Heel pain (painful heel) refers to pain on one or both sides of the heel, not red or swollen, and inconvenient walking. It is also called heel pain. It is a disease caused by lesions in the bones, joints, bursae and fascia of the heel. The common one is metatarsal fasciitis, which often occurs in people who stand or walk for a long time, caused by long-term, chronic minor injuries. Five easy to cause heel pain disease differential diagnosis A, plantar fasciitis 1, cause: plantar fascia from the bottom of the heel bone medially, and the distal phalanx is connected to split into five bundles, these fibers are closely linked to the surrounding dermis, transverse metatarsal ligaments and flexor tendons. Especially in the first metatarsophalangeal joint, dorsiflexion increases the tension of the plantar fascia and the longitudinal arch of the foot. In turn, it is inherently inelastic and can only lengthen by approximately 4%. The disease is mostly caused by repeated minor trauma and excessive tension. Recently, it is considered to be a non-inflammatory reaction and is more appropriately referred to as “plantar fascia degeneration”. Reduced ankle flexion due to tension in the Achilles tendon or gastrocnemius muscle is also associated with the development of plantar fasciitis. Obesity, excessive weight bearing, and other independent risk factors include: age, shoe discomfort, overtraining, and decreased mobility of the subtalar joint. High arches and flat feet are also important causes of plantar fasciitis. Clinical manifestations: Patients often feel initial pain, which is more pronounced in the morning or after taking the first step after a long rest, and the pain is relieved after a few steps, but increases with walking time or standing time. The pain is sharp and not radiating. Second, the heel pad atrophy 1, the cause: the heel pad for the heel bone below, a piece of tissue rich in fat. The disease occurs over 50 years old, due to the loss of water, collagen and elasticity, resulting in atrophy of the heel pad. 2, clinical manifestations: pain is mostly deep pain, non-radioactive, concentrated in the central weight-bearing part of the heel node. It is easily misdiagnosed as plantar fasciitis, which is easily induced by walking barefoot or walking on hard surfaces, and reduced by less walking. The plantar aspect of the heel node is prone to pressure pain, which correlates with the degree of swelling. The pain is usually unrelated to ankle and toe mobility and nodal compression. Baxter’s nerve entrapment syndrome 1. Cause: The first branch of the lateral plantar nerve, the only nerve located under the bunion muscle and the toe dorsiflexor, while on the square muscle. It dominates the square muscle, the toe dorsiflexor, the little finger abductor, and the sensation of the lateral plantar skin, the periosteum of the heel, and the ligament along the plantar. The places where compression is likely to occur: (1) below the bunion muscle; (2) the nerve passes through the medial heel tuberosity. 2, clinical manifestations: pain is mostly located 4-5 cm before the heel bone, or distal to the heel tuberosity, pain is mostly burning pain, radiating along the lateral plantar. It mostly coexists with plantar fasciitis. Physical examination includes: whether the gastrocnemius flounder muscle is atrophied and the force line of the posterior foot. The symptoms can be exacerbated by valgus in the posterior part of the foot due to insufficient strength of the posterior tibial tendon and valgus in the horseshoe foot. The lateral plantar pressure is highest when the foot is plantarflexed and rotated forward. Pain can be induced by percussion. Lateral plantar sensation is reduced in chronic disease. Neurophysiogram can be used to diagnose whether there is nerve entrapment at the site of stenosis. IV. Heel stress fracture 1. Cause: Compression fracture of the heel bone, the largest tarsal bone in the body, is uncommon and its incidence is only after the metatarsal bone. It occurs in athletes, military personnel, and elderly people with osteoporosis. Mostly caused by repeated overload and inconsistent bone resorption and osteogenesis. 2, clinical manifestations: pain is more intense, diffuse along the medial and lateral distribution of the heel bone. It is aggravated by activity and weight-bearing, and does not decrease at rest. There is pressure pain along the lateral side of the heel bone, and the heel bone squeeze test is positive. V. Ankle canal syndrome 1. Cause: The posterior tibial neurovascular nerve bundle is squeezed in the ankle canal and produces symptoms. This syndrome is relatively uncommon and easily overdiagnosed. Flat feet are most likely to cause ankle canal syndrome because of hindfoot valgus and forefoot abduction, which can easily cause nerve compression. Other causes include: fractures, narrowing of the ankle canal space, and tenosynovitis. Systemic systemic inflammatory arthropathy, diabetes, rheumatoid, etc. 2. Clinical manifestations and physical examination: The patient’s subjective sensation is vague and difficult to locate, however, the pain and numbness mostly occur in the ankle joint and the inner posterior part of the heel, and mostly radiates to the bottom of the foot. The pain and numbness occur mostly in the ankle and heel, and radiates to the bottom of the foot. Sensory dullness affects sleep. The muscle strength is reduced especially when there is significant entrapment, firstly in the toe abductor muscle and then in the little toe abductor muscle. TINEL syndrome along the ankle canal and irreparable hyperalgesia along the tibial nerve distribution are the most important symptoms. Other stimulation methods, such as dorsiflexion and stretching of the tibial nerve, also tend to induce lesions.