Pain in the heel ( heel pain ) - Causes, Symptoms and Treatment .MF .
Pain in the heel - it is a common symptom that has many possible causes.
reasons for heel pain
reason not caused by disease:
1. By the "syndrome of heel pain" can cause permanent overvoltage structures of the foot, which is manifested by pain in the heel when walking.It can be caused by shoes with unusually high heels.
2. Moreover, heel pain can occur as a result of thinning of subcutaneous fat on the plantar surface of the foot in the heel area with a sharp increase in motor activity.
3. Long stay on their feet throughout the day.
4. The recent rapid weight gain, obesity.
heel pain should not be underestimated.In addition, they bring significant distress and impair the quality of life of the patient, heel pain can be one of the first symptoms of serious illness.
Diseases accompanied by pain in the heels
1. Systemic diseases:
Ankylosing spondylitis (ankylosing spondylitis) - a chronic inflammatory disease of the spine and joints.The cause of ankylosing spondylitis - the aggressiveness of th
Rheumatoid arthritis - this is one of the most severe joint disease, occurring with a variety of complications.The main symptoms of rheumatoid arthritis include pain, swelling, and thereby limiting the mobility of joints (including joints of the foot, although it is not typical lesion localization).Pain can manifest itself only when the first movement.In case of severe inflammation and pain can be alone, they can even wake the patient.In addition to joint pain patient complains of general weakness, fatigue, loss of appetite.
Gout - a disease of the joints, which is caused by deposition of uric acid (urate).There is acute pain, swelling and redness of the joint (usually one or two).An attack of gout can last for several days or weeks (if you do not spend any treatment).It occurs more often during the night, the joint becomes hot to the touch and is very sensitive to even the lightest touch.It often affects the joints of the thumb on the foot, but they can be involved and other joints (ankle, knee, foot joints, fingers and wrist).In some cases both tendons become inflamed joint.
2. Infectious diseases, including reproductive tract (such as chlamydia, gonorrhea, ureaplasmosis etc.) And intestinal (dysentery, iersineoz, salmonellosis), flowing secretly, may lead to reactive arthritis (including jointsheel bone).This heel pain often occur not only when walking.Patients with reactive arthritis heel may hurt even alone at night.And sometimes at night they hurt the most.
In addition, inflammation heels in reactive arthritis, inflammation is often joined by a number of joints and eyes, as well as discomfort in the genital area.Patients can celebrate arthritis connection with the previous urogenital or intestinal infection.
Tuberculosis bone (including the calcaneus).Disease begins with a melting of bone substance bone, or with significant necrosis of the skin, a process that eventually begins to extend to greater and greater area.Regardless of the initial manifestations of tuberculosis of bones and joints causes the formation of a fistula or purulent cavity, opening outwards.It should be noted that after a few weeks, the inflammatory process can be stabilized and the patient comes remission.
osteomyelitis of the calcaneus - 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 the person may complain of weakness and pain in the muscles.Then abruptly the temperature rises to 39-40 degrees.The pain is clearly localized in the affected bone area, there is almost at once.Acute, boring or arching inside, aggravated by the slightest movement - such pain is difficult with something confused.Heel hydropic, the skin becomes stagnant-red color, the veins dilated.
Stretching or tendon rupture.The causes can be direct trauma (a blow on the tendon hard object) and indirect impact of a sharp reduction in leg muscles.Usually first it appears a sharp pain in the Achilles tendon.In the area of the tendon is marked edema.When the feeling is possible to determine the integrity of the tendon defect.Active plantar flexion is difficult or even impossible.
Bruising the heel bone with subsequent inflammation of adjacent tissues (for example, as a result of landing on your heels after the jump from a height).Such patients usually complain of burning pain under the heel, "as if to nail stuck" with a load on the heel pain increases.
For fractures of the calcaneus is characterized by pain in the area of injury and the inability to load on the foot.The heel is deformed in the outer or inner side, heel area extended stop hydropic, has bruising in the heel area and in the plantar surface of the foot.Arch flattened.Active motion in the ankle joint due to soft tissue edema and calcaneal tendon tension dramatically limited and the subtalar joint is impossible.
North disease or epiphysitis 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 there is over a full ossification of the calcaneus.Typically, symptoms of the disease occur in people who are actively involved in sports, at the age of 9 - 14 years.Heel pain is amplified when running, walking fast.Painfully standing up on tiptoes.In addition, there is limitation of movement in the calf muscle of the leg.Often in the field of separation there is some local swelling and fever.
4. Inflammatory diseases
Plantar fasciitis (heel spur is sometimes called) - painful inflammation of the plantar fascia (fibrous bunch in the sole of the foot, which helps to support the arch of the foot).Plantar fasciitis occurs when the load or excessive stretching of the plantar fascia.The main symptom is pain in the heel, arising out of or aggravated by stress.Painful sensations are more pronounced in the morning.The diagnosis of plantar fasciitis is established after analyzing the patient's complaints and physical examination.Radiography eliminates stress fracture of the calcaneus, and to identify the presence of heel spurs.
Osteochondropathy tuberosity of the calcaneus (Gaglunda-Shintsa disease).The disease is based on an aseptic (sterile) necrosis (necrosis) areas of cancellous bone, which are under the greatest mechanical stress.Heel pain occurs when the vertical position of the patient or after several minutes of reliance on the hill of the calcaneus, walking with a support on the heel bone due to the intolerable nature of the pain is no longer possible.Patients are forced to walk, loading the front and midfoot, using a cane or crutches.The majority of patients on the plantar surface of the calcaneus are determined by skin atrophy, moderate soft tissue swelling, increased tactile sensitivity.Often, there is atrophy of the leg muscles.
for bursitis is characterized by all the classic symptoms of inflammation.On the back surface of the heel there is swelling, redness, pain.At the touch of skin in this place becomes warm.Gradually the swelling increases.In chronic inflammation of swelling of the back of the heel can condense.
Tendinitis Achilles tendon - is its inflammation.It can occur due to excessive stress on the Achilles tendon (to stressed calf muscles, frequent running uphill or downhill, the sharp increase in the number of physical activities, such as long-distance running);wearing uncomfortable shoes, the frequent wearing of high-heeled shoes and a change nightly heel flat shoes.If tendinitis pain occur along the tendon, usually close to the heel;swelling in the tendon with a local increase in temperature of the skin, their redness and increased sensitivity;pain in the toes when standing up and jumping on his toes.Following a stressful state sore Achilles tendon may rupture, which is often accompanied by a characteristic sound of bursting.With a torn tendon is almost impossible to walk.If you can not stand on toes, you may have a tendon rupture.This is a medical emergency.
5. Malignant tumors. As with other primary malignant bone tumors, the earliest symptom is pain in the affected bone, passing first, then with a constant increase in its intensity.With the development of the disease in this zone is detected, it is becoming more noticeable swelling.Depending on the subtype of the tumor, its soft-tissue component can be hard or soft.With the rapid growth of the tumor (which is observed in children) may develop cachexia and progressive anemia.There are pathological fractures.Above the tumor sometimes it has a network of dilated blood vessels.
6. Neuropathy medial calcaneal branches of the tibial nerve. manifestations of disease consist of violations of plantar flexion of the foot and toes, as well as turning the foot inward.Disturbed sensitivity in the heel and sole.When long-existing lesions of the tibial nerve develop sores in the heel and forefoot deformity.
survey with heel pain
In a study of patients with pain in the heel are important complaints.In addition to pain in the patient's heel can disturb joint pains of various localization, the pain and the inability to movement in the back, pain in the I toe, its redness and swelling, etc.Pay attention to the history of the disease (eg, previous foot injury, previous chlamydial infection, morning stiffness, and others.) And physical examination (eg, redness, swelling, dysfunction, fistulas, etc.).These data together can lead to identification of causes of pain in the heel.If the diagnosis is not clear and requires confirmation, conduct laboratory and instrumental studies.
Laboratory and instrumental examination for pain in the heel
1. Complete blood count (possible anemia, leukocytosis, increased erythrocyte sedimentation rate in rheumatoid arthritis, ankylosing spondylitis);
2. Biochemical analysis of blood: increase in uric acid in gout;
3. Microbiological examination (eg, scrape from the urethra for chlamydia is suspected reactive arthritis);
4. The X-ray study - one of the main methods of examination for pain in the heel area.There will be specific changes are seen, characteristic of a particular pathology.
5. Study on onco-markers for suspected neoplasm zlokachestveenoe;
6. Serological analysis: rheumatoid factor in rheumatoid arthritis.
7. Puncture bone biopsy for suspected bone tuberculosis and osteomyelitis: the material for sowing obtained by aspiration of pus from the bone or soft tissue, or bone biopsy is performed.
plan further evaluation depends on the patient's age and clinical manifestations.Especially it must be careful when pain in the heel region observed for a long time.
Treatment for heel pain
Since heel pain is a symptom, its method of treatment depends on the cause has or underlying disease.However, to reduce pain and prevent its occurrence, regardless of the reasons you need to follow some recommendations:
1. The fight against overweight.Excess weight increases the load on the muscles of the foot.
2. Wearing orthopedic insoles.Especially with flat feet.
3. Wear comfortable shoes with a heel no more than 5 cm. Shoes without spikes is also not recommended.
4. Physiotherapy for the feet daily.
To quickly reduce severe pain in the heel, you can make a piece of ice on the aching place and keep the cold for 20 minutes, the heel itself, and the area above it is possible to rub anti-inflammatory cream (eg Fastum gel).
If heel pain torment you quite a long time, and you yourself do not deal with it, seek qualified medical advice.
the way physicians treat with heel pain?
Depending on whether there was injury, doctors - therapist, traumatology and orthopedics.You may need medical advice following specialties: neurologist, surgeon, oncologist, a TB specialist.
therapists Kletkina Y.