I. Causes of heel pain? The common causes of heel-plantar lateral pain: metatarsal tendinitis, heel fat pad inflammation, the first branch of the lateral plantar nerve entrapment, heel bone spur, heel bone fatigue fracture. Posterior heel pain is often caused by Achilles tendonitis, Achilles tendon bursitis. Although there are various causes of heel pain, the main cause is metatarsal tendonitis or Achilles tendonitis. Second, the cause of metatarsal tendonitis? This disease is most common in middle-aged and old people aged 40-60 years old and obese people. It is sometimes accompanied by bone spur formation, but the degree of heel pain is not proportional to the size of the spur, but is related to the direction of the spur. If the spur slopes downward, there is often pain; if the spur is parallel to the heel bone, there may be no symptoms. It is now generally recognized that heel spurs are not the cause of heel pain. The vast majority of researchers believe that the pain is caused by microtears in the metatarsal tendon membrane due to repetitive microinjuries, or by an inflammatory response secondary to microtears in the metatarsal tendon membrane. Others believe that the pain is triggered by repeated damage to the metatarsal tendon membrane and long metatarsal ligament, resulting in adhesions, edema, contracture of the tendon membrane, and aseptic inflammation. In normal gait, the metatarsal tendon membrane undergoes an alternating cycle of relaxation and tension from the anterior rotational force when the foot follows the ground to the posterior rotational force when the foot lands on the ground and the toes leave the ground. Metatarsal tendon membrane tension increases during full-foot landing and peaks during toe-off. The metatarsal tendon membrane is an important structure for maintaining the foot arch, and any torsional force acting on the arch produces the greatest tension on the metatarsal tendon membrane, especially on the medial eminence of the calcaneal tuberosity. Repeated pulling over time causes small tears at the beginning of the metatarsal tendon membrane, secondary to aseptic inflammation, leading to pain. Pathologically metatarsal tendonitis is not strictly an inflammatory condition, but a degenerative change. Third, the clinical manifestations of metatarsal tendonitis? Clinical manifestations: pain below the heel bone when standing or walking, the pain can be extended 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, the pain is obvious when starting to walk, after walking for a period of time, the pain is reduced, but with the increase of activities during the day, the pain is gradually aggravated. Running and jumping can cause acute attacks of pain, and the pain can be aggravated when going up and down the stairs. How is metatarsal tendonitis treated? More than 90% of the cases are treated non-surgically. Metatarsal tendon membrane stretching, extracorporeal shock waves, night splints, shoe inserts Injection therapy: localized closure, but multiple closures are not recommended. Surgery is indicated in cases where conservative treatment is ineffective and symptoms are severe: traditionally, the metatarsal tendon membrane is partially severed, but this can lead to arch collapse and is rarely used today. In recent years, open or closed perforation of the metatarsal tendon membrane with a plasma knife has been used, with an efficiency of more than 80%. So far, there is no one treatment that is effective. This disease is self-limiting, some patients can be cured without any treatment, and the general symptoms do not exceed 3 years. Fifth, what is the heel fat pad inflammation? Commonly found in middle-aged and elderly people and obese people. Due to the heel fat pad atrophy, loss of elasticity and cushioning effect, reducing the protective effect on the heel tuberosity, causing synovitis of the heel tuberosity, pain. Clinical manifestations of heel fat pad inflammation? Cannot wear shoes with thin soles, and the pain is heavier when walking on non-elastic surfaces. Diagnostic pressure on the metatarsal side of the heel with the hand has obvious pressure points, and can feel the bony protuberance, when squeezing the lateral side of the heel with the hand, so that the plantar fat accumulation becomes thicker, the original pressure points and bony protuberance disappeared. How to treat heel fat pad infection? Wear shoes with thicker and softer soles, reduce activities in the early stage, take non-steroidal anti-inflammatory drugs and treat with insoles.