Heel Pain (Rearfoot Pain)
Heel pain is a common foot problem. The pain can be felt in any part of the heel, usually just below or behind the heel where the Achilles tendon attaches. There are many bones, joints and tendons in the heel of the foot.
What Are The Causes Of Heel Pain?
There are many different conditions that can cause heel pain. The most common cause of pain under the heel is plantar fasciitis. The most common cause of pain behind the heel is Achilles tendinitis. These two diseases are the first to come to mind if the patient’s sporting activities and work are related.
If the patient has a systemic inflammatory disease (inflammatory rheumatic diseases such as ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, and sarcoidosis), enthesopathy/enthesitis should be considered as a cause of rear foot pain.
Injuries, sprains, bone fractures, tendon, ligament, and muscle pain can also occur as a result of exposure to trauma to the heels. Metabolic bone diseases (such as Paget’s disease), bone tumors, osteochondrosis, neuropathy, and osteomyelitis can also present with heel pain.
Determining the character of the pain is important in differential diagnosis. In mechanical pain, if there is also restriction in joint movements, bone problems can be considered.
When Should A Doctor Be Consulted For Heel Pain?
Short-term heel pain may occur after wearing the wrong shoes, excessive standing, strenuous sportive activities. However, if there is a history of trauma, if the pain persists for a long time, does not decrease despite rest, becomes increasingly severe and there is pain at night, if there are findings such as accompanying swelling and redness, the relevant doctor should be consulted.
What Should Be Questioned In Patients With Heel Pain?
- In addition to the pain felt in any part of the heel, are there accompanying swelling, redness findings?
- Does the pain increase with pressing/loading? Is there night pain?
- Is there more severe pain when first getting out of bed in the morning?
- Is there an increase in the intensity of pain with each passing day, difficulty in climbing stairs, difficulty in balancing?
- Are there pain and swelling in other joint areas?
- Is there a history of rheumatic disease or a family history of rheumatic disease?
- Has he/she experienced similar pain before?
- Has he/she changed shoes recently?
- What is his/her occupation? How long does he/she stand during the day?
- Does he/she do sports? How long has he been doing it? Has he/she recently engaged in an unfamiliar level of sportive activity?
- Does he/she dance? How often does he/she do activities such as jumping, jumping, climbing/descending stairs during the day?
How Is Heel Pain Diagnosed?
The diagnosis of heel pain is primarily based on a detailed anamnesis and physical examination. If deemed necessary, imaging modalities and laboratory tests may be requested for differential diagnosis.
Which Treatment Methods Are Used In The Treatment Of Heel Pain?
Avoiding giving load to the heel, using short-term painkillers, wearing orthopaedic shoes, local cold applications can be done in the first stage.
If there is severe pain or night pain and accompanying findings, the patient should consult a doctor. Treatment plan is determined depending on the cause.
Treatment of heel pain includes rest, local physiotherapy applications, exercise therapy, drug therapy, injection applications, surgical treatment.
Can You Talk About Plantar Fasciitis, Which Is One Of The Most Common Causes Of Heel Pain?
The plantar fascia is a tense connective tissue on the sole of the foot that supports the arch of the foot. Repetitive microtraumas (such as running, walking, standing) cause the plantar fascia to stretch and wear out. This condition is called plantar fasciitis.
In Whom Is Plantar Fasciitis Common?
It is more common in people who are generally over middle age, overweight, and who do prolonged standing and walking activities.
Intensive sportive activities that put load on the foot, standing for a long time with bad shoes are among the factors that trigger pain.
As a result of structural disorders in the foot, the change in the load distribution in the foot causes pain. The collapse of the inner longitudinal arch of the foot and the external rotation of the foot (planovalgus) increase the load in this area.
It can also develop in inflammatory rheumatism.
Which Complaints Do Patients Usually Present To You?
Most of our patients complain of pain radiating inwards in the heel when they first step after resting, i.e. when they first get up in the morning or when they first stand up after sitting/resting during the day.
Usually the first few steps are very painful and then the pain subsides a little. However, the pain increases at the end of the day and in the evening after prolonged exertion. Rising on the heel can be painful.
How To Diagnose Heel Spurs?
The diagnosis of heel spur is made with imaging methods performed in the presence of the patient’s complaints, history and clinical findings.
Physical examination may reveal restriction and pain in the big toe movements and pain in the heel region. In direct radiography, a heel spur (calcaneal spur) formed in the area of plantar fascia may be observed.
The diagnosis can be supported by findings such as thickening and oedema in that area on soft tissue ultrasonography or magnetic resonance imaging. These examinations can also be used to exclude other diseases.
Which Diseases Should Be Considered In Differential Diagnosis?
- Strain in the ankle muscles (abductor muscles and flexor muscles)
- Calcaneal stress fractures
- Subtalar arthritis
- S1 root involvement
Which Treatment Methods Are Used To Treat Heel Spurs?
Patient compliance is very important in treatment. Compliance with recommendations such as reducing the load on the problematic area, wearing appropriate shoes and avoiding prolonged standing will ensure a healthy treatment process.
Treatment methods can be summarised under several sub-headings.
- Reducing the load on the ankle by losing weight
- Choosing the right shoes
- Supporting the shoe with the right insole
- Using a night splint
- Pain control
- Use of pain relievers and creams
Physical Therapy Applications:
- Ultrasound therapy
Extracorporeal shock wave therapy (ESWT)
Regional Injection Applications:
- Corticosteroid injection
- PRP (platelet-rich plasma) injection
- Ozone injection
- Prolotherapy, etc.
- Plantar fascia stretching exercises
- Evaluation of lower extremity muscles and stretching exercises for shortened muscles, if any
- Proprioceptive exercises
- Strength exercises
- Balance-coordination exercises, etc.
In rare cases, surgical treatment may be required. The doctor plans the appropriate surgical treatment by talking to the patient.
As with all soft tissue pain, patient compliance is very important in the treatment of plantar fasciitis pain. Most of my patients, whom I ask to avoid overloading their feet, state that they cannot do this, that they cannot find time to sit for five minutes and want a quick solution.
He states that he cannot even spare time for cold application. In pain treatment, taking the necessary measures to prevent recurrence as well as pain relief ensures the integrity of the treatment.
When these measures are not taken, the likelihood of the same problem occurring after a while increases. For this reason, mistakes such as returning to overloading activities and quitting exercise should not be made by saying that my pain is gone, I am cured.
Even if a faster response is obtained with corticosteroid injections in the treatment of heel spurs, recurrence of the problem is common with the repetition of wrong activities.
After a while, patients may think that they have to endure the pain and live with it. No, you do not have to live with pain. In case of pain that does not go away, it is necessary to reconsider the cause of the pain and make sure that the treatment is done correctly.
In many cases, our wrong behaviour triggers the pain. Although it is difficult to change our lifestyle, it is not impossible and we should all review our lives, we can open the door to a healthier and more peaceful life by realising what we are doing wrong and switching to the right behaviour.