Achalasia is a common chronic injury disorder that occurs in the elderly, with heel pain being the main cause. Heel pain is often associated with a heel spur, but can also occur without a bone spur. There is no necessary parallel between heel spurs and achalasia. The heel pain is actually a sterile inflammation caused by damage to the periosteum and surrounding fibrous tissues of the heel bone 医学教 育网收集整理.
1. Pathogenesis
The bottom of the foot is not flat in normal people. The middle of the sole of the foot is bow-shaped concave upwards. The arch from the front to the back is called the longitudinal arch, and the arch from the inside to the outside is called the transverse arch. The arch structure of the sole of the foot makes the foot flexible when the body is bearing weight. The longitudinal arch of the foot is maintained by the metatarsal tendon membrane. The metatarsal tendon membrane starts from the nodes on the bottom surface of the heel bone, extends forward, and finally divides into five strands that end at the toes of each of the five toes.
The deep side of the metatarsal tendon membrane is attached to the short toe flexor muscle. The relationship between the metatarsal tendon membrane and the arch of the foot is like a string and an arch. Therefore, when standing and walking, the metatarsal tendon membrane is subjected to strong pulling force to maintain the normal structure of the arch. As such, the attachment point of the metatarsal tendon membrane at the heel bone is often subject to strong pulling forces, and the metatarsal tendon membrane and heel periosteum in this area are prone to injury. In addition, the heel node is also the negative point of the foot, and a large part of the body weight is concentrated on the heel node, which is also one of the reasons why it is easily damaged.
In middle-aged and elderly people, the elasticity of the metatarsal tendon membrane is weakened and the heel bone is osteoporotic, which is the internal cause of this disease. Sudden long-distance walking or prolonged standing labor is a common precipitating factor for the onset of heel pain. Heel pain is also easily caused when the sole of the shoe is too hard. The heel is a concentrated area of weight bearing, and inflammatory reactions can occur in the soft tissues surrounding the heel after injury. Because the soft tissues around the heel are tough, the pain is heavier. Soft tissue injury and then weight-bearing can further aggravate the injury. Therefore, heel pain can last for several months.
2.Clinical manifestations
The main symptom is pain at the bottom of the heel, which often occurs after exertion. The pain is persistent, and it is aggravated when the foot follows the ground. On examination, there is limited pressure pain on the bottom surface of the heel bone. In severe cases, the soft tissues of the heel may become red and swollen, and the pressure pain may expand.
On X-ray, bone spurs can be seen at the base of the heel bone. In some patients, there are no bone spurs. The size of the spur is not proportional to the clinical presentation. Those with spurs may be asymptomatic, and those with symptoms may be asymptomatic. Most patients have osteoporosis of the heel bone.
3.Treatment
Patients with heel pain have difficulty walking, and many patients have a long history of the disease, which affects their daily life, especially for the elderly. Therefore, attention should be paid to the treatment of heel pain. Clinical observation shows that active and regular treatment can effectively control pain. Otherwise, the pain can be prolonged and prolonged.
(1) Minimize weight bearing on the foot and allow the heel to rest adequately to create conditions for injury healing. When walking, the heel should be padded with thick cushions to reduce the damage to the heel.
(2) Topical application of the agent. Patients can be done at home, is a convenient treatment for the elderly. Commonly used drugs with good efficacy include Bone You Ling, a spray of pain, safflower oil, etc. Topical application should pay attention to the method of use. Before using the medicine, you should soak your feet in warm water and then apply the medicine. The scope of application should be larger than the pain range. Massage for a period of time after using the medicine.
(3) Oral anti-inflammatory and pain-relieving drugs. Patients with heavy pain heel pain can take oral anti-inflammatory and analgesic drugs. The role of these drugs is to inhibit the local inflammatory response, promote tissue healing and relieve pain. Commonly used drugs are: ibuprofen, fenbid, anti-inflammatory pain, futalin, etc. The price of anti-inflammatory pain and ibuprofen is low and the efficacy is good. Some patients feel discomfort in the upper abdomen after using the drug, but taking the drug after meals can avoid or reduce the irritation to the stomach.
(4) Hormone therapy. Most patients can have their pain relieved after the above treatment. Some patients with heavy pain, then, under the guidance of the doctor can be short-term, small doses of oral prednisone, the efficacy is indeed. Prednisone can be used in combination with anti-inflammatory and analgesic drugs. The combination of the two drugs will reduce gastrointestinal side effects when taken orally 1-2 hours apart. Prednisone should not be used for a long time, usually 3-5 days is enough. Patients with gastritis, peptic ulcer and diabetes mellitus should not use prednisone.
(5) Closed treatment. Patients who have not been treated with the above mentioned treatments can be treated with closure method. Hydrocortisone local pain point injection, generally good pain relief effect. The heel skin is tough, and the pain itself is heavy when injected, and there is a possibility of infection. Therefore, patients with heel pain should be treated with other methods first, and then closed treatment when ineffective.
4.Prevention
The onset of heel pain is very common in middle-aged and elderly people, which adds a lot of pain to them. Therefore, middle-aged and elderly people should pay attention to the prevention of achalasia.
Middle-aged and elderly people usually pay attention to exercise, especially adhere to the daily walk, so that the feet can often get exercise. Regular walking can make the ligaments of the foot keep elasticity, heel bone osteoporosis is improved, and help prevent the occurrence of heel pain.
People who do not exercise regularly, occasionally a long time walking or standing labor is prone to heel pain. Therefore, in addition to the usual attention to exercise, to avoid continuous weight bearing on the foot. When you need to walk long distances or stand for a long time, pay attention to intermittent rest to prevent excessive fatigue of the foot.
Daily foot soak with warm water to maintain foot hygiene and good blood circulation, which helps the health of the foot.
Wear shoes that are loose and have flexible soles. Soles that are too thin can easily damage the foot.
The above methods are expected to prevent the occurrence of heel pain. For patients who already suffer from heel pain, it helps to prevent recurrence.