Heel foot (Pes calcaneus) is a relatively common deformity in which the foot is bent so sharply upwards that the toes can touch the shin with slight pressure and the heel is the lowest point. There are two forms of heel foot, congenital or acquired.
What is a hackfoot?
With heeled foot, the foot stands straight up, it is not possible to stand on the sole of the foot. With a heeled foot, you can only stand on your heel. The sole of the foot is turned slightly outwards.
Excessive upward flexion, particularly in infants with the congenital heel of the foot, can bring the arch of the foot up to the shinbone. The Achilles tendon is severely overstretched and worn out as a result of this incorrect posture.
The tendons and skin on the back of the foot, on the other hand, are shortened. This form of deformity is the opposite of drop foot, in which the foot is severely overextended and the toes, not the heel, point downwards.
Causes
Heel foot can have different causes, depending on whether it is congenital or acquired. The congenital form can be caused by a genetic muscle imbalance.
Heel foot also occurs with certain spinal cord disorders, such as spina bifida, or with brain damage such as that caused by hypoxia (lack of oxygen). Another possible cause of heel-foot is an unfavorable position of the embryo in the uterus.
If the foot does not have enough space and is forced to bend upwards, a heel foot develops. However, this form regresses well in the first few weeks of life.
The acquired heel foot occurs when the muscles of the calf are dysfunctional. This can happen due to injuries to the shin nerve (nervus tibialis) or the Achilles tendon. A heeled foot can also result from an incorrectly applied plaster cast.
Symptoms, Ailments & Signs
In the case of a heeled foot, the heel is bent upwards, so that those affected have to walk almost exclusively on their heels, which puts an extreme strain on them and leads to pressure points. Due to the deformity, the foot is overstretched overall and it is hardly possible to put it on the ground when walking. It can only be stretched to a very limited extent and standing on your toes is almost impossible.
The misalignment can sometimes be so severe that the back of the foot can touch the lower leg. Children born with a heeled heel have difficulty learning to walk and learn to walk late due to foot deformity. Because the foot cannot be placed properly, there is a permanent deformity when walking, in which the knee and hip joints are bent and the pelvis is severely tilted.
Due to this faulty way of walking, the heel foot increasingly burdens the statics of the entire skeleton. Pain occurs in the heel because it is chronically overloaded when walking and standing. The permanent pressure on the heel tissue can lead to pressure necrosis because the oxygen supply to the tissue is impaired by the constant pressure.
Diagnosis & History
Heel foot can be clearly diagnosed by its appearance. The foot that is strongly bent upwards and the outward rotation of the sole of the foot result in the typical appearance. With an X-ray, the doctor can visualize the deformity of the foot and determine any effects on the rest of the skeleton.
In the newborn, the heel of the foot, if it was caused by a predicament in the uterus, resolves itself within a few days. If this malposition exists in adults, for example due to an injury to the tibial nerve, it is no longer possible for them to put their toes on the ground. Running takes place on the heels, which leads to overloading of the heel tissue.
In the long run, pain develops, walking is difficult or impossible, depending on the severity of the deformity. The posture changes as a result of the heeled foot, since those affected can no longer carry out the normal movement sequences when walking.
This can lead to a tilting of the pelvis, accompanied by an increasingly hollow back. The tissue on the heels can become inflamed due to the constant pressure and die off over time (pressure necrosis).
Complications
The heel foot leads to a very severe malposition of the foot. This malposition leads to various complaints when walking and standing and usually also leads to relatively severe pain. Due to the malposition, other complaints also occur with the Zeus, such as the so-called hollow back.
Due to the restricted movement and the permanent pain, many patients also suffer from psychological problems or depression. There may also be slight irritability. Children may also be teased or bullied because of the illness. Treatment of the disease is symptomatic and causal.
The pain can be reduced with the help of painkillers, but there are no complications. However, long-term use of painkillers can also damage the stomach. Furthermore, the heel foot can also be corrected relatively easily.
In most cases, however, various therapies are still necessary to completely limit the symptoms. There are no further complications or complaints during the treatment. As a rule, the complaints of heeled foot no longer appear in adulthood. The patient’s life expectancy is also not reduced by the disease.
When should you go to the doctor?
In most cases, heel-foot is congenital and is detected in infants immediately after birth. It can be caused by an unfavorable position in the womb during pregnancy or it can be genetically predisposed. It is often a temporary misalignment that corrects itself after a few days.
However, a heel foot can also occur later due to an injury, e.g. B. a rupture of the Achilles tendon. A doctor should definitely be consulted if the deformity is severe, causing pain and pressure points and making walking difficult. He can usually identify the reason from the type of misalignment and the symptoms it causes. In addition, an X-ray can provide more detailed information about the cause.
If the foot does not come back into the correct position on its own, the doctor can prescribe physiotherapeutic measures. In rare cases, an operation must be carried out to correct the misalignment. Since a heeled foot can cause further problems in the musculoskeletal system due to incorrect posture, those affected should consult a doctor as early as possible so that corrective measures can be taken in good time.
Treatment & Therapy
The therapy is based on the cause. Heel foot, which occurs in the newborn as a result of being too tight in the uterus, can be easily treated. It usually goes away almost by itself.
The treatment to be carried out here only has a supporting effect on the foot by repeatedly bringing it into the right position with gentle pressure massages, holding it for a few seconds and then letting go again. If the heel is more developed, it may be necessary to keep it in the correct position with splints during the night.
Physiotherapeutic measures can support the regression. If heel foot is acquired, an operation may be necessary. A wedge is cut out of the heel bone to correct the misalignment. Another possible surgical therapy is shortening the Achilles tendon or stiffening the ankle.
Outlook & Forecast
A heeled foot is a deformity of the foot in which the foot is constantly bent upwards. The entire heel bone stands steeply in a kind of extension of the lower leg. In addition, there is often a bend in the heel, which points outwards. It is very difficult to give a specific prognosis for an existing heeled foot, since this clinical picture can occur in different degrees of severity.
In general, a positive prognosis can be given for a heeled foot, since an improvement can be brought about by physiotherapy or surgery. In newborns, such heeled foot is very common. However, one does not speak of an explicit clinical picture. This phenomenon usually disappears within a few days, so that no appropriate treatment needs to be initiated.
Anyone who decides against treatment must expect considerable complications. As we age, permanent consequential damage to the joints can occur.
Prevention
Congenital heeled heel cannot be prevented as it is genetic or caused by the amount of space in the uterus. In order to prevent acquired heeled foot, care should be taken to ensure that the foot is in the correct position after an accident, when the leg has to be immobilized with a bandage or cast. Once the heel has formed, it should be treated as soon as possible to prevent further damage.
Aftercare
In most cases, there are no special or direct measures and options for aftercare available to those affected by heeled heel. In the case of this disease, early detection and diagnosis of the disease must take place in the first place, so that there are no further symptoms or further complications. The earlier the disease is detected, the better the further course of the disease is usually.
The disease is usually treated by wearing a splint or by wearing insoles. The person concerned should make sure to use these aids continuously so that the heel foot disappears completely. Physiotherapy or physiotherapy measures can also be very helpful with heel foot and relieve the symptoms permanently.
Physiotherapy exercises can often be carried out at home to speed up healing. If the heel foot is to be corrected by an operation, the person concerned should rest their foot after the operation and not exert themselves.
Physical and stressful activities should also be avoided. As a rule, heeled foot does not reduce the life expectancy of the person affected. Further aftercare measures are not necessary.
You can do that yourself
A congenital heeled foot usually resolves itself within a few days. In all other cases, the foot malposition must be treated therapeutically. The treatment can be effectively supported by a number of measures.
In addition to physiotherapy treatment, targeted foot training is recommended to strengthen the flexors of the feet and toes. Gentle pressure massages are just as effective and help especially with a slight heel-toe. Severe malpositions may have to be corrected with the help of splints or plaster casts – sometimes only at night. If it is not possible to correct the heel foot sufficiently, wearing orthopedic shoes with insoles is indicated.
Surgical treatment is necessary in adolescents and adults, especially in the case of heel foot caused by an accident. After the surgical procedure, those affected are strictly bed rested and rested. The affected foot must be slowly prepared for everyday stress with the help of physiotherapy or light sport. It makes sense to wear orthopedic insoles in the first days to weeks after the operation. It is up to the doctor in charge to decide which measures the affected person can take themselves.