Heel hurts, it hurts to step on - what to do? How to treat?

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Heel hurts, it hurts to step on - what to do? How to treat?
Heel hurts, it hurts to step on - what to do? How to treat?
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Heel hurts, it hurts to step on: causes and treatment

Sore heel
Sore heel

The human foot is a unique natural mechanism that allows us to move comfortably, provides high stability, maneuverability and speed, and all this despite the small size compared to the rest of the body. One of the most important parts of the foot is the heel, which performs the function of cushioning in the process of walking and running. This is possible due to the special structure of the calcaneus and the thick layer of subcutaneous fat, which forms a “cushion” on which we gently lean. Often this is accompanied by unpleasant sensations, and then questions arise: what to do if the heel hurts, it hurts to step on and it is impossible to walk normally?

Understanding the causes of such a problem can be difficult, since soreness in the heel region accompanies a number of diseases and injuries. However, most often the symptom is explained by non-pathological factors: a high load on the legs or wearing uncomfortable shoes. In a similar situation, the fair sex, carried away by beautiful high-heeled shoes, is especially often found. But under the signs of banal leg fatigue, serious diseases can be hidden that need to be noticed in time and started to be treated. Therefore, let's figure it out together why the heels can hurt in the morning or constantly, when walking or at rest, from below, behind or on the sides - in a word, we will discuss all the possible causes of the problem and consider treatment options at home.

Content:

Features of the structure of the human heel

The skeleton of the foot is formed by twenty-six bones, which is truly amazing, given its modest dimensions. The calcaneus is the largest in this design, it has a spongy structure and an elongated, laterally flattened body. In front, it articulates with the cuboid bone, above - with the talus, and behind there is a protrusion - the calcaneal tubercle, to which the Achilles tendon, the most powerful in the human body, is attached. In the lower region of the heel there is a cellular fatty layer 1-1.5 cm thick. It contains a whole network of vessels and nerves that can become inflamed, and this is one of the common reasons why the heel hurts and it hurts to step on.

Features of the structure of the human heel
Features of the structure of the human heel

The posterior and lateral surfaces of the calcaneus are practically not protected - the skin here is thin, there is little fatty tissue, and there are many vessels and nerve endings. Therefore, bruises and subluxations that have happened in this area at least once in almost every person bring tangible suffering and do not go away for a long time, not to mention full-fledged dislocations, fractures, sprains and torn ligaments.

So what can hurt in the heel? Here are the main options:

  • The calcaneus itself serves as a source of pain in reactive arthritis, osteomyelitis, tuberculosis, apophysitis or osteochondropathy of the tubercle, in addition, a crack or even a fracture may occur;
  • Surrounding joints – calcaneocuboid, calcaneotalocervical – can become inflamed in some common conditions such as gout;
  • Ligaments, tendons and fascia - these elements of the foot skeleton are one of the most common culprits in the situation when the heel hurts and it hurts to step on. The three most common diagnoses are plantar fasciitis, inflammation of the lateral ankle ligaments, and an Achilles tendon sprain;
  • Synovial bags, of which there are two in this area. The first is larger and surrounds the lower back of the calcaneus, and the second is very small and is located behind the junction of the calcaneal tuber with the Achilles tendon. Inflammation of synovial bags is called "bursitis", in the first case - subheel, and in the second - achilles bursitis or else achillodynia;
  • Nerves and blood vessels wrap around the heel bone in a dense network, so if it hurts to step on the heel, this is often the reason. Among the most common neurogenic factors, various polyneuropathies and erythromelalgia can be distinguished, and among vascular factors - diabetic angiopathy;
  • Skin and subcutaneous fat can be involved in the inflammatory process that occurs in the deeper structures of the heel region, in addition, external traumatic effects are not uncommon - bruises, wounds, burns.

How to guess the cause by the nature of the pain in the heel?

What exactly can become inflamed and hurt in the heels, we figured it out, now let's move on from localization to the nature of discomfort, because it is this factor that best helps to determine the preliminary diagnosis.

If your heel hurts for a long time and it hurts to step on your foot for no obvious reason, do not try to guess the disease and get cured on the Internet, do not spend money on medicines suggested by a pharmacy pharmacist - seek help from a doctor!

Burning pain, burning in heels and feet

As for the nature of the pain
As for the nature of the pain

The feeling of heat, tingling or burning, unbearable pain in the heel or the entire foot is almost certainly neurogenic in nature. This happens with erythromelalgia, Morton's metatarsal neuralgia, tarsal tunnel syndrome, as well as with some polyneuropathies: diabetic, demyelinating (in particular, with Guillain-Barré and Fabry syndromes).

The state of he alth of patients deteriorates sharply after a night's sleep under a warm blanket or just in hot weather, when blood vessels and capillaries further expand. Severe burning sensation in the feet makes you want to put your feet in cold water.

With erythromelalgia, an additional diagnostic sign is redness or even cyanosis of the skin of the lower extremities. Morton's neuroma is characterized by burning pain in the toes, which is due to thickening of the plantar nerve and often radiates to the heel, which is painful to step on. And with tarsal tunnel syndrome, a person additionally feels numbness and tingling in the area of \u200b\u200bthe inner ankle, which captures the arch of the foot.

Heel pain in the morning

In almost any inflammatory or degenerative-dystrophic disease that affects the foot and the heel region, pain will increase in the morning, because during the night's rest, the damaged structures have time to partially recover, but the very cause of their traumatization does not disappear anywhere. A person begins physical activity, tissues are damaged again, pain occurs. This vicious circle effect is most characteristic of plantar fasciitis, heel spurs, gout, arthritis and arthrosis. The second unifying symptom for this group of diseases is the fact that pain is much less pronounced at rest, but as soon as a person tries to walk, his heels are very sore and normal movement becomes almost impossible.

It hurts to step on the heel, the pain increases when walking

It would be strange to consider this symptom important when diagnosing, because with any disease or injury of the heels, stepping on them will be more painful than not stepping on. Therefore, you should pay attention to additional symptoms: general well-being, temperature, the presence of pain in other parts of the body. A more revealing moment is the constant pain in the heels, which does not subside even at rest, but only intensifies while walking. This happens with reactive arthritis, osteomyelitis, bone tuberculosis and other severe inflammatory pathologies. But such diseases are always characterized by vivid symptoms and, in addition to the feet, almost certainly affect other parts of the skeleton. On the other hand, it also happens that at rest, discomfort in the lower extremities is completely absent, but it is painful to step on the heel. The explanation for this is quite unexpected.

The source of sharp pain in the heel when walking may not be the calcaneal structure at all, but the sciatic nerve. When it is pinched, while the person leans on the leg, the pain "shoots" from top to bottom right in the heel, so it seems that the reason is in it.

Another example of irradiation of pain is tarsal tunnel syndrome, which is characterized by compression of the tibial nerve in the medial malleolus canal. Manifestations begin with numbness of the heel, arch of the foot and the area of the inner ankle, then there is a tingling sensation, and finally a burning pain that rises up and radiates to the buttock.

Pain in the back of the heels

The most common causes of pain in this area are rubbing backs of shoes, or, much more seriously, bruises, cracks and fractures of the calcaneus resulting from trauma. Almost everyone at least once in their life has had such an unsuccessful kick with their foot, for example, not calculating the distance to the obstacle located behind them when swinging. Sometimes calcaneal bursitis and Achilles tendon sprains are diagnosed. Among the relatively rare diagnoses, Haglund's deformity should be mentioned - this is calcaneal exostosis (bone and cartilage growth), which is localized precisely in the posterior upper region of the heel and causes pain when walking, and also significantly complicates the selection of shoes.

Pain in the sides of the heels

The most common cause of pain in the area of the inner surface of the heel is the sprain of the medial ligaments of the ankle, obtained when the foot is turned outward. The opposite situation, when the heel hurts from the outer side, is no less common and indicates that the person has twisted his leg inward. In addition, it can be a bruise, crack or fracture - in a word, the problem almost always has a traumatic origin, and it is impossible not to notice such an incident due to severe pain and subsequent swelling.

A calcaneal fracture is one of the most difficult: it is often accompanied by displacement of fragments, rupture of ligaments and tendons, requires careful immobilization of the limb and heals for 3-4 months, during which the patient should not step on the sore heel.

Diseases that cause heel pain

Causes of heel pain
Causes of heel pain

Now let's look at the likely causes of the ailment in more detail and figure out what to do if your heel hurts and it hurts to step on your foot - how to treat it, how to get rid of the pain and prevent the problem from recurring.

We will not touch on injuries of the heel zone here, such as bruises, cracks, fractures, dislocations and sprains, since the moment of receiving such injuries cannot go unnoticed, and the injured person probably knows exactly the answer to the question why he has heel hurts and it hurts to step on the foot. If such a misfortune occurs, apply dry cold to the bruised area, immobilize the leg and consult a doctor as soon as possible.

Arthritis of the heel

This is an inflammatory lesion of the calcaneus, its surrounding structures and tissues. It rarely occurs in isolation – it usually affects other joints as well.

By etiology, heel arthritis is divided into the following categories:

  • Reactive - begins as a complication a few weeks after an infection, most often respiratory, intestinal or urogenital;
  • Rheumatoid - occurs as a result of immune cells attacking the body's own tissues;
  • Post-traumatic - becomes a response to a bruise, dislocation, sprain, crack or fracture of the calcaneus;
  • Gouty - due to the high level of uric acid in the blood and the deposition of its s alts (urates) on the articular surfaces.

Each of the forms of calcaneal arthritis manifests itself with different intensity of pain, in addition, there is often swelling and redness of the skin. The treatment program depends entirely on the nature of the disease and may include the appointment of non-steroidal anti-inflammatory drugs, antibiotics, hormones, immunomodulators, chondroprotectors, healing and cellular repair stimulants, physiotherapy, and in severe cases, surgical intervention.

Arthrosis of the heel

The disease is a degenerative-dystrophic process leading to thinning of cartilage and the appearance of bone growths (osteophytes) on the articular surfaces. Arthrosis of the heels is very often associated with plantar fasciitis and heel spurs.

Reason for the development of the disease:

  • Wearing uncomfortable high-heeled shoes;
  • Heavy leg work;
  • Endocrine disorders;
  • Overweight;
  • Deficiency of vitamins and minerals;
  • Old age;
  • Genetic predisposition.

Arthrosis of the heels begins to manifest itself as increased fatigue of the legs, crunching when walking, then the discomfort gradually intensifies, the feet become deformed, the person has severe heel pain, it hurts to step on his feet and in the last stages of the disease, movement becomes impossible even with the help of a cane or crutches. It is important not to start heel arthrosis, start taking chondroprotectors as soon as possible, do massage, undergo physiotherapy, and exercise therapy. A radical method of treating heel arthrosis is arthroplasty, that is, the surgical removal of osteophytes and the growth of cartilage tissue.

Plantar fasciitis

The plantar aponeurosis, or plantar fascia, is an oblong flap of dense connective tissue that is attached to the calcaneal tuber on one side and to the heads of the metatarsal bones on the other side, forming and supporting the arch of the foot. With increased loads on the aponeurosis, its micro-ruptures occur in the heel region, where the tension is the strongest, which leads to inflammation, and then the heel hurts, it hurts to step on the foot, and more often both limbs suffer at once. Women over 40 who are accustomed to wearing stilettos, as well as professional athletes and people with gout, flat feet, diabetes and overweight, are most at risk of getting sick with plantar fasciitis.

The most characteristic symptom of the disease is severe pain in the heels in the morning. This is due to the fact that during the night's sleep, the cracks in the aponeurosis partially heal, but as soon as a person gets on his feet and starts walking, the damage occurs again, and in the same place. The situation is aggravated by the frequent complication of plantar fasciitis - the heel spur, which we will discuss separately below. If the spur has not yet arisen, the treatment is mostly conservative - anti-inflammatory drugs, painkillers ointments, sparing regimen, massage, foot baths and physiotherapy.

Heel spur

This term is commonly called osteophyte, that is, a bone outgrowth that occurs in the plane of the plantar fascia or above it at the point of attachment to the calcaneal tubercle. The osteophyte is formed from calcium s alts as a result of constant irritation of the periosteum and aseptic inflammation in this area, in other words, the heel spur is a direct consequence of plantar fasciitis. The length of the growth varies from 2 to 12 mm, and the heel hurts and it hurts to step on the foot because the soft tissues are injured.

The intensity of pain depends, rather, not on the length of the spur, but on its location. If there are nerve endings nearby, the pain will be very severe, as if a nail had been driven into the heel, especially in the morning. By evening, the malaise can also intensify, already due to tired legs and microdamages accumulated during the day. A heel spur of considerable size can be detected by probing. The most effective and reliable method of treatment is shock wave therapy, during the procedure, the osteophyte is destroyed by ultrasound and excreted through the bloodstream.

Achilles tendonitis

This is an aseptic inflammation that affects either the tissue around the tendon (peritendinitis), or the Achilles tendon itself (tendinitis), or where it attaches to the calcaneus (enthesopathy). All three forms can occur both in isolation and together, as well as pass into achillodynia and lead to the formation of a heel spur. Tendinitis occurs due to constant ankle overload, and sometimes after a single injury to the Achilles tendon, for example, in an elderly person who suddenly decides to go in for physical education.

Achilles tendonitis
Achilles tendonitis

As a rule, the disease develops gradually. Initially, the patient feels pain in the tendon, shooting into the heel and disturbing mainly in the morning. After a warm-up or a short walk, the unpleasant sensations are released. After a few weeks, the pain gets worse and does not go away throughout the day, it is especially difficult to walk up stairs or climb an incline. The calf muscle is tense, the ankle is red and slightly swollen, and may become hot to the touch. Treatment of tendinitis of the Achilles tendon is conservative - rest, tight bandaging of the leg, taking NSAIDs, physiotherapy and massage. In case of unbearable pain, injection blockades are performed using steroid hormones.

Heel bursitis

In the area of the calcaneus there are two synovial bags or burses: one, very small, is located at the top, behind the place of attachment of the Achilles tendon, and the second, larger, is below, under the skin of the back surface of the heel. Bursae are isolated cavities filled with joint fluid that reduce friction and protect bones from injury. Constant pressure on the bag or the ingress of infectious pathogens into it, for example, staphylococci or streptococci, leads to the development of bursitis. In the first case, the disease is called "Achilles bursitis" or in other words "Achilledinia", and in the second - "heel bursitis".

Heel bursitis
Heel bursitis

The disease can be the result of wearing uncomfortable shoes with a rubbing, narrow back, or it can be a complication of an injury or a systemic infection (tuberculosis, gonorrhea). Heel bursitis and achillodynia are diagnoses well known to professional athletes and dancers. Recognizing the disease is quite simple: the inflamed bursa is filled with serous, and sometimes purulent exudate, due to which it increases in volume and sticks out, the skin in this place is red and hot, severe pain occurs when pressed, even just stepping on the heel hurts, not to mention trying to walk. Treatment is predominantly conservative: for aseptic inflammation - NSAIDs and corticosteroids, for infectious - antibiotics, in a severe case - puncture of the synovial bag to pump out pus. In any case, rest, orthopedic shoes and physiotherapy are shown.

Heel spike

A spiny, or plantar wart, is a benign growth caused by the human papillomavirus. Most often, such defects occur precisely on the heels, less often - in the upper part of the foot or on the big toe. Usually there is one wart, but sometimes there are two or three of them, located side by side. The color is yellow-gray with a whitish coating on the head, the spine almost does not protrude above the surface of the skin, but it has a powerful root that goes deep into the soft tissues. Chronic warts look black - these are the mouths of clogged vessels peeping out. The very structure of the plantar wart is quite dense, which explains the discomfort when walking.

Calcaneal spike
Calcaneal spike

If your heel hurts, it hurts to step on and there is a sensation of a foreign body, carefully examine your foot - even a small spike can cause suffering. You can get rid of it in a conservative way, with the help of topical preparations (Solcoderm, Superchistotel, Ferezol, Kollomak, Salipod patch), and if such measures no longer help, you will have to contact a surgeon to remove the neoplasm.

Haglund deformation

Pathology is otherwise called Haglund's syndrome and consists in the formation of an osteo-cartilaginous outgrowth in the form of a rhinoceros horn on the upper back surface of the calcaneus, that is, at the point of attachment of the Achilles tendon. This horn is often overgrown with spikes, additionally injuring soft tissues. The cause of the development of the disease can be flat feet, clubfoot, hallux valgus, too high arch of the foot, wearing shoes with tight backs, overweight, endocrine disruptions, and simply a hereditary factor. External manifestations of the disease are very eloquent: tubercles form on the back of the heels, usually hard to the touch and red, the skin on them sometimes peels off, calluses are not uncommon in these places.

Haglund deformity
Haglund deformity

Haglund's deformity is very often combined with Achilles bursitis, which we have already talked about above. The symptoms are vivid: the heel hurts in the back, it hurts to step on the foot, it is difficult to climb the stairs, the lump interferes with the normal wearing of shoes. As a rule, pathology affects both lower limbs, but can develop in isolation. Conservative treatment of Haglund's deformity consists in the removal of inflammation, the selection of orthopedic insoles, physiotherapy exercises and physiotherapy. If such efforts are not enough for a complete recovery, one has to resort to surgery: the osteophyte is excised with an oscillatory saw.

Osteochondropathy of the calcaneal tuberosity

In various sources, this disease is referred to under different names: Schinz or Haglund-Shinz disease (not to be confused with the previous Haglund deformity, the same doctor had a hand in describing it), apophysitis or epiphysitis of the calcaneus, osteochondropathy of the calcaneal tuber, disease of the North. In addition, this disease is childish and occurs mainly in girls aged 10-14 years, less often in boys aged 12-16, although there are cases when this type of ACP affected children of eight years of age.

The essence of pathogenesis is as follows:

  • The heel bone of a person after birth is represented by cartilaginous tissue. In order for a child to start walking, his heels must be ossified. This process begins from the so-called "ossification points", of which there are two: one is activated at 5-6 months of life, and the second at 7-8 years. All this time, a layer of cartilaginous tissue remains between them, which disappears only by the age of 16-18;
  • Under the influence of factors not fully established (heredity, lack of sun, vitamins and minerals, hormonal changes in the body, problems with blood circulation, too early and intense sports), an area of aseptic necrosis appears on the surface of the calcaneal tubercle;
  • This area falls inward, a depressed fracture occurs, the bone is divided into fragments, the necrotic tissue gradually dissolves, and a new, he althy bone forms in their place.

usually missing.

Osteochondropathy of the calcaneal tuberosity
Osteochondropathy of the calcaneal tuberosity

The epiphysis is a rounded expanded end part of the bone, and the apophysis is a process that arose near the epiphysis from an independent ossification nucleus and serves to attach muscles and ligaments.

In addition, with Haglund-Schinz disease, the heel swells, palpation responds with pain, the skin around is hypersensitive, sometimes there is slight atrophy of the leg muscles, extension and flexion of the foot causes difficulties, the child begins to walk "on tiptoe". Treatment is conservative - rest, if necessary, immobilization of the leg with a splint, wearing orthopedic shoes or special insoles, physiotherapy, vitamin therapy, if the heel is very sore - taking NSAIDs.

Tarsal tunnel syndrome

Alternative names for this pathology: tarsal (tarsal, medial ankle) canal syndrome, tibial nerve neuropathy. The tarsal tunnel runs between the medial malleolus and the flexor tendon retinaculum. The posterior tibial nerve passes from top to bottom through this tunnel, branches out and innervates the entire foot. When compression (compression) of the nerve occurs, a person feels characteristic symptoms: numbness, burning or tingling with "needles" in the area of \u200b\u200bthe inner ankle and arch of the foot, then there are shooting or "electric shock" pains that capture the heel, calf muscle and radiate to the buttock. The toes become weak, the foot responds with pain during flexion and extension.

Tarsal tunnel syndrome
Tarsal tunnel syndrome

With tarsal tunnel syndrome, the heel hurts and it hurts to step on it after a long stay on the feet, and at rest and after a night's rest, as a rule, discomfort does not bother. This syndrome is not an independent disease, but a consequence of other pathologies that can cause compression of the tibial nerve. We are talking about varicose veins, tendonitis, arthritis, diabetes, flat feet, hallux valgus, trauma or neoplasm. For any of these reasons, the posterior tibial nerve may become compressed in the tarsal canal. Wearing tight shoes with high heels and unreasonably high physical loads on the legs also predispose to the development of this neuropathy. Tactics of treatment of tarsal tunnel syndrome depends on the causes and severity of the pathological process. As a rule, anti-inflammatory therapy and temporary immobilization of the diseased leg with an orthosis are sufficient.

Valgus foot deformity

This deformity usually develops in childhood and is characterized by an X-shaped curvature of the ankle, flattening of the soles and walking with support on the inside of the heels. If you put the legs of a sick child together, the distance between the heels will be 4-5 cm, and sometimes more. The cause of the pathology lies either in violations of the intrauterine development of the fetus, or in congenital connective tissue dysplasia, metabolic and endocrine failures (rickets, dysfunction of the thyroid gland or hypothalamus). Wearing uncomfortable, unsuitable shoes, as well as curvature of the spine and stoop additionally lead to hallux valgus. The disease is always combined with flat feet and can occur in an adult, for example, after an injury, encephalitis or poliomyelitis, due to a sharp weight gain or diabetes.

Valgus deformity of the foot
Valgus deformity of the foot

With hallux valgus deformity of the patient's foot, chronic pain in the heels and arch of the foot is disturbing, discomfort is greatly increased after a long walk or standing. In childhood, you can try to get by with conservative therapy: wearing orthopedic shoes, massage and physiotherapy. In severe cases, when this does not help (for example, with congenital shortening of the Achilles tendon or a vertical position of the talus), surgical intervention is indicated. Adults with hallux valgus in any case have to rely only on surgery.

Erythromelalgia

The pathology was originally called post-traumatic hyperesthesia, then Mitchell's disease and finally erythromelalgia - this term was introduced by the surgeon himself, who described the disease. Erythromelalgia belongs to the group of angiotrophoneurosis, that is, disorders of vascular innervation. It mainly affects the feet, but can also affect the hands. The disease is very rare, most common among middle-aged people (30-40 years), almost never occurs in children. The primary form of erythromelalgia is considered an independent disease with an unclear etiology, and the secondary may be the result of multiple sclerosis, neurosyphilis, polycythemia, hypothyroidism, diabetes mellitus, gout, chronic alcoholism.

erythromelalgia
erythromelalgia

The essence of pathogenesis lies in the local expansion of small and medium peripheral vessels and an increase in the volume of arterial blood flow due to a disorder in the nervous regulation of the vascular walls. The symptoms are very specific: the patient is tormented by paroxysms - attacks of burning pain, accompanied by redness and swelling. As a rule, the pain begins with the big toe or heel, then quickly grabs the foot and spreads to the knee joint. Erythromelalgia almost always affects both limbs, but the attack begins with any one. It can last from several minutes to 2-3 hours. Overheating, prolonged hanging position of the legs, wearing tight shoes can provoke the onset of paroxysm. The disease has a persistent course and is difficult to treat. Vasoconstrictor, antihistamines and painkillers are used, as well as physiotherapy, mud therapy, acupuncture. Erythromelalgia can be relieved with cold and raising the legs to an upright position.

Morton's Neuroma

Neuroma or Morton's neuroma, also known as Morton's metatarsal neuralgia, is a pathological thickening of the plantar nerve, usually between the third and fourth toes of one foot, but there are exceptions. Morton's neuroma is not a tumor in the direct sense of the word; this name of the disease arose historically. It is more correct to call it simply metatarsalgia, that is, painful foot syndrome. A large neuroma is palpable on palpation, a small one only responds with severe pain.

Morton's neuroma
Morton's neuroma

The main cause of Morton's neuroma is wearing tight shoes that squeeze the top of the foot in a horizontal direction. Of course, this disease is most common among young women. Additional risk factors are obesity, exhausting physical activity, concomitant orthopedic diseases. In the first stages, Morton's metatarsal neuralgia manifests itself as numbness of the toes, pain when they move and press on the foot, and a sensation of a foreign body inside. Then the symptoms intensify, the whole foot and heel hurts, it is impossible to step on the foot. If conservative therapy is ineffective, one has to resort to surgery - either cut the transverse ligament that compresses the neuroma, or remove it itself.

Gout

This is a metabolic pathology, which consists in chronic hyperuricemia (an elevated level of uric acid), due to which its s alts, urates, form arthritic nodes on the joints - tophi. Feet are a favorite localization of tophi, so if the heel hurts, it hurts to step on your feet, especially in the morning, it can be assumed that it is gout. To diagnose the disease, it is necessary to pass a biochemical blood test. The reasons for the development of pathology are diverse: a hereditary factor, an increased intake of purine compounds from food, kidney failure, increased synthesis of uric acid, and so on. More often than others, older men suffer from gout, especially those who abuse alcohol.

Video: 10 expert tips to fight gout attacks:

Gouty arthritis is manifested by terrible pains in the heels and feet in the morning, immediately after waking up, because during the night a lot of uric acid s alts accumulate in the body, and the joints have time to grow new microscopic osteophytes. Treatment is aimed at reducing inflammation and normalizing disturbed metabolic processes. Allopurinol, Colchicine, Febuxostat, Probenecid, as well as drugs from the NSAID group (Diclofenac, Ibuprofen, Naproxen, Ketorolac) are used. An acute attack of gout is usually removed in a hospital, it is very difficult to cope with it at home.

Osteoporosis of the calcaneus

This is also a metabolic disease that occurs due to calcium deficiency. On the one hand, in any person, the strength of bone tissue deteriorates with age, and on the other hand, the problem may be a lack of vitamin D, without which calcium is poorly absorbed by the body. The situation worsens significantly during menopause in women, since a decrease in the level of estrogen in the blood leads to an accelerated leaching of calcium from the bones, therefore, to their fragility and the risk of fractures. Therefore, osteoporosis is often and not without reason called a disease of older women.

Video: Dr. Evdokimenko “osteoporosis - treatment of osteoporosis, its symptoms and diagnosis. Do I need to drink calcium?”

Heel bones are just as prone to osteoporosis as other parts of the skeleton, meanwhile, heels have a tremendous load during life, which is why they can start to hurt and collapse one of the first. In the early stages of the development of osteoporosis, there are almost no painful symptoms, sometimes there are complaints that the legs get tired quickly, it hurts to step on the heels in the evening, and cramps of the calf muscles occur in the morning. The later stages of the disease are dangerous for bone fractures, so if you are diagnosed with osteoporosis, you need to review your diet and start taking vitamin and mineral supplements prescribed by your doctor to slow the progression of the disease.

Tuberculosis of the calcaneus

This form of the disease is extremely rare, since tuberculosis bacteria in 90% of cases choose the lungs of a person, and among the bone forms, large parts of the skeleton are in the lead: the spine, pelvis, knees. But sometimes the disease still affects the ankle joints and heel bones. This process is accompanied by the formation of non-healing fistulas, and over time, the feet undergo ankylosis, that is, the fusion of damaged articular surfaces and complete loss of mobility.

Video: What you need to know about tuberculosis of the bones of the joints and spine?

Diagnosis of such a serious disease is usually not difficult. Treatment is long, it takes from six months to several years, depending on the severity and stage of pathogenesis. Multistage therapeutic schemes involving several powerful antibacterial drugs are used. After recovery, a rehabilitation course is carried out, sanatorium treatment, massage, physiotherapy procedures are shown.

Osteomyelitis of the calcaneus

Extremely dangerous disease, which is a purulent-necrotic process in the bones and surrounding soft tissues, caused by infection with pyogenic bacteria. Such pathogens can enter the heel region through the systemic circulation from other foci, or directly through a wound on the leg. Inflammation begins with swelling, redness and pain in the heel, it is painful to step on the leg, then an ulcer forms on the surface of the skin, through which purulent discharge is expelled. Body temperature rises, general well-being deteriorates sharply.

Acute osteomyelitis of the heel can lead to gangrene and limb amputation, not to mention blood poisoning and possible death. At the first signs of a purulent abscess, it is urgent to contact a surgical hospital. An injection of antibiotics is carried out, and if necessary, the focus of inflammation is opened and washed. Complications may develop in a diseased limb after recovery: muscle contractures that cause chronic pain and interfere with walking.

Diabetic angiopathy

This term refers to pathological changes in the vascular wall caused by a constant excess of sugar in the blood. The products of glucose metabolism, as well as water, accumulate in the endothelium (inner shell) of blood vessels and capillaries, which leads to edema, increased permeability, ruptures, the formation of aneurysms (dilations), blood clots, and atherosclerotic sites. In addition, the person suffers from high blood pressure.

Video: What is diabetic angiopathy and why is it dangerous for a diabetic?

About 10% of patients with insulin-dependent form of diabetes mellitus after 45 years of age have manifestations of diabetic angiopathy of the lower extremities, or, simply speaking, "diabetic foot". This syndrome is manifested by chilliness and blanching of the legs, thinning of the skin and hair loss on them, slowing down the growth of nails, impaired sensitivity, and in the later stages - the appearance of deep non-healing ulcers and the development of gangrene. If you have diabetes, you need to carefully monitor the condition of your legs and contact your doctor in time to correct the therapeutic regimen.

Cracked heels

Let's end today's discussion of the possible causes of heel pain with a discussion of a widespread problem - cracked skin. They can appear due to wearing uncomfortable and low-quality shoes in which the legs do not breathe, as well as due to a fungal infection, dermatitis, diabetes mellitus mentioned above, or a banal deficiency of vitamins and minerals in the body (primarily iron). With anemia, cracked heels are a very common occurrence.

You can certainly get rid of cracks only by eliminating the cause of their appearance. It is recommended to donate blood for general and biochemical analysis so that the doctor can decide on treatment tactics. They may include dietary adjustments, taking vitamin and mineral complexes, drugs to improve blood circulation, antifungal, antihistamine and anti-inflammatory drugs. For topical application, healing ointments are well suited.

Negative factors causing heel pain

Negative factors
Negative factors

Let's continue talking about the most common negative factors that are not associated with illness or injury and are completely eliminated by our own efforts. It is, first of all, about the correct selection of shoes and the establishment of an adequate regime of physical activity.

There are five main causes of heel pain in this category:

  • Tight, rubbing and simply uncomfortable shoes in which the feet get tired quickly;
  • Extra pounds that increase the load on the feet;
  • Sudden weight loss, to which the body does not have time to adapt;
  • Long walking and/or standing during the day;
  • Exhausting sports loads.

Wearing uncomfortable shoes

In the pursuit of fashion and beauty, women often push convenience into the background, tiring their legs with high heels and stilettos. Meanwhile, experts consider heels above 7 centimeters to be unhe althy, and thick platforms are completely dangerous - it is very easy to twist your leg on them and get a sprain or even rupture of the ligaments. Oddly enough, shoes with completely flat, thin soles, such as the now popular ballet flats, are also not suitable for regular wear, because they do not take into account the anatomical features of the arch of the foot.

This applies to people of any age and gender - if you have flat feet, hallux valgus or any other structural pathology of the feet, you must use orthopedic shoes or appropriate insoles.

The modern he alth industry offers a wide range of shoe accessories that make it easier to stay on your feet, even for those people who have diseases of the musculoskeletal system. But even a he althy person who has sore heels and it hurts to step on his feet from fatigue will benefit from special insoles or separately selected shoes with a medical marking “+”, in which it will be possible to comfortably spend a working day.

Wearing uncomfortable shoes
Wearing uncomfortable shoes

Truly comfortable shoes must meet all of the following requirements:

  • Have the right fit and fully encircle your feet without creating voids or pinching protruding parts such as high insteps or underwired toes;
  • Do not squeeze the leg, blocking normal blood flow and provoking swelling, but do not hang out - this will lead to chafing of the skin;
  • Be made of quality, breathable materials - at least the inside of the shoe should be trimmed with natural leather, suede or cotton fabric;
  • If these are high heel shoes, the reliability of the instep is of great importance.

In the case when the heel hurts and it hurts to step on the foot because of the recently acquired uncomfortable shoes, you should refuse such a new thing, and if it is a pity to part with beautiful shoes, at least you need to get a tool for breaking in in the form spray - you can find it in any shoe store.

Overweight

Now almost every second person complains about extra pounds, and if the body weight exceeds the age and sex norm by 20% or more, leg he alth problems cannot be avoided. In people with severe obesity, the ankle joint suffers so much that it comes to surgery or complete immobility. But this situation obviously does not fall into the category of physiological causes of heel pain - here we are talking about pathology.

As for a slight excess of weight, then it is necessary to get rid of it as soon as possible, especially if you are over 45 years old, because the problem will only get worse. If you already now, despite comfortable shoes, come home from work completely exhausted, your heels hurt and it hurts to step on your feet, you should think about losing weight, because when you get rid of extra pounds, not only pain in your feet will go with them, but also high risks of developing endocrine, cardiovascular, oncological and other serious pathologies that shorten the life of obese people.

Sharp weight loss

Discussing the structure of the heel, we have already mentioned the presence of a cellular fat "cushion" located under the heel tubercle and acting as a natural shock-absorbing system. So, when a person parted with an impressive excess of body weight too quickly, his heels also lose weight, sometimes even wrinkle, and a bone begins to be felt under a thin layer of skin.

If you notice that it became painful for you to step on your heels after you lost excess weight, do not rush to get upset - very soon the body will adapt to its new state and accumulate the necessary amount of fat in the heel area. In the meantime, wear comfortable shoes, massage your feet, and take more sit-down breaks.

On my feet all day

Chronic heel pain most often affects people who, due to their activities, stand and walk for a very long time during the working day. There are a lot of professions in this “risk zone”: a sales assistant, a bartender, a waiter, a public transport conductor, and so on. No matter how obvious the reason may seem, why the heels hurt and it hurts to step on the feet of such people, there are non-standard situations.

All day on your feet
All day on your feet

As a result of constant overexertion of the lower extremities, pain may first appear in only one heel. Also, sometimes mild lameness develops, which intensifies at the end of the working day, and is almost absent in the morning. If you notice such symptoms in yourself, do not rush to assume a serious diagnosis - perhaps in this way your body sends an “SOS” signal. Listen to him, because you won’t earn all the money, and he alth is priceless.

Sports loads

We will not dwell on professional sports here - it is obvious that it wears out the human body, often leads to injuries and the development of chronic pain, especially when it comes to athletics, rhythmic gymnastics, tennis or dynamic team games: football, hockey, volleyball, basketball and so on. For such athletes, not only the heels hurt, the entire musculoskeletal system suffers.

Sports loads
Sports loads

If you recently made friends with physical education just for fun and maintaining he alth, then this is in any case good. And heel pain is easy to manage: you need to choose comfortable sports shoes, warm up thoroughly before training, massage your feet and take relaxing baths when you return home.

Diagnosis of pain in the heels

Heel pain diagnosis
Heel pain diagnosis

When you see a doctor with heel pain, you will be interviewed and examined, and if necessary, additionally referred for tests and diagnostic procedures. Let's discuss in more detail what tests you are likely to encounter and what they are for.

Lab tests:

  • Complete blood count is performed when any disease is suspected, this is the first step to making a diagnosis. An increased level of white blood cells indicates the presence of an inflammatory process in the body, a low level of hemoglobin indicates anemia, a lack of platelets indicates problems with clotting, and so on;
  • Biochemical blood test allows you to study the patient's condition in much more detail, in particular, to suspect diabetes due to high sugar content, gout due to excess uric acid, rheumatoid arthritis due to the corresponding factor or infection, caused by group A hemolytic streptococcus, by the presence of antistreptolysin;
  • A blood test for tumor markers is necessary in case of suspicion that heel pain is caused by metastases of a malignant tumor. Although rare, this happens in medical practice;
  • Bakposev of purulent exudate from an abscess in osteomyelitis or punctate from a synovial bag in bursitis is needed to identify the type of pathogen and prescribe the most effective antibiotic therapy.

Instrumental methods:

  • X-ray is the most commonly used method for diagnosing unexplained heel pain. In the picture, for example, a spur, Haglund's deformity, a crack or fracture of the calcaneus will be clearly visible;
  • Ultrasound is suitable for diagnosing arthritis, tendinitis, bursitis, Morton's neuroma or tarsal tunnel syndrome, because ultrasound waves well display inflammation, swelling and nerve compression;
  • Punctureof the synovial bursa is performed for Achillodynia and subcalcaneal bursitis, and if tuberculosis of the calcaneus is suspected, its puncture is indicated;
  • Magnetic resonance and computed tomography are the most modern and highly accurate diagnostic procedures used in cases of dispute and when it is impossible to make a diagnosis with the above methods.

Heel pain treatment

Heel pain treatment
Heel pain treatment

Therapeutic tactics will depend on what kind of pathology caused the pain. Above, in the section "Causes of pain in the heels", we considered, among other things, the methods of treating the most likely diseases. And here we will discuss specific drugs and procedures with which you can relieve heel pain at home and even completely eliminate an unpleasant symptom if it is caused by physiological factors, and not by a disease.

Nonsteroidal anti-inflammatory drugs:

  • Diclofenac;
  • Ibuprofen;
  • Analgin;
  • Ketorolac;
  • Naproxen;
  • Meloxicam;
  • Nimesulide;
  • Indomethacin.

In case of ineffectiveness of oral or rectal administration of painkillers, novocaine blockade is performed - an injection into the diseased joint, and if we are talking about aseptic inflammation, as happens with arthrosis or tendinitis, corticosteroid blockades are acceptable, but not more than once a week.

Pain-relieving anti-inflammatory ointments:

  • Voltaren Emulgel;
  • Fastum gel;
  • Nise gel;
  • Amelotex;
  • Nurofen Express;
  • Aertal cream.

Warming ointments:

  • Finalgon;
  • Viprosal;
  • Quick gel;
  • Apizartron;
  • Capsicam;
  • Dikul's balm.

Chondroprotectors:

  • Chondroxide;
  • Teraflex;
  • Glucosamine;
  • Inoltra;
  • Artrolon.

Heel Pain Prevention

Prevention of heel pain
Prevention of heel pain

To never know what kind of misfortune it is - the heel hurts, it hurts to step on the foot - you should follow simple recommendations:

  • Watch your weight;
  • Exercise;
  • Give up bad habits;
  • Eat well;
  • Wear good, comfortable shoes;
  • Get regular medical checkups;
  • Treat diseases in a timely manner;
  • Do not overload your legs;
  • Have a good rest;
  • Avoid injury.

These are common truths that everyone knows about. Take care of yourself and stay he althy!

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