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Why are heels sore and painful to attack?


Soreness in the heel while walking is a common symptom of various diseases or the effects of traumatic factors, familiar to almost everyone. In women, such a disease is more common than in men, due to walking in high heels.

The heel due to the anatomical structure and the presence of a dense layer of fat can withstand enormous loads. But due to the spongy structure of the calcaneus, the large number of nerves passing through it, the blood vessels, it is very vulnerable and sensitive to injury or illness. Damage to many nerve endings leads to constant pain when walking, difficulty, and sometimes the impossibility of stepping on the heel.

Features of the heel

The heel serves as a kind of shock absorber when relying on the foot. It accounts for the bulk of the load while walking or standing on the legs. The heel consists of muscles, ligaments, tendons, calcaneus, a thick fat layer, a network of blood vessels and a multitude of nerve fibers.

Spongy heel bone is the largest of the 26 skeletal bones of the foot. Located in the lower part of the posterior metatarsus. It has a flattened laterally and slightly elongated body, a well palpable heel tubercle and two articular surfaces, which are used for articulation with the cuboid bone in front, and the talus bone from above. In addition, there is a projection, which is the support of the talus. She ties the bones of the lower leg and heels.

Causes of heel pain when walking

Heel support pain can occur due to a variety of reasons, conditionally dividing into several groups: factors not related to any diseases; diseases with direct damage to the structures of the foot; diseases affecting the osteo-articular apparatus; injuries.

Reasons not caused by disease

Sore heels

  1. Prolonged overstrain of the structures of the foot contributes to the appearance of "heel pain syndrome". Wearing shoes with the wrong shoe, lifting, insole, as well as frequent change of high heels to unusually low, can lead to overstressing muscles. Tension of the foot may be due to flatfoot.
  2. Atrophy of the subcutaneous adipose "cushion" in the heel occurs as a result of a dramatic weight loss or an increase in daily physical activity, coupled with physical overload.
  3. Constant standing on the legs for a whole day . By the end of the day, the legs get tired and the person may feel soreness in the heels when walking.
  4. Stable obesity or a sharp weight gain in a short time helps to increase the load on the foot.

Diseases of the structures of the foot, manifested by pain in the heels

  1. Plantar or plantar fasciitis is the most common cause of pain in the heel area. Pathology is commonly known as the heel spur. This is a disease of the foot, characterized by inflammatory lesions of the plantar aponeurosis, a dense leaf of connective tissue that connects the bases of the proximal phalanges of the fingers with the anteromedial surface of the calcaneus. Stretching, aseptic inflammation, micronadry of the plantar fascia result from increased stress on it, weakness of the ligamentous apparatus, hypertonicity of the gastrocnemius muscles, etc. The process affects the mucous bags, soft tissues and periosteum, accompanied by the deposition of calcium salts in the area of ​​inflammation. As a result, a pathological bone growth is formed, leading to chronic pain in the heel when walking (calcanodynia).
  2. Achilles tendonitis - an inflammatory lesion of the calcaneal tendon, accompanied by degenerative changes.
  3. Northern disease, or apophysitis of the calcaneus , is often a disease diagnosed in children, accompanied by painful tension and / or stretching of tendons and muscles, leading to pain in the foot after a long run, playing sports or due to the rapid growth of the skeleton.
  4. Haglund – Shinz disease is a disease caused by aseptic necrosis (necrosis) of the bone surface in the place of the greatest mechanical effect.
  5. Bursitis is an inflammation of the synovial cavity with abundant production and accumulation of inflammatory exudate in it.
  6. Achillodynia - the occurrence of the inflammatory process in the heel tendon.
  7. Tarsal canal syndrome is characterized by compression of the branches of the posterior tibial nerve.
  8. Morton's neuralgia, or compression neuropathy of the plantar nerves , is a compression compression of the common nerves of the sole, which innervate the toes of the foot. The result is a sharp burning pain that spreads over the entire surface of the sole.
  9. Sensory neuropathy of hereditary nature - a type of polyneuropathy. In the autosomal dominant type of pathology, there is hypotrophy of the distal legs with dissociated sensitivity disorders, leading to severe pain in the feet.
  10. The valgus deformity of the foot is a pathology characterized by an X-shaped curvature of the axis of the feet, as a result of which they flatten, “collapsing” inward, and the heels unfold outward.

Common diseases leading to damage to the bones and joints of the feet

  1. Erythromelalgia is a rare vascular disease caused by paroxysmal dilation of capillaries and small arteries, disturbing peripheral vasomotor reflexes. The foot can be the affected area, with burning pains occasionally occurring from exposure to heat.
  2. Malignant neoplasms in the bones of the feet. The growth of the tumor leads to compression of the nerve endings and blood vessels, causing chronic pain.
  3. Metastatic disease . Metastasis of cancer with blood flow is recorded in the lower limb, in particular the foot.
  4. Rheumatoid arthritis is a systemic inflammatory-degenerative disease affecting the small joints of the entire body, including the feet.
  5. Ankylosing spondylitis is a serious systemic disease of a chronic nature, affecting the advantage of large joints and joints of the vertebrae. Sometimes, due to the ossification of the ligaments and the discs of the spinal joints, the patient experiences pain in the heels.
  6. Osteomyelitis is a bacterial infection affecting bone, periosteum, and bone marrow. With osteomyelitis of the calcaneus, deformity and sclerosis of bone structures is observed.
  7. Tuberculosis of the bone with its melting or necrosis.
  8. Gout is a serious metabolic disease. The deposition of uric acid crystals in the joints leads to pronounced deformations of the bones, and in the kidneys - to inflammation and the formation of stones.
  9. Various infectious diseases . Some intestinal infections, such as yersiniosis or salmonellosis, as well as urogenital infections , be it gonorrhea or chlamydia . Flowing in a latent form, they often lead to the occurrence of reactive arthritis, affecting along with other joints and articulation of the calcaneus.
  10. Cracked heels resulting from diabetic foot, mycosis or dermatitis.


  1. Tendon rupture or sprain.
  2. Fracture or fissure of the calcaneus.
  3. Bruised heels.

The nature of pain in the heel when walking

Depending on the etiological factor, heels can hurt in different ways. By nature, pain is burning, cutting, dull, shooting, aching. It is important to distinguish its features, it will help doctors determine the exact cause and prescribe adequate treatment. Pain can be either the initial manifestation of the disease of the foot, or one of the symptoms of a common disease.

Burning pain occurs in erythromelalgia and polyneuropathy. In the first case, hot weather or even sleep under a warm blanket leads to the pathological expansion of capillaries and blood vessels in the limbs, with the result that a person suffers from a debilitating burning sensation not only in the heel, but in the entire foot. Sleep and mood are disturbed, discomfort appears while walking. The skin on the heel gets red with a bluish tint color. There is only one desire - to cool the legs, dropping them in cold water. In the second case, for example, in metatarsal neuralgia, the compression of the plantar nerves ends with the appearance of sharp, burning pains spreading throughout the foot. Inflammation or injury to the tendon is also manifested by acute burning pain in the affected area.

Pain in the heel, affected by fasciitis, occurs when walking after sleeping or resting, especially in the morning. It is so strong and unbearable that a person is forced to avoid stepping on the heel. At rest, the pain subsides or becomes dull, but at the slightest load on the heel resumes. The return of pain when walking is due to repeated micro-fractures of the inflamed and edematous aponeurosis, which grow together during the absence of human motor activity.

When the heel spur patients complain of a dull aching pain in the middle of the heel, aggravated when walking. Each pain can be different: periodic, when you step on the heel, or constant aching, alternating acute when walking. Often a person feels a nail in the heel. Obese people have the hardest time. They are due to obesity, the load on the legs is several times higher than that of people who have normal weight.

Achilles tendonitis, ligament rupture, plantar fasciitis, heel contusions are often diagnosed in jogging athletes or those who are forced to dramatically increase the systematic load on the legs.

Sharp unbearable pain in the heel with the impossibility of relying on it appears when the heel bone fractures. Traumatologists know that the period of bone accretion and recovery period is very long. Even after the removal of the gypsum, the patient can not fully step on the injured heel for a long time.

The lesion of the foot joints, accompanied by pain of varying intensity, occurs in rheumatoid arthritis, ankylosing spondyloarthritis, some systemic autoimmune or infectious diseases. Diabetes leads to a violation of the trophic tissue of the feet, manifested by painful cracks and ulcers on the heels.

Diagnosis of pathologies leading to heel pain

For heel pain, refer to a rheumatologist or orthopedic traumatologist. It may be necessary to consult other "narrow" specialists - an oncologist, an infectious diseases specialist, a surgeon or a neurologist.

The scheme of diagnostic measures is determined after the physical examination of the patient. Collecting anamnesis and complaints with ascertaining the presence of chronic or recently transferred diseases, a visual physical examination with palpation of the painful area allows the doctor at this stage to make a preliminary diagnosis and prescribe the necessary examinations, the results of which will serve as a basis for confirming or excluding the alleged pathology.

Laboratory diagnosis

  • "Biochemistry" and a clinical blood test can detect the presence of inflammation, such as arthritis. An increase in uric acid levels indicates gout.
  • Blood test for tumor markers . Prescribed for suspected malignant tumor.
  • Revm tests with rheumatoid factor, circulating immune complexes, albumin, C-reactive protein, detection of antibodies to O-streptolysin. Needed to confirm rheumatic and autoimmune diseases.
  • Bacterioscopic examination of the exudate taken after the puncture of the articular sac. These methods allow you to identify the inflammatory lesion of the bursa.
  • Microbiological examination of scrapings from the urethra in order to determine the pathogen of the genital sphere.
  • Bacteriological analysis of joint fluid to clarify the nature of inflammation, the type of pathogen and determine its sensitivity to antibiotics.
  • Blood test for sugar. It is necessary to determine the level of glucose in diabetes, in order to stabilize the indicator, to reduce the negative effect of sugar on the vessels of the legs.

Instrumental diagnostics

  • X - ray - a leading diagnostic method for pain in the heel. Allows you to identify violations of the integrity of bone tissue and other specific changes in structures.
  • Puncture bone biopsy . It is indicated for suspected tuberculosis of the bone system.
  • Puncture of the synovial sac . Conducted with suspected bursitis.
  • Ultrasound, magnetic nuclear resonance or CT . Assign in cases of controversy or to identify a malignant tumor.
  • Electroneuromyography - registration of the bioelectric potentials of the muscles against the background of the excitation of muscle fibers.

Heel pain treatment

Pain in the calcaneus is a symptom of some pathological condition or the underlying disease. Based on this method of treatment is selected. But first, the patient must adhere to the general recommendations:

  • rest more and eliminate everyday long walks or standing on your feet;
  • to refuse shoes with an uncomfortable shoe with high heels or its complete absence;
  • reduce weight in obesity;
  • use instep supports or wear orthopedic shoes;
  • engage in therapeutic exercises for the feet.

In case of pain in the heel, not related to trauma, they get rid of the malady mainly with the help of conservative therapy. If the pain is a consequence of the underlying disease, the emphasis is on its treatment, and depending on the disease, the therapy has its own nuances: during urogenital infections, antibiotics are prescribed for the eradication of microorganisms; for rheumatoid arthritis, nonsteroidal anti-inflammatory drugs and corticosteroids are used; bone tuberculosis is treated with antibiotics and synthetic anti-tuberculosis drugs.

Treatment of fasciitis soles:

  • course taking one of the nonsteroidal anti-inflammatory drugs (diclofenac, nimesulide, or other);
  • with the ineffectiveness of non-narcotic analgesics make extra-articular drug blockade;
  • taping;
  • physiotherapy, such as electrophoresis;
  • compresses on the heel with a solution of Dimexidum, novocaine, acetylsalicylic acid;
  • applications from a mixture of tincture of Sabelnik, badger oil and mummy;
  • gymnastics;
  • foot massage.

In certain pathologies, accompanied by constant pain in the sole of the foot, orthosis (brace) or splint is often used. For fractures of the calcaneus for immobilization on the leg from the knee to the fingers impose a plaster splint for a period of 3 to 8 weeks.

From physiotherapeutic procedures, besides electrophoresis, shock wave therapy, magnetic and laser therapy, ultrasound, phonophoresis, and UHF are effective. It also helps manual therapy, massage.

Surgical treatment is indicated for severe cases of pathologies that cannot be resolved by medical methods of treatment. The operation is done with tendon ruptures, in some cases, to remove the heel spur, etc.

Preventive measures to prevent pain in the heel area

  • Refusal of shoes with high heels or with a flat sole. The heel should be wide and steady, not more than 5 cm tall. Fashionable ballet flats today have a negative effect on the structure of the feet, leading to an overstressing of the muscles and tendons.
  • Timely treatment of major diseases, such as diabetes or osteomyelitis.
  • The fight against obesity, as each extra kilogram increases the load on the legs.
  • Use orthopedic insoles.
  • Regular foot care.
  • Maximum avoidance of foot injury.

| 18 June 2015 | | 6 646 | Symptom Handbook
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