Inflammation of the heel

introduction

Inflammation on the heel can have a variety of causes and in most cases it is permanent overload or Improper loading of the foot structures. As a rule, they do not arise suddenly, but develop insidiously, so that, with early initiation of a suitable therapy, in the vast majority of cases they are again without residue disappear. A chronic course can develop in a few cases, but is rarely observed in general.

root cause

The causes that can lead to inflammation in the heel area are diverse and can arise from a wide variety of structures in the foot and lower leg area. Based on the localization of the maximum pain point, which is generated by the inflammatory process, lower and upper causes of inflammation can be distinguished. Pain and signs of inflammation in the upper and rear heels often result from inflammatory processes in the Achilles tendon area and the bursa in the Achilles tendon area and heel bone area or from an inflammation of the attachment of the Achilles tendon caused by an upper heel spur. In Achilles tendinitis (Achilles tendon tendonitis) it is a disease of the tendon structure itself, which can result from excessive strain (e.g. in runners) or incorrect strain (e.g. from shortening of the lower leg muscles) as well as micro-injuries in the Achilles tendon tissue.

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This is not an inflammation in the classic sense, which is characterized by inflammation foci and immigrated inflammatory cells in the affected tissue, but rather a pathological, degenerative change the Achilles tendon (Tendopathy), which, due to progressive destruction of the tendon tissue, causes inflammation-like symptoms 2-6 cm above the Tendon attachment caused on the calcaneus. The two bursa in the heel area can become inflamed and lead to characteristic pain problems in the upper-rear heel area. The bursa on the heel is a fluid-filled bag that is responsible for the mechanical stress on the tendon to bufferto evenly distribute the pressure of the tendon on the bone and allow friction-free movement of the tendon. Especially the bursa, which is located between the Achilles tendon and the calcaneus (Bursa subachillea), but can become inflamed as part of a gout disease or an overload or heel bone syndrome. The second bursa located between the Achilles tendon and the skin (Bursa praeachillea), on the other hand, is more likely to ignite as a result of local pressure or friction, for example caused by long-term wearing of incorrect footwear.

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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At a upper calcaneal spur (also Haglund syndrome called) it is a acquired (e.g. through chronic shoe pressure) or innate Enlargement of the upper Heel bone end (in the form of a thorn-shaped bony process), which leads to increased irritation of the immediately surrounding tissue, so that the Achilles tendon attachment or the calcaneal bursa can become inflamed.

Pain and signs of inflammation, which are mainly concentrated on the lower heel in the area of ​​the rear sole, usually have other causes, such as B. a lower heel spur or inflammation of the Tendon plate under the foot (Plantar fasciitis). The lower heel spur is, as with the upper one, a bony outgrowth of the calcaneus that is caused by chronic mispressure, which, however, tends to be attached to the bottom of the calcaneus and causing chronic irritation to the area where the short foot muscles and attach the tendon plate to the sole of the foot. In the course of this, inflammatory reactions can also occur in this area. Plantar fasciitis is an inflammation caused by wear and tear of the tendon plate that extends between the metatarsal bones and the calcaneus and is involved in the formation of the Longitudinal arch of the foot is involved. The inflammation, which is usually concentrated in the area of ​​the tendon plate near the heel bone, is usually caused by Overloads in sports, Incorrect loads in everyday life, micro-injuries in the tendon plate tissue or through irritation in the context of a lower heel spur.

Symptoms

Because of the different causes that can lead to inflammation in the heel, the symptoms are also slightly different, so variable complaints to be possible.

Achilles tendonitis manifests itself at the beginning with pinching pain, usually 2-6 cm above the calcaneus bone, initially usually limited to moments after a longer period Rest periods, such as. in the morning after getting up, after sitting for a long time or at the beginning of a running training. In the further course the pain can then also in the rest phases remain. In addition, a swelling, one Redness and a overheat Noticeable in the area of ​​the Achilles tendon as well as small, palpable bumps (nodules) along the tendon cord.

In the case of bursitis underlying the heel inflammation, pain primarily only occurs when Go, at Movements in the ankle and at pressure on the heel, which is particularly concentrated in the rear-upper heel area. Later the pain is too in peace noticeable as well as a swelling in the Achilles tendon-heel area visible. Another characteristic is the releasable pain when the Calf muscles, which tense the Achilles tendon and compress the inflamed bursa that surrounds it.

Symptoms of a upper calcaneal spur, are usually symptoms of an Achilles tendon attachment caused by Tenderness (e.g. through the edge of the shoe) and Exercise pain (e.g. when walking, running) is characterized. The skin in the upper and rear heel bone area can also be red, swollen and overheated. Since bursitis can be associated with the upper heel spur, its symptoms can also occur.

Of the lower heel spur usually manifests itself through load-dependent, sharp pain in the lower heel area near the sole of the foot, in the morning after getting up or occurs particularly intensely after long periods of sitting (so-called Starting pain).In some cases, the pain can improve somewhat after some time of exertion, but then it usually increases again with prolonged and increasing exertion. The lower heel spur goes with inflammation of the Tendon plate under the sole of the foot (Plantar fasciitis), typical signs of inflammation can also appear on the bottom occur on the heel.

In both the upper and lower heel spurs, in some cases even the bony outgrowth of the calcaneus can be found under the skin felt become.

diagnosis

Achilles tendonitis is usually diagnosed by describing the symptoms and performing a physical examination. Above all, the painfulness is tested Movements in the foot, for example when lifting the toe while stretching the calf muscles. In addition, an ultrasound examination can confirm an inflammatory process on the Achilles tendon. If the findings are unclear, an additional MRI examination (Magnetic resonance imaging) be performed. The same examination methods can also be used to diagnose bursitis. For diagnosing an upper or lower heel spur, an X-ray image of the foot is primarily taken in order to show and verify the bony outgrowth on the heel bone. The ones caused by the heel spur Tendinitis However, like Achilles tendon or bursitis, they can be diagnosed by an ultrasound and / or MRT examination.

As with most inflammatory processes that take place in the body, certain inflammatory parameters can also be found in blood tests in the case of heel infections.

therapy

In order to successfully counteract an inflammation of the Achilles tendon or a bursitis, a consistent discharge and keeping the affected foot still in the foreground. Additionally, the signs of inflammation can through Cool and by taking anti-inflammatory and pain relieving drugs (NSAIDs, such as ibuprofen or diclofenac). If this is not enough, the treatment can be extended to the application of ointments containing cortisone or the administration of cortisone injections into the affected area. Furthermore you can insoles a more homogeneous one for shoes, heel cushions or improved footwear Foot position Promote or foot strain and the implementation of physiotherapeutic therapy counteract a muscular imbalance. An additional therapeutic measure that can be used in particular with an existing heel spur is the so-called Extracorporeal shock wave therapy (ESWT), in which local pressure waves can in some cases lead to the resolution of the symptoms. Operative interventions are only necessary in rare cases in the context of inflammation of the heel, so that they are only used as a last resort if the conservative therapy be considered.