Heel pain (also called talalgia or in more common terms heelitis ), is a rather common disorder, considering the central role that this structure plays in maintaining the upright position and walking.
On the heel, in fact, most of the body weight is unloaded and it is easy to understand how much this exposes the anatomical seat both to a constant pressure exerted by its own weight, and to the stresses of the surfaces on which it rests. But heel pain , especially if referred to both right and left feet , can also indicate the presence of a systemic pathology of relevant clinical interest.
In any case, it is a painful, annoying disorder that, by virtue of the function of the heel in supporting the body weight and allowing walking, can, albeit temporarily, limit or prevent the performance of normal daily activities.
Heel pain can occur both during exercise and at rest , or even at specific times such as the night and the early morning hours (hypothesis that tends to be more severe).
It can affect only one foot ( left or rightindifferently), especially in trauma, or both (more common situation in systemic pathologies). Furthermore, the pain can be localized only at the level of the heel or extend to the entire sole of the foot and radiate to the ankle and again the pain in the heel can become worse when the foot is placed on the ground in the morning.

When to see a doctor
If the pain that occurs is mild, perhaps it appears as a result of a small trauma or intense physical activity, or perhaps after a day spent standing, there is no need to worry.
Generally, a little rest and the application of cold packs help to relieve and quickly restore a normal condition. When on the other hand the pain in the heelit lasts longer, makes walking and maintaining an upright position difficult or impossible, and other manifestations such as swelling, redness, bone deformations and tingling in the legs are associated and it is necessary to seek medical attention as soon as possible.
Now let’s get to the heart of the discussion by analyzing what may be the most frequent causes of heel pain .

What are the main causes of heel pain
There are two types of causes at the origin of the symptoms, the most common are those relating to factors that, although of a non-pathological nature in the long term, can trigger serious repercussions, such as the use of inadequate shoes, and causes instead of a more serious entity. triggered by pathological events.
For simplicity of consultation and understanding we have decided to collect them in two separate groups.

Non-pathological causes

  • Incorrect postures: very common, especially related to the use of unsuitable shoes, that is, the frequent use of shoes with heels or shoes that are too narrow or too wide compared to one’s size;
  • Physical fatigue: typical of those who practice training sessions that are too hard for their state of preparation or of those who remain standing still for many hours during the day;
  • Obesity and overweight: overweight subjects, and even more so obese ones, exert excessive pressure to the detriment of the legs and feet, and above all to the detriment of the heel , the area in which all body weight is discharged. This excessive weight load in the long term generates fatigue and consequent pain, also taking into account the phenomena of water retention that affect overweight subjects.

Pathological causes

  • Trauma: taking into account the constant weight load to which it is subjected, of all the traumatic stimuli and stresses to which the heel is subjected, we realize why traumatic events are at the basis of a large part of the pain in the heel . affect both the bones of the tarsus, in particular the calcaneus, and the soft tissues, then the tendons, ligaments and muscles. Obviously the traumas can be of different intensity, from slight bruises to fractures, with different painful outcomes, but in all cases the pain in the heel can easily result in limitations such as to compromise movement;
  • Lumbar disc herniation: this term indicates the protrusion, therefore the escape of the cartilaginous disc that is interposed between two lumbar vertebrae, with respect to its anatomical site. The release of the disc causes a compression on the blood vessels and on the nevi of the lumbar plexus, causing pain, motor difficulties but also sensory disturbances and therefore tingling;
  • Heel spur: also called ” heel spur “, consists of a phenomenon of bone growth (exostosis) that is formed mostly at the level of the heel, where calcium aggregates accumulate gradually in pathological conditions. This process represents a response to continuous phenomena of inflammation such as arthrosis or plantar fasciitis. The new bone formation creates friction and exerts continuous pressure on the tendons and ligaments of the heel, causing severe pain that occurs especially during the night;
  • Arthritis: inflammatory pathology affecting the joints, often the consequence of an infection or a moderate trauma;
  • Rheumatoid arthritis: rheumatic disease, autoimmune, which mainly affects the female gender. This disease affects the joints causing severe pain, deformation of the bones of the foot, lack of strength and reduced motor ability. All joints are affected, so if the pain occurs only at the level of the heel, there are no prerequisites necessary to suspect this pathology;
  • Gout: a condition that typically occurs in subjects who lead a diet that is too rich in proteins, especially those who consume red meat in an excessive way, responsible for the increase in levels of uric acid in the blood . Uric acid aggregates in crystalline formations that infiltrate the joints causing severe pain so as to reduce movements. For information on proper nutrition in case of gout , please read the in-depth study;
  • Plantar fasciitis:inflammation of the arched ligament of the foot. In the early stages, the pain is localized in the heel, and then spreads to the entire sole of the foot as the inflammation progresses.All this negatively affects walking, so the affected person will experience pain and fatigue while walking, limiting their activities. It is a multifactorial pathology, which therefore arises when several factors arise: it can derive from the use of shoes that are too tight and rigid, or more frequently from the use of shoes with heels, or this condition can easily arise in obese subjects, due to the excessive load of weight that exerts pressure on the foot. Another common factor behind plantar fasciitis is a training session that is too intense for your physical preparation.
    The pain typically arises during the night or early in the morning, when the foot is raised from a resting position to a position where the body weight is loaded, generating a rather acute pain that lasts for a few minutes;
  • Inflammation of the tendons: they are called tendonitis and among the most common forms affecting the heel is inflammation of the Achilles tendon , a sturdy fibrous band that connects the calf muscle to the tarsal bone called the calcaneus. In this case the pain is very intense and affects the heel and ankle.

Having analyzed all the possible causes of this pain, let’s explore how the diagnosis of this disorder is made and if there are effective therapies and remedies to solve the problem.

What elements is the diagnosis based on?
We have seen that the causes of heel pain can be multiple and of different entities, however, given the importance of this structure in walking and maintaining an upright position, whatever the cause, pain can to limit if not to prevent the normal course of daily activities.
Which is why, if the problem persists and if the heel painit is very acute and perhaps also radiates to the rest of the foot and to the ankle, it is necessary to seek timely evaluation by an orthopedic specialist.
During the medical history phase, the doctor collects all the information regarding the symptoms complained of by the patient, asking specific and targeted questions that allow to understand when the pain arose, what type of pain it is (if continuous or episodic) and if it occurs in special moments such as night or morning, or following physical activity sessions. It is also important to assess whether the pain in the heels is triggered at rest and whether it involves the ankle, the sole of the foot and if tingling and motor disturbances are also added.
The doctor then proceeds by examining the patient’s foot, verifying its mobility, walking, the way in which the subject rests his feet with the aid of appropriate platforms, the points of pain and the presence of traumatic signs.
Based on the data collected, the doctor assesses the need to subject the patient to further diagnostic investigations, capable of validating or denying the hypotheses.
A blood test can be useful to check for the presence of an autoimmune disease (rheumatoid arthritis), or any metabolic conditions of interest, while through radiography and magnetic resonance it is possible to view the state of health of the bones and soft tissues. then of tendons and ligaments.

What therapies do we have available
If the pain in the heel is mild, transient, resulting from physical fatigue, or appears after standing still for a long time, there is no reason to worry.
Generally it is sufficient to leave the affected foot or feet at rest, preferably raised with respect to the plane of the body, and applying cold compresses with ice. On medical advice, anti-inflammatory and pain-relieving drugs can be taken.
If, on the other hand, the pain is very acute, prolonged, limits or prevents walking or the ability to stand and radiates to the sole of the foot or ankle, it is necessary to consult an orthopedic doctor promptly.
In these cases the therapy will be in relation to the disorder at the origin of the symptoms of the heel pain . Generally, anti-inflammatory and painkilling drugs are administered, or the use of orthotics or specific braces is recommended.
Physiotherapy sessions are often necessary, to speed up recovery times and to restore complete mobility without causing further trauma, but sometimes, when all other treatments are not exhaustive, it is necessary to undergo surgery.
In any case, it is not recommended to waste time, waiting for the pain to pass by itself, or even worse trying to stop the situation by applying natural remediesfound on the internet or undertaken on their own beliefs, in fact these attitudes could seriously compromise the health of the foot, even irreversibly worsening the condition.
Instead, it is recommended to rely on the care of orthopedic doctors and professional physiotherapists.
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