Cao Yun, Department of Acupuncture and Moxibustion, Nantong City Hospital of Traditional Chinese Medicine
In our clinical work, we often meet patients who come to see us for heel pain, and as soon as they enter the consultation room, 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 that heel pain is caused by bone spurs! This view is not entirely correct! Because some patients with heel pain have heel spurs and some do not, and also people with heel spurs do not necessarily experience pain. In fact, heel pain is caused by damage to the heel bone and surrounding tissues resulting in sterile inflammation. 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. Inferior heel 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 heel by uneven pavement or small stones choking, or due to prolonged standing and walking pressure stimulation, it will cause sterile inflammation of the fat pad, congestion, edema, and even hyperplasia and other changes, 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 on the understanding of heel pain Chao Yuanfang, a famous medical doctor in the Sui Dynasty, in the “source of diseases Hou”, called heel pain as “foot root decay”, the book cloud: “foot root decay heel pain suddenly, can not be on, the world called the foot root decay.” Zhu Danxi, one of the Four Great Masters of Jin Yuan, called it “heel pain” in “Danxi Xinfa”. In Chinese medicine, the etiology of heel pain is divided into three categories: 1, qi stagnation and blood stasis: various causes of local blood flow is slow, blood stasis is blocked, the veins and channels are blocked, the qi and blood does not run smoothly and pain, and pain has a fixed place, pain refuses to press, walking is limited. 2.Cold stagnation 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. 3, liver and kidney deficiency type: liver and kidney and its branches of the other meridians around the heel walk, 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 bones are not master, the bones are atrophied and tendons are relaxed, so when standing or walking heel pain, vague pain, weakness, pain like to press, 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 bone spur: when standing or walking, the plantar or anterior and inferior heel pain, pressure pain is obvious, involving the plantar fascia can make the pain worse. 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, 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 epiphysis 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 is heel pain treated? Heel pain is a group of symptoms caused by strain and degeneration with pain around the heel bone or under the heel bone as the main symptom, and there are many treatment methods, but conservative treatment such as closure, physiotherapy and Chinese medicine fumigation is easy to relapse, while surgical treatment requires lumbar anesthesia or epidural anesthesia, which is traumatic, and some methods are still controversial…. The use of Chinese medicine nine needles (such as: paddle needle, blade needle, needle knife, etc.) minimally invasive closed release, through the fixed point stabbed into the pressure point, the local degenerative contracture of the tendon membrane part of the cut, relieve tension, reduce local stress, is the current treatment of heel pain better therapy!
What should patients with heel pain 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 soft cushion, or with the heel pad, to reduce the stimulation of the heel and injury.