Achilles pain is a general term for painful disorders around the heel, which are common in middle-aged and elderly people aged 40 to 60 years. It includes a variety of injuries to the heel, such as Achilles tendon bursitis, inferior heel fat pad inflammation, metatarsal tendonitis, heel spur, heel hypertension, etc.
Etiology and pathology
(1) Achilles tendon bursitis There is the thickest tendon in the whole body attached to the Achilles tendon at the back of the heel bone, and it is a stress concentration area for standing and walking with gravity and tension. There are three bursae around the Achilles tendon: one is located between the skin and the Achilles tendon, called the posterior bursa of the Achilles tendon; one is located between the Achilles tendon and the posterior superior angle of the heel bone, called the posterior bursa of the heel bone; one is located between the weight-bearing part of the heel bone and the fibrous fat pad of the heel when the human body is standing, called the posterior bursa of the heel. The above three groups of bursa long-term wear and tear or trauma, can cause bursitis and pain.
(2) Subheel fat pad inflammation Mostly due to injury to the fat pad caused by hard objects or long-term pressure on the heel, resulting in congestion, edema, hyperplasia and hypertrophic changes and causing heel pain.
(3) Metatarsal tendonitis The metatarsal tendon membrane is a fibrous structure that maintains the longitudinal arch of the foot, starting from the nodes of the heel bone and ending at the top bone. Continuous weight-bearing causes the metatarsal tendon membrane to be stretched for a long time, resulting in fatigue injury and causing pain in the foot.
(4) Heel spur On a lateral view of the foot, it is common to see a heel nodule, i.e., a bone spur at the attachment of the metatarsal tendon membrane. The heel spur is only an x-ray sign and does not necessarily correlate with heel pain, and it should be said that most spurs do not cause pain. However, the spur grows obliquely downward, and its tip may be subjected to greater pressure when bearing weight on the bottom of the foot, resulting in pain. It is also believed that the junction between the bone spur and the metatarsal tendon membrane is worn out for a long time, which may lead to bursitis and become the cause of pain.
(5) Heel hypertension is a painful condition of the heel mainly due to increased pressure in the bone and is common in middle-aged and elderly people. The main reason is that the heel bone is composed of spongy cancellous bone, the venous sinus in the medullary cavity is large, and the heel is located at the lowest part of the body, which is affected by gravity and has high resistance to venous return, causing stasis of blood in the heel bone and increasing pressure, resulting in symptoms.
Diagnosis
(A) Symptoms
1, posterior Achilles tendon bursitis and posterior heel bursitis The main symptoms are pain and swelling in the heel, and posterior Achilles tendon bursitis is seen as a localized elevation, and the pain increases when walking.
2, heel subluxation bursitis foot trauma or cold stimulation after the onset of the foot followed by pain in the ground, to the elderly.
3, subheel fat pad inflammation pain below the heel when standing or walking.
4, metatarsal tenosynovitis pain under the heel or the heart of the foot when walking, and a feeling of swelling and cracking on the bottom of the foot.
5, heel spur pain during walking, mostly in the heel, usually without radiating pain.
6, heel hypertension Most often seen in middle-aged and elderly people, heel pain affects walking, lower limb elevation and rest can relieve the symptoms.
(B) Signs The main difference is the location of pressure points and the nature of pain.
1.Posterior Achilles bursitis Local elevation is obvious, and the pressure pain point is superficial.
2, posterior Achilles bursitis The pressure point is slightly higher than the posterior Achilles tendon pressure point, and the pressure point is deeper in.
3, subacromial bursitis The pressure pain below the heel node, sometimes can be touched subcutaneous fat fiber mass, as if sliding nodes, pressure pain deep in.
4.Subheel fat pad inflammation Painful pressure below the heel bone, swollen hard lump feeling when pressed, shallow pressure pain.
5, metatarsal tenosynovitis and heel bone spur Both pressure points are in the same location, but the former has no bone spur on film, while the latter is seen to have bone spur.
6, heel hypertension The pressure pain is widespread, with pressure pain on both the medial and lateral sides of the heel bone and the metatarsal side.
Most of the above-mentioned heel pains are caused by a single cause, but sometimes they may also be caused by compound factors. As mentioned above, the heel spur causes lesions of the metatarsal tendon membrane and subacromial bursa.
Differential diagnosis
Rheumatoid arthritis can sometimes cause heel bursitis. Blood sedimentation, anti-rheumatoid factor, HAL-B27, etc. can help in differential diagnosis.
Treatment
(A) Non-surgical treatment
1, the acute period requires rest, after the symptoms improve still also reduce walking, heel weight-bearing pressure pain, can apply hollow heel pad, avoid weight-bearing heel pain point.
2.Local physiotherapy: swelling is obvious, Chinese herbal medicine seal pack is applied externally, swelling is slight, medium frequency electrotherapy, local warm treatment, microwave, Chinese herbal medicine soak, etc., to promote local blood circulation, improve the nutrition of surrounding tissues, to achieve the purpose of swelling, anti-inflammation and analgesia.
3, the use of painful points closed, once every 7 days, 2-3 times for a course of treatment, the general effect is better. However, if the skin of the heel is thick and hard, and the pain sensation is sensitive, the patient can hardly tolerate it, so a fine needle can be used to inject medicine into the pain point from the lateral side of the heel.
(2) Surgery If the pain is severe and affects work and life, and the above treatment is ineffective, surgery can be considered.