When a painful condition occurs in the heel, we speak generically of heel pain, a disorder which, in a clinical setting, is defined as tallodynia, plantar talalgia or calcaneal pain

It can have different origins and nature and concern only one or both feet.

In the first case it will be unilateral heel pain, while in the second case it will be bilateral heel pain

The appearance of tallodynia can be determined both by simple postural alterations and by traumatic, metabolic, neurological and congenital pathologies.

The latter in turn can affect both the soft parts, causing tendonitis, bursitis, tendon inflammation or fasciitis, and the bone parts, causing stress fractures, heel spurs, talo-calcaneal arthrosis or, in rare cases, tumors.

Main causes

As previously mentioned, heelitis can have metabolic, neurological and congenital origins.

Many factors and aspects must be considered to establish the cause of the onset of this painful inflammation, including:

• Primary and secondary postural alterations;
• Inadequate footwear for foot compliance: prolonged use of high heels, shoes that are too tight or worn out or safety shoes;
• Obesity or overweight;
• Sedentary lifestyle;
• Rheumatic pathologies or arthrosis;
• Intense sporting activity with excessive heel strain;
• Incorrect workouts from a qualitative point of view;
• Insertional tendinopathy, a clinical condition involving the tendon and the immediately adjacent parts that occurs following an abuse of load;
• Metabolic diseases such as gout, a pathology caused by the alteration of uric acid metabolism which leads to an excessive accumulation and subsequent precipitation of uric acid crystals and, consequently, inflammation in the joints;
• Rheumatic diseases such as ankylosing spondylitis, rheumatoid arthritis, chondrocalcinosis, psoriasis, etc.

Another cause of heel pain is bursitis, an inflammation that affects the retrocalcaneal serous bags or subcutaneous bags, structures that favor the sliding of the peripheral structures of the tendon.

This inflammatory process can, in turn, be caused by anatomical problems such as heel spurs or cavus foot.

Identifying the root cause of heelitis is the best way to understand how to treat it properly and prevent it from becoming chronic.

For this reason, a medical or podiatry visit is always recommended to find out the origin of the inflammation in the heel.

Symptoms of heelitis

Heelitis manifests itself with pain of variable intensity concentrated in the posterior inferior area of the foot, where the heel is located.

The discomfort is perceived more after the subject has been standing or sitting for a long period of time.

Usually, in fact, the pain is more acute in the morning, immediately after getting out of bed and, in general, tends to recur after you get back on track after sitting or lying down for a long time.

In addition to heel pain, the subject may also experience generic foot pain or complain of swelling and tiredness in the lower limbs.

Heel pain in sport

In the world of sport, heel pain is one of the most common pathologies.

In most cases, the disorder is caused by continuous stresses and microtraumas suffered by the foot for a prolonged period of time.

These are real micro-injuries which, in the long run, can alter the normal functionality of the tendons and of the foot in general.

Plantar talalgia is very frequent in sports such as:

• Soccer;
• Volleyball;
• Basketball;
• Gear;
• Running;
• Rugby;
• Basketball.

In general, the disorder is frequent in all those sporting activities that involve intense stress on the heel region and in which the feet undergo intensive and prolonged stress due to impact with the ground.

The risk of developing tendonitis then increases in overweight people, in the absence of adequate training, following exercises performed incorrectly and with the use of footwear that is not suitable for the sport practiced.

The use of the right footwear is essential to avoid the onset of the disease

For this reason, if you practice a sport it is advisable to buy the right shoes in specialized sporting goods stores, which offer a wide range of functional footwear to withstand the intense stresses suffered by the foot during sporting activity.

This type of shoe is generally equipped with the so-called shock absorber, a special material positioned in the heel which is able to attenuate the shock from repeated impact with the ground.

Calcaneal pathologies can also arise after having practiced motor activity on particularly rigid surfaces such as asphalt or synthetic fields, which amplify the impact shock suffered by the feet.

Furthermore, the appearance of heel pain can be caused by inadequate preparation for sporting activity and poor musculature.

For this reason it is always recommended to start sporting activity after an adequate warm-up and to increase the intensity of the workouts from time to time.

Care and medications of heelitis

Fortunately, common heel infections resolve within 1 to 3 weeks.

First of all, it is recommended not to overstress the foot and to apply ice to the affected area, especially in the most acute phase of inflammation.

However, since the causes of heel pain can be, as we have seen, multiple, it is advisable to go to the doctor or a specialist who will be able to make an accurate diagnosis and establish a more suitable treatment plan.

It is important to promptly treat the pathology which, otherwise, could worsen or favor incorrect postural attitudes.

In fact, those affected by heel pain tend to limit the load on the foot affected by the inflammation to feel less pain.

However, this type of compensation could, in the long run, lead to problems with other body structures such as the pelvis, knees and spine.

During the medical examination it may be necessary to perform a radiographic and postural examination of the foot.

In some cases, the doctor could also prescribe an MRI or an ultrasound, to get a more in-depth picture and observe the state of the surrounding soft tissues and the presence of any hematomas, edemas or lesions.

A period of rest and the application of ice packs may be sufficient to eliminate the inflammation, but if these solutions are not effective, the doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to the patient.

Among these, the most commonly prescribed active ingredients are:

• Ibuprofen, usually given orally;
• Ketoprofen, administered both orally and in the form of preparations for cutaneous use;
• Diclofenac, in the form of an ointment or an intramuscular injection.

It will be the doctor’s task to establish the most suitable active ingredient and dosage, assessing the severity of the inflammation, the patient’s state of health, his previous medical history and his response to treatment.

In very rare cases, when the pain is particularly intense and non-steroidal anti-inflammatory drugs are ineffective, the doctor may prescribe opioid pain relievers for the patient.

These types of drugs, which have codeine and tramadol as active ingredients, are very powerful, have many contraindications and can lead to unwanted effects.

For these reasons they should be used with caution and only if strictly necessary.

Another solution for the most serious cases of heel pain is the administration of parenteral corticosteroids.

However, the administration of these powerful anti-inflammatory drugs is not so widespread and, according to some doctors, may not have any benefits against the pain caused by inflammation.

Some specialists could then prescribe hyaluronic acid infiltrations to the patient combined with specific programs of stretching exercises.

Although this type of therapy seems to be useful in the treatment of tendonitis, the response to treatment is still subjective and varies from patient to patient.

In cases where the patient has a particularly acute plantar fasciitis or bursitis, it may be necessary to resort to surgery.

In this case, a longer period for rehabilitation, the use of specific footwear and a custom-made insole will be essential.

It is not necessarily necessary to resort to pharmacological treatments to cure heel pain

In some cases it can be easily cured using non-pharmacological treatments such as massage, tecar therapy or ultrasound therapy.

Even in cases like this, however, it is always better to have the preventive consultation of a specialist, in order to avoid aggravating the situation.

There are all-natural remedies that help soothe heel pain during the healing phase.

According to many, the application of arnica-based compresses is particularly effective, thanks to the anti-oedematous, anti-rheumatic, anti-traumatic and anti-inflammatory properties with which this preparation is equipped.

Also in this case, despite being a natural product, it is advisable to consult your doctor before proceeding with the application of the compress.

In cases of heel pain due to plantar fasciitis, stretching exercises of the plantar fascia, calf and Achilles tendon are very useful.

Furthermore, the use of night braces and rigid knee-highs to be worn during walking can be beneficial for a more timely resolution of heel pain.

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