Pain in the heel (or in the hindfoot) refers to the painful condition located in the posterior region of the foot that corresponds to the anatomical location of the calcaneus and talus bone, ligaments, muscles and joints.
How is Pain Produced?
Generally the most frequent cause is due to the action of factors or mechanical agents. The plantar bone (calcaneus and talus), is covered by soft structures that function as shock absorbers of direct and / or indirect agents that produce traumas.
A very strong encounter with a rigid object can cause traumas either in the bone structure, in the soft muscular, articular and ligamentous parts. Likewise the overload of the heel by overweight, the use of very tight footwear or a constant friction with the foot are also factors that generate pain in the hindfoot as well as high intensity sports, with consecutive injuries in the same area can generate traumas.
The hindfoot may be accompanied by swelling or edema in the area, that may suggest it is an inflammatory or joint soft tissue processes. When the pressure is applied to the bone or structure, it awakens intense pain.
The pathologies that present with hindfoot pain are presented according to the affected structures:
Condition of the bone structure:
- Fracture of the calcaneus bone
- Fracture of the talus bone
- Osteomyelitis or bone infection
- Septic arthritis
- Paget's disease
- Bone tumors
Soft tissue condition (ligaments and muscles):
- Plantar fasciitis / calcaneal spur
- Inflammation of the Achilles tendon or Aquileitis
- Retro calcaneal bursitis
- Inflammation of the fat pad
- Wear or atrophy of the fat pad
- Tarsus sinus syndrome
- Channel syndrome or tarsal tunnel.
Conditions of the Articular structures:
- Ankylosing Spondylitis
- Reiter's syndrome
- Thickening of the synovial capsules
Entesitis (or Plantar Fasciitis) is the most frequent cause of hindfoot. Enthesitis is the inflammation of the area where the plantar fascia adheres to the tubercle of the calcaneus bone. The origin is usually mechanical due to overload and is more frequent in overweight women between 50-60 years of age.
The patient feels pain in the plantar area of the heel when the foot rests on the ground, that becomes apparent when supporting the foot after a period of rest, especially in the morning and when supporting the foot for the first time.
The treatment that the specialist can perform is the infiltration of the painful area with slow-release steroid medications and local anesthetic.
The treatment can be complemented with a cushion of cushioning , rest and non-steroidal anti-inflammatories.
Only in very rare occasions is surgery required. However recommendations of orthopedic insoles, soft with an elevated internal arch in order to decrease the tension of the plantar fascia in the insertion area in the calcaneus.