Achilles pain is a disease named after the pain in the heel. It is a condition caused by chronic strain around the heel tuberosity and is mainly associated with pain and difficulty walking, often accompanied by the formation of bone spurs in the heel tuberosity. The disease is mostly seen in middle-aged and elderly people aged 40 to 60 years old and obese people.
1.Etiology and pathogenesis
(1) Bursitis of the Achilles tendon stop:
Mainly due to shoe friction, especially women often wear high-heeled shoes, the back of the shoe and repeated friction between the heel nodes, resulting in chronic aseptic inflammation of the bursa at the heel nodes, so that the bursa increases, the bursa wall thickening, the occurrence of the disease.
(2) Inferior heel fat pad inflammation:
Patients generally have a history of trauma, mostly due to careless walking, the heel was injured by uneven pavement or small stone road, causing injury to the fatty tissue below the negative focus of the heel bone, local congestion, edema, hyperplasia.
(3) Heel epiphysitis:
This disease occurs only during the period from the appearance of the heel epiphysis to its closure. The second ossification center of the heel bone appears from the age of 6 to 7 and gradually closes at the age of 13 to 14, so this disease occurs mostly during the developmental growth period of adolescents.
(4) Metatarsophalangeal fasciitis:
This disease is due to long-term occupational relationship standing in hard ground work, or due to flat feet, so that the talar tendon membrane in a long-term tension, at its starting point due to repeated strains of congestion, exudation, over time, the bone hyperplasia, the formation of bone spurs.
(5) Kidney deficiency heel pain:
Old age and frailty or prolonged illness in bed, kidney deficiency, then bone atrophy and tendon relaxation, modern medicine believes that prolonged illness in bed, the heel because of infrequent weight-bearing and degenerative changes, thinning of the skin, partial atrophy of the fat pad under the heel, bone decalcification changes caused by.
2.Clinical manifestations
(1) Bursitis of the Achilles tendon stop:
In the Achilles tendon attachment swelling, pressure pain. The pain can be caused by the friction of shoes when walking a lot. It is more serious in winter than in summer, and the pain is related to weather changes. Examination:There is a cartilage-like elevation above the posterior aspect of the heel bone. The skin on the surface is thickened and slightly red, and the mass is cystic to touch and painful to pressure.
(2) Inferior heel fat pad inflammation:
Pain below the heel bone when standing or walking, with stiffness, swelling and pressure pain, but no cystic sensation.
(3) Staghorn epiphysitis:
Most commonly seen in children aged 6 to 14 years. Radiographs show that the heel bone is flattened, the density is unevenly increased, the shape is irregular, wavy or worm-like, and the posterior epiphysis is widened.
(4) Metatarsal fasciitis:
When standing or walking, pain under the heel bone, pain can extend forward along the medial side of the heel bone to the sole of the foot, especially in the morning after waking up or after resting when just starting to walk pain is obvious, but after walking for a period of time the pain is reduced.
(5) Kidney deficiency heel pain:
Bilateral aching and weakness in the heel when standing or walking, but no obvious local pressure pain. X-rays show that there is no obvious abnormality except for slight decalcification of the heel bone itself.