Heel Pain (Talalgia): Symptoms, Causes, Treatment?

We can all experience heel pain from time to time. The heel pain, from their medical name, often appear during or after a long and intense physical exertion. They can become very disabling and hinder walking. Fortunately, there are effective means of prevention and treatment to alleviate them. Explanation by Pr Didier Mainard, orthopedic surgeon and president of the French Association of Foot Surgery (AFCP).

Heel Pain: Where Is Heel Pain?

Heel pain refers to the pain that can be felt:

  • under the heel
  • at the back of the heel
  • around the heel (so-called “crown pain”)
  • True all over the heel

“The pain can be more or less intense, depending on its origin. It occurs with weight bearing or exertion, but can also occur at rest, especially in the morning,” specifies Professor Mainard. Only one foot is usually affectedbut the pain can also affect both feet and worsen with walking, standing for long periods, or climbing stairs.

Anatomical reminder: where is the heel bone?

The heel denotes the rear part of the foot, consisting of a bone, the heel bone (or heel bone) and tissues. In talalgia, all parts of the heel can be the source of pain: the heel bone, the tendons and the fibrous muscle membranes that attach to it, as well as the nerves, soft tissues and skin.

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Why do my heels hurt?

“The main causes of heel pain are: trauma, plantar aponeurosis and insertional tendonitis“, notes the orthopedic surgeon. We take stock.

Mechanical causes, usually

Heel pain is mainly related to mechanical causes. In other words, they affect the bone, ligaments or muscles of the foot. Professor Mainard notes:

  • the plantar aponeurosis (or plantar fasciitis), “which often causes defiant and chronic pain”.
  • the Heels (inflammation of the soft tissues caused by RSIs);
  • the calcaneal fractures
  • the ruptures of the plantar aponeurosis, is most common during a jump;
  • stress fractures at the heel;
  • the wearing inappropriate footwear : “the pain can be associated with the friction of new shoes, which causes painful dermatological lesions at the heel”, explains the specialist.
  • the insertion Achilles tendinopathies (TAI): Calcifications develop at the insertion of the tendon;
  • Haglund’s disease (characterized by a deformity of the heel bone, which causes inflammation of the Achilles tendon in contact with it);
  • skin lesions: painful heel (very common in the elderly), a wart under the sole of the heel, plantar calluss lesions different etc.

In the case of children and young people, we can also think of: Sever’s diseasewhich primarily affects boys, between 8 and 13 years of age, and results in microfractures and damage to the ossification core of the calcaneus.

To note : heel spurs (a bony growth at the level of the calcaneus) is often accused of causing heel pain. “But it rarely causes pain,” emphasizes Professor Mainard.

Inflammatory disease, nerve damage… the other causes

“Some heel pain may indicate an inflammatory rheumatic diseaseespecially in adolescents or young adults, such as ankylosing spondylitis,” the surgeon warns. Other, less common diseases may also play a role:

Finally, a nerve damage (due to compression, following sciatica type S1 or diabetes-related neuropathy) may also be painful in the heel.

Arteritis of the lower extremitiesdue to fatty deposits (or atheroma) on the walls of the arteries, the caliber of the vessels of the legs narrows, which can lead to a vascularization defect, sometimes responsible for burns on the sole of the heel.

Painful heel: when and with whom to consult?

Do you suffer from heel pain and show no visible signs of a fracture? Better consult a doctor to take stock:

  • if the heel pain is sudden and severe and occurs after a shock or fall;
  • if your heel becomes red and swollen
  • if you can’t put your heel on the floor;
  • if, after two to three weeks of home carethe pain does not go away, worsens or comes back after a period of rest;
  • when you presentother symptoms (sciatica, joint pain, fever, psoriasis, abdominal pain, diarrhea, etc.);
  • or if you suffer from chronic illness (Ankylosing Spondylitis, Diabetes, Lower Limb Arteriopathy, Rheumatoid Arthritis, Osteoporosis.).

First see your GP, who will eventually refer you to a specialist. In particular, he may prescribe an X-ray to determine the exact cause of the heel pain.

It is possible to temporarily relieve heel pain by taking over-the-counter pain relievers or by applying practical advice. When pain occurs:

  • take care of your foot as much as possible: avoid painful positions or movements and stop all physical activity during the inflammation phase;
  • apply ice to the painful area;
  • do not walk barefoot and avoid shoes that are too narrow or shoes with high heels (prefer shoes that offer good arch support);
  • and so forth

Depending on the cause, the doctor may also suggest:

  • the wear a splint (especially at night) to stretch the foot;
  • by physiotherapy sessions
  • or wearing silicone gel heel cushions in shoes or custom orthopedic insoles.

What medication should I take if my heel hurts?

Initially, to relieve pain related to heel pain, favor painkillers (acetaminophen). In case of contraindication, bet on a non-steroidal anti-inflammatory, or “NSAIDs” (ibuprofen, ketoprofen). Anti-inflammatory creams and patches may also be helpful.

It is best to seek advice from your doctor or pharmacist. For responsible use:

  • do not use a medicine if you have any of the contraindications listed in the package leaflet;
  • carefully follow the dosage recommended by the instructions (maximum allowable daily dose, amount and frequency of doses, minimum interval between two doses);
  • use the analgesic or non-steroidal anti-inflammatory drug for as short a time as possible;
  • avoid combining or alternating painkillers of different compositions (unless medical advice indicates otherwise).

Heel pain: when to have surgery?

“For persistent pain, when medical and conservative treatment is no longer sufficient, shock waves may be given at the heel, or even cortisone infiltrations or at the heel insertion point. Surgery is only considered a last resortfor example in the case of a resistant plantar aponeurosis,” insists Professor Mainard.

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