In our clinical work, we often meet patients who come to see us for heel pain, and as soon as they enter the clinic, they say, “Doctor, I have heel pain, and I want to take a film to see if I have a bone spur?” In their eyes, they think heel pain is caused by bone spurs!
This is not entirely true! Some patients with heel pain have heel spurs and some do not, and those with heel spurs do not necessarily have pain. In fact, heel pain is caused by a sterile inflammation due to damage to the heel bone and surrounding tissues. Here we will talk about the causes, characteristics, treatment methods and problems that should be paid attention to in life.
How does heel pain develop?
Heel pain, medically known as “heel pain”, is a common condition with heel pain as the main symptom, mostly occurring in middle-aged and elderly women and obese women. There are many causes of heel pain, which can be caused by different diseases, and different diseases have their own characteristics: 1.
1, subheel fat pad inflammation: we humans have a fat pad below the heel bone, its main role is to absorb shock and relieve the impact of gravity on the heel bone. If the fat pad is injured, such as walking with the heel being choked by uneven pavement or small stones, or stimulated by the pressure of prolonged standing and walking, it can cause a sterile inflammation of the fat pad, with changes such as congestion, edema, and even hyperplasia, resulting in pain under the heel.
2, metatarsal fasciitis and heel bone spurs: metatarsal fascia is located in the lower part of the foot, from the front and bottom of the heel tuberosity. If you work standing for a long time, or because of flat feet, the metatarsal fascia is under long-term tension, and the starting point of the fascia, which is below the front of the heel tuberosity, will become congested, edematous, and exudate due to repeated pulling stimulation, forming a sterile inflammation and pain. Over time, osteophytes may also appear, forming bone spurs.
3, Achilles tendon stop bursitis: the Achilles tendon is attached to the upper part of the Achilles node, and there are many small bursae around it. If trauma or strain, such as wearing shoes friction or walking for a long time, it can lead to inflammation of the bursa and pain.
4, heel epiphysitis: the disease is mostly seen in children and adolescents aged 6 to 14 years old, due to excessive running and jumping or improper exercise.
5, other: heel hypertension and periheel fasciitis, etc., can lead to heel pain.
Chinese medicine’s understanding of heel pain
Chao Yuanfang, a famous medical doctor in the Sui Dynasty, called heel pain “foot root decay” in the “Treatise on the Origin of Diseases”, and the book said, “Foot root decay is a sudden pain in the heel, which cannot be held, and the world calls it foot root decay.” Zhu Danxi, one of the Four Great Masters of Jin Yuan, called it “heel pain” in “Danxi Xinfa”. Chinese medicine classifies the etiology of heel pain into three categories.
①Qi stagnation and blood stasis type: various causes lead to slow local blood flow, blood stasis and obstruction of the veins and channels, then the qi and blood does not run smoothly and pain, and pain has a fixed place, pain refuses to press, walking is limited.
②Cold clotting and blood stasis type: slow flow of qi and blood and cold, cold is the main stagnation, the main attraction, resulting in blocked meridians, qi and blood stagnation and pain, pain and refusal to press, preferring heat and fearing cold.
Liver and kidney deficiency: liver and kidney and their branches walk around the heel, the liver is the main tendon, the main blood collection, while the kidney is the main bone, the main collection of essence, essence produces marrow. Older body, liver and kidney deficiency, essence and blood deficiency, the meridians are not filled, the tendons are displaced, the bone is not master, the bone is atrophied tendon relaxation, so when standing or walking heel pain, vague pain, weakness, pain like pressing, the pain is reduced by touch.
What are the characteristics of heel pain?
1, subheel fat pad inflammation: pain below the heel bone when standing or walking, stiffness and swelling, pressure pain is obvious, pressure pain points in the weight-bearing area under the heel and its medial side. x-ray can be seen in the soft tissue image below the weight-bearing area of the heel bone with increased density.
2, metatarsal fasciitis and heel spur: when standing or walking, the plantar or anterior and inferior part of the heel bone is painful, and the pressure pain is obvious, and the pain can be aggravated by pulling the plantar fascia. In the case of heel spurs, hyperplasia can be seen on X-ray. However, the size of the heel spur is not proportional to the degree of pain in the heel, and the heel spur remains after the pain disappears after treatment.
3. Achilles tendon stop bursitis: pain at the Achilles tendon attachment, swelling, and pain can be aggravated by excessive walking. Local pressure pain is obvious, and the pain is aggravated when the ankle joint is dorsiflexed and plantar flexed, and it is not possible to stand on tiptoe. Local calcification shadow can be seen on X-ray of some patients.
4. heel epiphysitis: pain in the lower posterior part of the heel, limping after walking, increased pain after exercise, pressure pain in the lower posterior part of the heel, slight swelling, flattening of the heel epiphysis, uneven increase in density, irregular shape, wavy or worm-like, and widening of the epiphyseal line are seen on X-ray.
5.Other: heel pain in heel hypertension and periheel fasciitis is scattered, the pressure pain is more widespread, and the symptoms will be aggravated after prolonged walking and standing.
How to treat heel pain?
I. Chinese medicine.
The principle of treatment is to activate blood circulation, remove blood stasis, warm the meridians, and tonify the liver and kidney.
1, Chinese medicine.
Internal medicine: blood and qi stagnation and stasis type use the seven cents, tumbling pill; cold blood stasis type with dolichophora parasitic soup plus reduction; liver and kidney deficiency take Liu Wei Di Huang Wan or Jin Kui Kidney Qi Wan. External application: blood circulation and pain relief cream, dog skin cream, joint pain relief cream, etc.
Chinese herbal topical treatment: Haidongpi, mugwort, safflower, Liu Yixinu, wine army, Sichuan pepper, Sichuan cow knee, poria, zedoary, Lulutong, stretching the tendon grass, through the bone grass, Wei Ling Xian, Qing Pi, etc., add or subtract as appropriate, boil and fumigate, one dose daily.
2.Tui na massage: mainly press and knead the painful part of the heel, smooth the meridians on the bottom of the foot, squeeze both sides of the heel, follow the meridian points, rub and press the points of Taixi, Kunlun, Yongquan, Dazhong, Sanyinjiao, Zhaohai, Rangu, Chengshan, Yinlingquan and so on. The function of the manual method is to promote local blood circulation, activate blood circulation and remove blood stasis, warm up the meridians, eliminate swelling and relieve pain.
3.Small needle knife therapy: small needle knife therapy is a minimally invasive treatment technique with precise efficacy, mostly used for patients with inferior heel fat pad inflammation and heel bone spur and metatarsal fasciitis who have been poorly treated by other therapies.
4.Acupuncture treatment.
The acupuncture and moxibustion can be used to enhance the efficacy of the treatment, using the diarrhea method or the flat tonic and flat diarrhea method. Commonly used acupoints are Taixi, Zhaohai, Kunlun, Shen pulse, Hanging bell, A-Yi point, etc.
Western medical treatment
1.Anti-inflammatory and analgesic: For those who are not in pain, they can take ibuprofen, anti-inflammatory pain, fotarine and other drugs, or apply fotarine ointment externally.
2.Closure therapy: It has a good anti-inflammatory and analgesic effect and is suitable for patients with severe pain and obvious pressure pain. Tretinoin or compound betamethasone can be used, plus lidocaine, saline dilution after doing painful point closure.
3.Surgical treatment: for pain caused by heel hypertension, those who are not effective by conservative treatment can consider doing heel drilling decompression treatment to reduce the pressure of the intramedullary veins and relieve pain.
What are the problems that patients with heel pain should pay attention to?
1, reduce the heel weight stimulation: less standing, less walking, especially not deliberately to walk the cobblestone road, so that the heel fully rest, in order to facilitate the healing of the injury and the absorption of inflammation.
2, wear shoes to be slightly: wearing shoes should be used loose soft-soled shoes, such as travel shoes; walking in the heel plus thick cushion, or use the heel pad to reduce the stimulation and damage to the heel.
3, physical therapy heat therapy: in addition to targeted physical therapy at the hospital, the night before bedtime can be used to soak feet for about half an hour with hot water, or place the foot on the heating effect of electric heaters, electric hand stoves, infrared lamps, home physical therapy instruments and other equipment, the role of warmth can improve local microcirculation, for the relief of pain is very helpful.
4, for the use of topical medications for patients friends, the best use of warm water to soak the feet before using drugs, and then topical rubs or creams.