Heel Pain: Causes and Help

Pain in the heel when standing, walking, running, jumping is familiar to many people, not least those who are active in sports. Read how it works better again

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Typical pain points on the heel (diagram)

© mauritius images / Nucleus Medical Art Inc / Alamy

Who Was Achilles? Exactly: Achilles, hero from Greek mythology, falls in the battle for Troy after being hit in the heel - his only vulnerable point - by a deadly arrow.

Anyone who speaks of the Achilles' heel does not really mean the foot. Rather, it is about a weak point in a system or in personal well-being. In the case of heel pain, the Achilles tendon is actually the focus.

If there is pain at the anchorage of the tendon on the heel bone, doctors call it achillodynia. Running and jumping athletes in particular often have problems with it.

The one-legged one if possible! - Standing on the toes reveals quite well whether the associated Achilles tendon is intact

© Jupiter Images GmbH / Ablestock

First of all: heel pain - background

Overuse damage to the Achilles tendon is a well-known weak point in the heel area. Often with it: inflamed bursa. But also irritation of the tendon of the sole of the foot - it runs under the sole of the foot, between the heel bone and toe, plays an important role in heel pain.

Heel spurs, on the other hand, appear to be overrated as a source of pain. They arise at the insertion of the Achilles tendon at the top of the heel bone or at the origin of the sole tendon further down on the heel bone (see chapter "Heel pain: What you need to know about anatomy" in this article).

Spurs in the soles of the feet are quite common. But in less than half of those affected, the calcified thorn is actually responsible for the often boring pain in the heel.

Also involved as causes of pain in the heel: Weak ligaments in the foot, foot malpositions such as arched arched feet, in which the changed position of the calcaneus transfers more pressure to the tendon set, then one-sided foot loads due to incorrectly stressed muscles - and not just on the foot, but also on the knees, hips or trunk.

After all, damage to nerves in the leg or foot can be the cause of pain. Here, in turn, different causes come into play, such as constriction of a nerve when passing through anatomical constrictions (nerve compression syndrome).

If adolescents and children who, for example, do a lot of rhythmic gymnastics or play intensive ball games such as soccer, suddenly complain of heel pain, symptoms of overuse can be behind it.

It's good if a doctor clarifies this. An irritation of the Achilles tendon attachment or an overload reaction of the heel bone would be considered, for example. After a few weeks of exercise or relief, the corresponding complaints usually disappear again.

A benign bone cyst is less to blame (more on this under "Heel pain - causes: foot misalignments, bone diseases, nerve damage" in this article).

! Important: If there are indications of another illness related to heel pain, the doctor will look for it and, depending on the diagnosis, treat it as specifically as possible. Of course, you have to tell him where the problem is.

Heel spur gymnastics: Strengthen the arch of the foot

© W & B / Martin Ley

Check: What is what on the foot?

  • Heel bone: Largest tarsal bone with cusp at the back = heel
  • Heel spur: Calcified tendon anchorage on the heel bone when overstrained; often incidental finding, less often the cause of heel pain.
  • Überbein (orthopedic ganglion): misleading name, as it does not consist of bones; rarely on the foot in contrast to the hand. Lump on a joint capsule or tendon sheath with joint connection, can irritate a nerve (nerve compression).
  • Sesamoid bone: Small bone, mostly embedded in a tendon near the joint (Latin: Os), which serves as a spacer and deflection "button". In the rare POPS syndrome (painful os peroneum syndrome) with involvement of a so-called os peroneum as an excess foot bone, there is pain on the outside of the sole of the foot.
  • Bone spur: Related terms: exophyte, osteophyte, exostosis; real over leg. Outgrowth on the bones, due to the condition (Haglund's heel) or with osteoarthritis, rarely as a hereditary disease with involvement of several bones and differently pronounced functional disorders.
  • Ossicle: Excess foot bones, for example as the trigonum on the ankle bone: Occasionally loosens or presses on a nerve when the foot is extremely overstretched towards the instep and then causes discomfort at the back of the foot (for example in ballet dancers).

Painful Appearance: Causes of Heel Pain at a Glance

Problems with the Achilles tendon, heel spurs, bursae

  • Inflammation of the Achilles tendon where it attaches to the heel bone; upper calcaneal spur
  • Achilles tendon tear
  • Haglund's heel - a special case of heel spur
  • Inflammation of the plantar tendon (plantar fasciitis) at its origin on the calcaneus; lower heel spur (most common type of heel spur)
  • Inflammation of the bursitis (bursitis) of the heel
  • Shrinkage of the heel fat pad

More on this as well as on the diagnosis and treatment of the clinical pictures mentioned here in the chapter "Heel pain - causes: Achilles tendon, bursa, heel spur & Co.".

Foot abnormalities, bone diseases, nerve damage, skin problems on the foot

  • Congenital and acquired malpositions of the feet such as flat feet or flat feet

  • Surplus bones (ossicles): Mostly symptom-free skeletal variants that can sometimes cause heel pain

  • Calcaneal apophysitis (Sever's disease; affects children)

  • Heel bone fracture due to fatigue
  • Benign bone cysts (rare; in childhood)

  • Pressure damage to the nerves of the foot (nerve compression syndrome)
  • Very rarely malignant tumors on the foot (children, adolescents and young adults)

  • Skin problems on the foot such as calluses and warts

The chapter "Heel pain - causes: foot misalignments, bone diseases, nerve damage" provides more detailed information on these topics.

Diseases that arise far from the foot or are systemic, i.e. affect several areas of the body

  • Knee misalignments such as knock knees and bowlegs
  • Diseases of the leg nerves
  • Rheumatism (rheumatoid arthritis) and other rheumatic diseases, gout
  • Circulatory disorders: Peripheral arterial occlusive disease (PAD, smoker's leg, intermittent claudication): Depending on the location and stage of the vascular narrowing, pain in the foot, calf or more extensive pain in the leg from a certain walking distance. Concomitant symptoms such as paleness and a feeling of coldness in the skin, in the advanced stage pain even at rest and skin damage, for example on the heel.

In the chapter "Heel Pain - Causes: Diseases beyond the foot" you can read more about this, information on the therapy options can be found in the causes chapters of this article.

And: You can find practical tips on how to prevent foot problems in the chapter: "Heel pain: prevention and self-help".