurt when standing for a long time. What to do when your heel hurts. Not related to pathologies

The heel is made up of nerves muscle fibers, bones and thin fat layer. The structure of the foot and heel allows it to withstand prolonged physical activity, including training. It is the heels that protect the spine from possible injuries and are, in fact, shock absorbers that reduce pressure on the legs and body.

The heel bone consists of extremely sensitive nerve endings, blood vessels, muscle tubular tissues and tendons, making them sensitive to various kinds damage.

In case of external injuries or work disorders, pain in the heels will be felt when walking or at rest.

Plus, anatomical structure and external unprotected feet, allows you to easily receive injuries and damage.

Painful feeling in the heel after waking up

Pain in the heel area is not a common occurrence; it usually occurs immediately after waking up and taking the first steps. Painful sensations can vary in intensity from weak aching to dull sharp ones, during which it is almost impossible to walk fully, only on tiptoe. The pain either subsides or comes with renewed vigor. It usually appears after prolonged sitting or lying in bed.

The main cause of this syndrome is called - plantar fasciitis. The disease is insidious, characterized by inflammatory and degenerative changes in calcaneus, gradually the disease spreads to fasciitis connective tissue, causing unbearable pain and torment.

Plantar fasciitis develops due to the following reasons:

1. excessive stress on the foot due to exercise or long period wearing shoes on high heels;
2. a sedentary lifestyle, for example, frequent sitting or standing in one position leads to the formation stagnant processes in vessels and veins;
3. rapid obesity;
4. pathological flatfoot, in which the arch of the foot shifts and drops.

Untimely treatment or deliberate delay in the diagnostic process most often leads to the formation of calcium-salt deposits, which are called heel spurs. It is the heel spur that causes pain in the heels, especially in the morning.

Heel pain and painful stepping: causes and symptoms

The causes of pain in the feet and heels can be varied; as a rule, there are several types, namely:

1. systemic diseases;
2. injuries and sprains;
3. inflammatory processes;
4. infectious diseases;
5. other associated disorders in organism.

Systemic diseases

Ankylosing spondylitis – a systemic chronic disease accompanied by extensive inflammatory processes in the spine and joints. The disease develops due to the pathology of one’s own immunity, in which intervertebral discs grow together, and gradually the spinal girdle loses its former flexibility.

Most often, the first symptoms of the disease are severe and excruciating pain in the heels. The sensations are so intense that it is impossible to stand on a flat surface for more than 10 minutes.

Rheumatoid arthritis – a difficult to diagnose disease, characterized initially by acute dull ache in the heel when walking, and then lying down.

Gout . With gout, urea accumulates, mainly near the joint of the big toe. Gradually, the tendons and joints swell, turn red, become inflamed, and sharp pain pain in the heels, making it almost impossible to walk.

Injuries and sprains

Heel bone bruise accompanied by inflammatory processes in neighboring tissues of the legs. The pain under the heel is sharp and cutting, as if the soles of the feet were pierced sharp knife. It is almost impossible to get on your feet.

Heel bone fracture. With it, the inner or outer part of the foot turns outward, it is impossible to step on your feet, and the skin becomes covered with hematomas.

Tendon rupture or sprain. When you bend the soles of your feet, you feel strong painful sensations in the heel.

Calcaneal Epiphysitis occurs when connective tissue in the heel bone ruptures. arise painful sensations on the outer and inner surface of the foot and occurs during active walking.

Inflammatory processes

Bursitis occurs after leg injuries and is accompanied by an extensive inflammatory process. In some cases, the causes of heel pain are not known. With bursitis, the skin is irritated, swelling and swelling appear.

Tendon tendinitis arises as a result excessive loads on the calf muscles and tendons. If timely measures are not taken, the legs swell over time, turn red and the heels begin to hurt when stepping on them.

Infectious diseases

Bone tuberculosis. This disease is characterized by extensive necrosis of foot tissue or “melting” of the heel bone. The inflammatory process can be stopped and the disease cured, but most often the consequences remain - lameness, foot deformity and severe pain in the heel when walking.

Reactive arthritis occurs against the background of an intestinal or genital infectious infection that occurs in a latent form. The disease makes itself felt at night, less often during the day.

Osteomyelitis of bone occurs against the background of infection by infectious bacteria of the bone marrow, accompanied by extensive purulent necrosis in which the heel looks swollen and red. The inside of the heel hurts, as if it were being drilled with a sharp cutting object.

Other associated disorders in the body

These include diabetes mellitus, cancer, and any type of neuropathy of the tibial nerves or muscle fibers.

If you have heel pain, what should you do?

First of all, contact your doctor, he will refer you for a special diagnosis capable times and forever accurately determine the nature of the disease.

Treatment of heel pain is carried out by the following specialists:

1. neurologist;
2. traumatologist;
3. oncologist;
4. rheumatologist;
5. surgeon.

Medical treatment for heel pain

How to treat heel pain?

After carrying out all the necessary diagnostic tests, identifying the exact causes and staging correct diagnosis, therapy is prescribed. If your heel hurts, the treatment will be complex and long. At the same time, it is necessary to pay close attention to preventive procedures.

Advice for women: Do not always wear high-heeled shoes; give preference to models made from natural materials. It is better to eliminate the heel altogether, or no higher than 4-5 cm.

An excellent preventive measure for heel pain is light exercise, massage, leisurely walks or walking barefoot on grass, sand or pebbles.

Orthopedists recommend regularly cycling and visiting a bathhouse with brooms. These methods can eventually restore the normal functioning of blood vessels and capillaries. Heel pain in obesity, successfully treated with strict vegetarian diet and a gym.

Diagnosis of causes

If your heel hurts and it hurts to step on, the causes may be different. If there are painful signals in the feet, this may become clear after a high-quality diagnosis. The attending physician first collects general anamnesis patient, then performs manual palpation of the pain area and, based on these data, writes a referral for further research.

The following studies include the use of ultrasound, x-ray, computed tomography and magnetic resonance imaging. The diagnosis is completed by comprehensive blood, urine and stool tests. Based on these data, the causes of acute heel pain are determined and a final diagnosis is made.

Why do heel surfaces hurt in children?

In most cases, all pain in the heels of the feet is somehow associated with injuries and sprains. This is due to high physical activity and a certain recklessness that accompanies children.

If you are not careful sports games, it is the heel parts of the foot that suffer first. If you suspect a heel injury, you should immediately contact the nearest emergency room.

Traditional methods of treatment

Above the question: “How to treat heels at home?” have been thought about for more than one generation.

Problems with legs and feet are not a rare event and suffered from it at all times. Time passed and folk wisdom has preserved to this day a treasure trove of amazing, and most importantly effective recipes in case your heels hurt.

Recipe No. 1

Prepare two containers for carrying out foot baths. Pour into one container cold water, in the other - hot. If desired, you can add a couple of tablespoons of propolis or mumiyo extract to the water. Dip your feet into containers one at a time, starting and ending with hot water.

The time required is a few minutes for each container, 5-6 approaches. Then wipe your feet dry, lubricate them with a cream with a warming effect and put on thick cotton or woolen socks.

Recipe No. 2

Turpentine relaxing baths. IN large capacity, with a volume of at least 5 liters, pour a few tablespoons of natural turpentine or, if you don’t have it, use a regular pharmaceutical pine extract.

Pour hot water and steam your feet for at least 20 minutes, every other day for 1 month. Then take a break for 1 month and repeat the course of procedures. You can add 100 grams to the water if desired. natural sea salt.

Recipe No. 3

Make warming cream at home. Take 3 tbsp. l. honey, mixed with 1 tbsp. l. mummy and add a little olive oil. After everything is thoroughly mixed before going to bed, smear your feet, wrap them tightly in cotton or woolen socks and leave it like that all night. In the morning, rinse with warm water adding 1 tbsp. l. vinegar.

It hurts to step on - people come to the doctor with this problem quite often. It is quite possible that someday you will experience this pain too. Many people, if their heels hurt, postpone treatment. I must say, they do this in vain. Many people wait almost six months until severe pain forces them to go to the doctors. People forget that the heel is constantly loaded, and if it is also injured, it simply cannot recover on its own.

The heel hurts, it hurts to step on - patients complain, unfortunately, knowing very little about the structure of this important part of the body. What is a heel? In fact, this is the most ordinary shock absorber. It consists of a fatty layer and is the largest of all the bones of the foot. It can withstand enormous loads when walking and running. The point is that this bone is also spongy, it is permeated blood vessels and nerves.

Many nerves pass from there to other areas of the foot. Precisely because large quantity nerve endings in the heel are very sensitive spot.

It is very easy to damage the heel. Heel pain, the causes of which are tears or inflammation of the connective tissues, is a very common occurrence.

This disease is known as It is not only the heel that hurts, but the pain also radiates to other areas of the body. In addition, the heel may hurt for other reasons. For example, due to the fact that the person was wearing uncomfortable shoes. Or because a person has biomechanical problems when running. This may also be a consequence of inflammation of the tendons or banal rheumatoid arthritis.

The heel hurts, it hurts to step on - what to do in this case? Considering that the heel is a vulnerable part of the body, if it is sick, you need to send your feet to a specialist’s office. Only this person can tell you what exactly your problem is. Only then will you be prescribed the only correct treatment. Although, I must admit that the heel cannot be cured quickly. After determining the diagnosis, you need to be patient. And treat.

It is worth paying attention to a few tips that will help you if your heel hurts and it hurts to step on it.

If you feel it for the first time, you need to place your foot in the cold. At least for the first two days. Take a small ice cube and massage your foot with it. It doesn’t take long, about 5 minutes, until it starts to go numb. This procedure should not be carried out once, but at least several times a day. After two days, cooling procedures will need to be alternated with warming ones. First, apply ice to the sore spot for 15 minutes, then pause for a short period of time, and then apply a warm heating pad there for 15 minutes. It will be enough to carry out this simple procedure once a day.

Of course, you will also need to take pills. Any anti-inflammatory drugs. For example, Ibuprofen. Or anything else, depending on what the doctor recommends to you.

You can use a special heel support, which will make the load on the heel more even. An excellent tool To combat such a problem, an orthopedic device will be used - an insert, which, when installed in shoes, will significantly reduce the pain over time, and then, perhaps, eliminate the cause of the disease altogether. In addition, such a device will eliminate other existing problems. Of course, the heel needs to be warmed up. After all, if the tendons are not elastic enough, they can cause pain. And if you knead them, you will get rid of the problem. It is advisable, if possible, to reduce the load on the legs, at least for the duration of treatment.

If your heel hurts, then you need to work on it and you should start by visiting good specialist, who will accurately determine the diagnosis and then prescribe the appropriate treatment.

Sometimes severe pain in the heel occurs instantly and makes it difficult for a person to walk. Modern life is designed in such a way that we spend most of our time on our feet, sometimes excluding the possibility good rest. This gives increased load on the feet, which causes injury to the heel, which results in unpleasant sensations. The pain may gradually intensify, and to avoid this, you need to contact a rheumatologist or traumatologist in a timely manner.

The main function of the heel is to provide shock absorption when moving or running. This is done with the help of the heel bone and fat layer. The heel has many nerve endings and capillaries, so it is quite vulnerable.

What are the causes of pain?

Heel pain can indicate a variety of bone and joint diseases. Most often, patients' complaints are directed at pain resulting from plantar fasciitis. This disease is characterized by inflammation or tearing connective tissue. Often, the occurrence of this disease is associated with wearing uncomfortable shoes, flat feet, severe physical activity and other mechanical disorders. Enough common cause pain is inflammation of the tendon, characterized by a tingling sensation. Pain is common with rheumatoid arthritis.

Gout, arthritis and other inflammatory diseases may be characterized by pain in the left or right heel. The sensations can appear at any time of the day while performing any activity or even at rest. Correct treatment These diseases will help you get rid of pain in the heel area.

Fasciitis affects both adults and young people. This is due to today's environment, food containing chemicals and preservatives, as well as numerous stresses. Due to all these factors, metabolic disorders and calcium saturation occur, as a result of which the strength of bones and joints is impaired. Tendon injuries and overloads, bone bruises, chlamydia, gonorrhea and other infections and chronic diseases- these and many other reasons can cause pain even at rest.

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The effect of fasciitis on the body

The first sign of fasciitis is pain that occurs when walking immediately after rest or sleep. This pain is very difficult to endure, so patients do not want to lean on the sore heel. After a certain period of time, the pain may subside, and then suddenly return. This is due to the fact that when a person rests, the pain subsides, the constantly overloaded aponeuroses swell, and micro-tears heal. As soon as the patient walks a little, the fascia is again subject to rupture.

Patients with fasciitis experience constant pain dull aching in the area of ​​the middle of the heel bone, sometimes throughout the day. Athletes especially often suffer from fasciitis. fat people or those who have a non-sedentary job. There are cases where this heel pain becomes a factor pathological disorders Achilles tendon. The likelihood of fasciitis occurring is permanent shift sports shoes. But when making a diagnosis, a rheumatologist or traumatologist can be confused by tendinitis or paratendinitis, especially in combination with plantar fasciitis.

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Arthritis and heel spurs

With arthritis, heel pain appears very often, and inflammatory processes spread to the entire foot. This disease is associated with damage to the tissue connecting the phalanges of the fingers to the heel bone. This pain is detected in an increasing form, mainly in the morning. When massaging the feet, pain and discomfort fade away, but under the influence physical activity they may appear again.

Treatment of arthritis must be timely, since it contributes to the destruction of joints and bones and even affects internal organs. By contacting a doctor as quickly as possible, you can eliminate the cause of the pain as quickly as possible.

Heel spurs are called chronic plantar fasciitis. The cause of its occurrence is salt accumulation and the development of growths. When walking, pressure occurs on the foot, which causes discomfort and pain in the heel. A person, while at rest or in a sitting position, may not experience pain, but when taking several steps, the pain is more severe.

Plantar fasciitis can only be detected by X-ray examination. In some cases bone spur may be completely absent, and pain may continue. If such pain occurs, you need to determine where it is localized, because these sensations may indicate injury to tendons or ligaments.

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Impact of Rheumatoid Arthritis

The danger of rheumatoid arthritis is that the immune system confuses the body's cells with foreign ones and begins to attack them. As a result, constant inflammatory processes occur, due to which destruction begins bone tissue and joint damage. The result of such an impact may be an undermining immune system or complete defeat the organ being attacked.

With partial damage to the legs, the pain syndrome spreads simultaneously to the toes and heel. The joints are quickly destroyed, and the antibodies produced against the body's cells act as a kind of poison.

Reasons for the development of this disease:

• exposure to viral infections;
• severe colds;
• all sorts of complications after suffering from the flu.

The main symptoms include acute pain in the heel area, sometimes the patient experiences severe high temperature body, he loses his appetite and becomes depressed. It is impossible to completely recover from rheumatoid arthritis; to improve the patient’s condition, it is necessary to consult a doctor as soon as possible.

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

Causes of heel pain

Cause not caused by disease:

1. “Heel pain syndrome” can be caused by constant overstrain of the foot structures, which manifests itself as pain in the heel when walking. It can be caused by shoes with unusually high heels.
2. In addition, heel pain may appear as a result of thinning of the subcutaneous fat on the plantar surface of the foot in the heel area with a sharp increase in motor activity.
3. Long stay on your feet during the day.
4. Recent rapid weight gain, obesity.

Heel pain should not be underestimated. In addition to the fact that they cause significant suffering and worsen the patient’s quality of life, heel pain can be one of the first symptoms of serious illnesses.

Diseases accompanied by heel pain

1. Systemic diseases:

Ankylosing spondylitis (ankylosing spondylitis) is a chronic inflammatory disease of the spine and joints. The cause of ankylosing spondylitis is the aggressiveness of the immune system to own tissues joints and ligaments. With this disease, “ossification” of the spinal ligaments, intervertebral joints and discs occurs. There is a gradual process of “fusion” of the vertebrae with each other, the spine loses its flexibility and mobility. In some cases, the very first symptoms of ankylosing spondylitis are pain in the heels, which makes standing on a hard floor very unpleasant. Without proper treatment, complete immobility of the spine can occur over several years, when almost all vertebrae fuse into one rigid bone structure.

Rheumatoid arthritis- this is one of the most difficult joint diseases, which occurs with many complications. The main symptoms of rheumatoid arthritis are pain, swelling and, as a result, limited joint mobility (including the joints of the foot, although this is an atypical location of the lesion). Pain may initially appear only when moving. When severe inflammation Pain can occur at rest, and it can even wake the patient up. In addition to pain in the joints, the patient complains of general weakness, fatigue, loss of appetite.

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

2. Infectious diseases, including urogenital (such as chlamydia, gonorrhea, ureaplasmosis, etc.) and intestinal (dysentery, yersineosis, salmonellosis), occurring latently, can lead to reactive arthritis (including the joints of the heel bones). At the same time, heel pain often occurs not only when walking. In patients with reactive arthritis, the heels may hurt even at rest, at night. And sometimes it is at night that they hurt the most.

In addition, inflammation of the heels in reactive arthritis is often accompanied by inflammation of a number of joints and eyes, as well as discomfort in the genital area. Patients may note a connection between arthritis and a previous genitourinary or intestinal infection.

Bone tuberculosis(including the heel bone). 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 over time begins to spread to an increasingly large and large area. Regardless of the initial manifestations, tuberculosis of bones and joints causes the formation purulent fistula or a cavity opening outward. It should be noted that after a few weeks inflammatory process may stabilize, and the patient goes into stable remission.

Osteomyelitis of the calcaneus is a purulent-necrotic process that develops in the bone and bone marrow, as well as in the surrounding soft tissues, caused by bacteria. At the beginning of the disease, a person may complain of weakness and muscle pain. 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 the inside, intensifying with the slightest movement - such pain is difficult to confuse with anything. The heel is swollen, the skin takes on a stagnant red color, and the veins are dilated.

3. Injuries

Tendon sprain or rupture. Causes may include direct trauma (strike to tendon hard object) and the indirect effect of a sharp contraction of the lower leg muscles. Usually, acute pain in the Achilles tendon area appears first. There is swelling in the tendon area. By palpation, a defect in the integrity of the tendon can be determined. Active plantar flexion is difficult or even impossible.

Heel bone bruise With further inflammation adjacent tissues (for example, as a result of landing on your heels after jumping from a height). Such patients usually complain of burning pain under the heel, “as if a nail had been stuck there,” the pain increases when putting pressure on the heel.

For calcaneal fractures Characterized by pain in the area of ​​injury and the inability to put weight on the foot. The heel is deformed to the outside or inside, the heel area is expanded, the foot is swollen, there are bruises in the heel area and on the plantar surface of the foot. The arches of the feet are flattened. Active movements in ankle joint due to swelling of the soft tissues and tension of the calcaneal tendon, they are sharply limited, and in the subtalar joint are impossible.

Sever's disease, or epiphysitis of the calcaneus, is a painful gap between the apophysis of the calcaneus and the body of the calcaneus. This condition usually develops during the period when complete ossification of the heel bone has not yet been completed. Usually manifestations of this disease occur in people actively involved in sports, aged 9–14 years. Heel pain intensifies when running or fast walking. Standing on tiptoes is painful. In addition, there is a limitation of movements in the calf muscle of the leg. There is often some swelling and a local increase in temperature in the area of ​​the avulsion.

4. Inflammatory diseases

Plantar fasciitis (sometimes called heel spur)- painful inflammation of the plantar fascia (the fibrous ligament on the sole of the foot that helps support the arch of the foot). Plantar fasciitis occurs when there is stress or excessive stretching of the plantar fascia. The leading symptom is pain in the heel area, which occurs or worsens with exertion. Pain is more pronounced in the morning. The diagnosis of plantar fasciitis is established after analyzing the patient's complaints and physical examination. X-rays can rule out a stress fracture of the calcaneus and also identify the presence of heel spurs.

Osteochondropathy of the calcaneal tuberosity(Gaglund-Schinz disease). The basis of the disease is aseptic (sterile) necrosis (death) of areas of spongy bone that are under conditions of the greatest mechanical load. Heel pain occurs when vertical position the patient immediately or a few minutes after resting on the tubercle of the heel bone, walking with support on the heel bone becomes impossible due to the unbearable nature of the pain. Patients are forced to walk, loading the anterior and middle departments feet, using a cane or crutches. In most patients, skin atrophy is detected on the plantar surface of the heel bone, moderate swelling soft tissues, increased tactile sensitivity. Atrophy of the lower leg muscles often occurs.

Bursitis is characterized by all the classic symptoms of inflammation. Swelling, redness, and soreness appear on the back surface of the heel. The skin in this area becomes warm to the touch. The swelling gradually increases. With chronic inflammation, the swelling behind the heel may harden.

Achilles tendonitis– this is its inflammation. It can occur due to excessive load on Achilles tendon(overstrained calf muscles, frequent running uphill or downhill, a sharp increase in the amount of physical activity, for example, long-distance running); wearing uncomfortable shoes, frequently wearing high-heeled shoes and changing heels to flat soles every night. With tendonitis, pain occurs along the tendon, usually closer to the heel; swelling in the tendon area with local promotion temperature skin, their redness and hypersensitivity; pain when standing on your toes and jumping on your toes. After stressful condition An inflamed Achilles tendon can rupture, often accompanied by a characteristic popping sound. It is almost impossible to walk with a torn tendon. If you can't stand on your toes, you may have a tendon tear. This is a medical emergency.

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

6. Neuropathy of the medial calcaneal branches of the tibial nerve. Manifestations of the disease consist of impaired plantar flexion of the foot and toes, as well as inward rotation of the foot. Sensation in the heel and sole area is impaired. With long-term damage to the tibial nerve, trophic ulcers in the heel area and foot deformity.

Examination for heel pain

When examining patients with heel pain important have complaints. In addition to heel pain, the patient may experience joint pain various localizations, pain and impossibility of full movements in the back, pain in the first toe, its redness and swelling, etc. Pay attention to the medical history (for example, previous foot injury, previously suffered chlamydial infection, morning stiffness, etc.) and objective examination (for example, redness, swelling, dysfunction, fistulas, etc.). Together, these findings can lead to identifying the cause of your heel pain. If the diagnosis is not clear or requires confirmation, a laboratory and instrumental examination is performed.

Laboratory and instrumental examination for heel pain

1. General analysis blood (possible anemia, leukocytosis, increase in ESR at rheumatoid arthritis, ankylosing spondylitis);
2. Biochemical blood test: increase in uric acid in gout;
3. Microbiological examination(for example, scraping from the urethra for chlamydia if reactive arthritis is suspected);
4. X-ray examination- one of the main examination methods for pain in the heel area. Specific changes characteristic of a particular pathology will be visible.
5. Testing for tumor markers in cases of suspected malignancy;
6. Serological analysis: rheumatoid factor in rheumatoid arthritis.
7. Puncture bone biopsy for suspected bone tuberculosis and osteomyelitis: material for culture is obtained by aspiration of pus from the bone or soft tissue, or a bone biopsy is performed.
The plan for further examination depends on the patient’s age and clinical manifestations. It should be especially thorough if pain in the heel area has been observed for a long time.

Treatment for heel pain

Since heel pain is a symptom, its treatment method depends on the cause or underlying disease.

However, to reduce pain and prevent its occurrence, regardless of the cause, you must follow some recommendations:

1. Fight with overweight bodies. Excess weight increases stress on the foot muscles.
2. Wearing orthopedic insoles. Especially with flat feet.
3. Wearing comfortable shoes with a heel of no more than 5 cm. Shoes without heels are also not recommended.
4. Physiotherapy for feet daily.

To quickly reduce severe pain in the heel, you can apply a piece of ice to 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, fastum gel).

If heel pain has been bothering you for quite a long time and you cannot cope with it on your own, seek qualified help from a doctor.

Which doctors should I consult for heel pain?

Depending on whether an injury occurred, doctors - a therapist, a traumatologist, an orthopedist. You may need to consult doctors of the following specialties: neurologist, surgeon, oncologist, phthisiatrician.

General practitioner Kletkina Yu.V.

Heel pain when walking and after sleeping is a very common occurrence. In most cases, this symptom is associated with plantar fasciitis or heel spurs, but other causes are possible.

According to some estimates, about 10% of people complain of heel pain at least once in their lives. Most often, heels hurt in runners, as well as in people aged 40 to 60 years. In most cases, only one heel hurts; both feet are affected in about a third of people. Typically, heel pain is most severe in the morning or during the first steps after sleep. If you disperse, the discomfort subsides, but reappears after a long walk or heavy loads. Some people develop a limp or a strange gait as they try to walk on the affected leg.

The most common cause of heel pain is damage and thickening of the bundle of connective tissue fibers that support the arch of the foot - the plantar fascia. It connects the heel bone to the bones of the foot and also acts as a shock absorber. Due to injury or gradual wear and tear, microtears can appear in the structure of the plantar fascia. Because of this, it thickens and hurts. The scientific name for this phenomenon is plantar fasciitis. The surrounding tissue and heel bone may also become inflamed. A bone spike often grows on the heel - a heel spur, which injures the surrounding tissues when walking and causes pain.

Physiotherapy is used to treat heel pain. physical therapy, various fixation devices and foot bandaging, as well as medications. IN in rare cases resort to surgery. In about 80% of people, the disease goes away within a year.

To prevent foot problems or quickly get rid of heel pain, you need to wear comfortable shoes with low heels that protect the arches of your feet. Controlling body weight is of great importance because overweight creates additional stress on the heels.

Why does my heel hurt?

The most common cause of heel pain (about 80% of cases) is plantar fasciitis. This is damage and thickening of the calcaneal fascia, the thick bundle of fibers that connects the heel bone to the rest of the foot. Damage to the heel fascia can occur in the following ways:

• as a result of injury, for example while running or dancing - such injury is more common in young and physically fit active people;
• during the gradual wear and tear of the tissues of the plantar fascia - typical for people over 40 years of age.

The risk of gradual wear and tear and subsequent damage to the plantar fascia increases in people with overweight or obesity, for those who spend most of the day on their feet, as well as for those who like flat-soled shoes - flip-flops or flip-flops.

With plantar fasciitis, heel pain after sleep is more common. After some time, it becomes easier, but by the middle of the day, with long walking, the pain in the heel intensifies again.

Less common causes of heel pain

Heel spur- This is the growth of bone tissue in the form of a spike on the heel. Heel spurs are often associated with plantar fasciitis, being its consequence, but can develop independently without causing heel pain.

Fatigue (stress) fracture occurs as a result of long-term excessive loads on the heel bone when walking, running, jumping, etc. It is more common in people who play sports. It happens less often with osteoporosis - when the heel bone loses strength and even normal walking or light jogging can lead to destruction of its structure. Stress fracture accompanied by aching pain, intensifying when pressing on the heel. There may be a slight swelling at the fracture site.

Atrophy of the fat pad- thinning of the layer of fatty tissue under the heel bone under the influence of excess pressure on it. The layer of fat between the bones of the foot and the skin plays an important role as a shock absorber when walking, softening impacts on the ground. The risk of developing atrophy of the fat pad is increased in women who wear high heels for a long time, as well as in older people. In rare cases, atrophy of the fat layer on the foot develops after injections of corticosteroids into the joints, as well as after fractures. Orthotics can help treat this cause of heel pain.

Bursitis is an inflammation of one or more bursae (small sacs of fluid typically found around joints and between tendons and bones). Near the heel there are three bursae, each of which can become inflamed under the influence of heavy loads on the foot or infections.

Tarsal tunnel syndrome - carpal tunnel syndrome, associated with compression of the tibial nerve in the connective tissue canal near the medial ankle of the foot. The cause of the narrowing of the canal may be damage after dislocations, fractures, or the formation of a cyst in it. Tarsal tunnel syndrome is characterized by impaired sensitivity (from pain to numbness) in the foot and toes, including at night, and weakness in the foot muscles. When you feel the inner ankle of the leg and the area around it, the pain and discomfort in the foot intensifies. Sometimes there is pain in the heel.

Aseptic necrosis of the calcaneus may cause heel pain in children. Most often, necrosis develops as a result of stretching and contraction of the muscles and tendons behind the knees and ankles due to rapid growth child. When stretched, the calf muscle pulls the heel (Achilles) tendon. This causes the growing area of ​​bone at the back of the heel (the growth plate) to stretch, causing pain. This pain intensifies when playing football or doing gymnastics. The pain often appears on the side of the heel, but can also be felt underneath it. Usually, aseptic necrosis Heel bone can be treated well with stretching exercises for the hamstring and calf muscles and tendons, as well as, if necessary, wearing special pads under the heel.

Diagnosis of heel pain

To diagnose heel diseases, you need to contact an orthopedic traumatologist. In most cases, it is this specialist who will deal with your further treatment. If it is difficult to get an appointment with this specialist, you can start by visiting a surgeon. It is possible that during the examination you will need to consult other doctors: a rheumatologist - to exclude systemic joint diseases, a neurologist - to exclude diseases of the nerves of the foot.

There are some additional signs, which will help you and your doctor suspect the cause of your heel pain. So, numbness or tingling in the leg is more likely to indicate nerve damage. This may be the tarsal tunnel syndrome described above or a manifestation general defeat peripheral nerves, which happens, for example, with diabetes. If your foot is hot to the touch and swollen, it may be infectious lesion soft tissue or calcaneus. In these cases, the help of a surgeon will be required. Restricted mobility and pain in the joints of the foot indicate the likely development of arthritis - inflammation of the joint.

To clarify the diagnosis, the doctor may prescribe the following examinations:

• blood tests;
• radiography - the use of a small dose of radiation to detect pathologies in the bones;
• Magnetic resonance imaging (MRI) or ultrasound (US) are methods for more detailed scanning of soft tissues.

How to treat sore heels?

Typically, heel pain is treated in a comprehensive manner, such as stretching exercises and pain medications. This can be a long process, sometimes up to a year. If after this time the pain has not gone away, as a last resort surgery is recommended. This happens only in 0.5% of cases.

The success of treating heel pain largely depends on the lifestyle you lead. Regardless of the reason, you will need to wear the “right” shoes, take the time physical exercise and how to rest. Most procedures for the treatment of heel pain can be performed independently, without the participation of a doctor.

If possible, spare your sore heel - try not to walk long distances or stand for long periods of time. In this case, you should regularly perform special exercises for stretching feet and calves.

Physical therapy for heels

Stretching exercises for the calf muscles and plantar fascia can help relieve pain and increase flexibility in sore feet. As a rule, it is recommended to perform exercises with both legs, even if only one of them hurts.

Stretching with a towel. Keep a long towel near your bed. Before you get up in the morning, place a towel over your foot and use it to pull your toes toward you, keeping your knee straight. Repeat three times with each leg.

Stretching against the wall. Place your hands on the wall at shoulder level with one foot in front of the other. The front foot should be approximately 30 cm from the wall. Keeping your back straight, bend your front knee, leaning toward the wall until you feel a stretch in the calf muscles of your other leg. Relax. Repeat 10 times with one leg, then the same number with the other. Do this exercise twice a day.

Stretching on the stairs. Stand on the step, facing the stairs, lean on the railing. Your feet should be slightly apart, your heels hanging off the step. Lower your heels until you feel a stretch in your calf muscles. Stay in this position for about 40 seconds, then return to the starting position. Repeat six times, at least twice a day.

Stretching on a chair. Sit on a chair, bend your knees at right angles. Turn your feet so that your heels touch and your toes point in opposite directions. Lift your toes on your painful foot, pressing your heel firmly into the floor. You should feel a stretch in your calf muscles and Achilles tendon (the bundle of fibers that connects your heel bone to your calf muscles). Stay in this position for a few seconds, then relax. Repeat 10 times, 5-6 approaches per day.

Dynamic stretching. While sitting, roll the arch of your foot (the concave part of the sole) over a round object, such as a rolling pin, tennis ball, or can. Some people note that if you use cold jar, it also helps relieve pain. Move your foot in all directions over the object for several minutes. Repeat twice a day.

Painkillers for heel pain

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be used to relieve pain. Applying a cold compress to the sore heel for 5-10 minutes can also sometimes help relieve pain and inflammation. However, ice should not be applied directly to the skin; it should be wrapped in a towel. You can use a bag of frozen vegetables instead of ice.

Orthopedic insoles

Orthotics are inserted into shoes to support the foot. correct position and soften heel strikes when walking. Ready-made insoles can be purchased at sporting goods stores, large pharmacies and orthopedic salons. Sometimes your doctor can recommend custom insoles that will fit your feet perfectly. They are made to order. However, there is currently no reason to believe that custom insoles are any more effective than standard insoles.

Bandaging or taping feet for heel pain

To reduce the load on the plantar fascia and the pain in the heel associated with its inflammation, you can bandage your foot elastic bandage. An orthopedist will show you the bandaging technique. Instead of a bandage, you can use an adhesive plaster or a special sports tape - tape. Applying strips of plaster or tape to the foot is called taping. The patch creates additional support for the foot, simulating the supporting role of the fascia. You can find foot taping techniques for heel pain on the Internet or check with your doctor.

Some podiatrists recommend using special night orthoses or braces to sprain the foot while you sleep. Most people have their toes pointing downward when they sleep, which causes the plantar fascia to contract. The pain after waking up is associated with its sharp stretching and microtrauma.

Foot braces are designed in such a way that your toes and feet point upward while you sleep. This helps stretch the Achilles tendon and plantar fascia, which allows the torn ligament fibers to heal in the correct position and speeds up recovery. As a rule, such orthoses or braces can only be purchased in specialized stores or on the Internet.

Corticosteroid injections

If the above methods do not help relieve pain, your doctor may prescribe corticosteroid injections. These are potent anti-inflammatory drugs that must be used with caution as they have severe side effects, such as weight gain and high blood pressure (hypertension). Therefore, it is not recommended to give more than three corticosteroid injections per year to any part of the body. Before giving a corticosteroid shot, your doctor may administer a local anesthetic.

Surgery for heel pain

If none of the treatments work and you are still in pain after a year, you may be referred for surgery. Surgery is sometimes recommended for professional athletes and other athletes if heel pain is negatively impacting their careers.

Plantar fascia excision surgery- the most widely used type of surgery for heel pain. The surgeon cuts the fascia to separate it from the heel bone and relieve tension in it. This should eliminate inflammation and relieve pain. The operation can be carried out in two ways:

• open - when a section of the calcaneal fascia is dissected through an incision in the heel;
• endoscopic, or minimal intervention surgery - when a small incision is made through which microsurgical instruments are inserted under the skin.

The recovery period after endoscopic surgery is shorter, so you will be able to walk normally much sooner (almost immediately), while recovery after open surgery takes from 2 to 3 weeks. The disadvantage of minimal intervention surgery is that it is performed only by a specially trained surgical team and with special equipment, so the waiting time for such surgery may be longer. Endoscopic surgery also associated with increased risk damage to nearby nerves, which can cause symptoms such as numbness, tingling and loss of mobility in the foot.

Like any other surgery, plantar fascia excision may have complications such as infection, nerve damage, and worsening symptoms after surgery (although this is rare). Discuss the advantages and disadvantages of both types of surgery with your doctor.

Shock wave therapy for heel spurs

This is a relatively new method of non-invasive treatment, that is, it does not involve surgical intervention. Shockwave therapy is especially effective in cases where heel pain is associated with a heel spur. The method involves sending high-energy sound pulses to the heel using special apparatus. This may be painful, so your doctor may inject a local anesthetic into your foot.

It is believed that shock wave therapy acts bidirectionally, namely:

• has an analgesic effect;
• stimulates and accelerates the healing process.

However, there is no exact evidence for this. Some studies have shown that shock wave therapy more effective than surgery and other methods of treating heel pain, and others - that this procedure is no different in effectiveness from placebo (pseudo-treatment).

Prevention

Preventing heel pain

It is not always possible to avoid heel pain, but there are steps you can take to prevent such problems from occurring in the future. Excess weight is known to place additional stress on the feet, especially the heels, increasing the risk of damage. If you are overweight, lose weight and maintain normal weight body by combining regular exercise with a healthy, balanced diet will be beneficial for your feet. (BMI) to see if your weight is appropriate for your height and body type.

Choosing the “right” shoes is of great importance for the prevention of heel diseases. If you wear high heels to a party, it's unlikely to hurt you, but if you wear them all week at work, it can damage your feet, especially if you have to walk or stand a lot. It's best to choose lace-up shoes with low to mid heels that support and protect your arches and heels. Don't wear flat shoes.

Do not walk barefoot on asphalt or hard ground. Heel pain often occurs when a person starts walking barefoot on vacation after wearing shoes all year. In this case, the feet are not used to the additional pressure, which causes heel pain.

If you are driving active image life, for example, if you do jogging or any other sport, change your sneakers regularly. Most experts recommend changing your running shoes after you've run about 500 miles in them. Be sure to stretch after exercise, and include regular strength and flexibility exercises in your workouts.

Who is treating?

Which doctor should I consult if my heel hurts?

In most cases, heel pain requires consultation with a doctor. Using the NaPopravka service, you can quickly find an orthopedic traumatologist who will diagnose and treat you. If it is difficult to get to a specialist of this profile, contact