The heel undergoes stress from various directions during prolonged walking and standing, leading to degeneration of muscles, tendons, bursae, fat pads around the heel, and changes in internal heel pressure. A series of clinical symptoms characterized by heel pain are known as heel pain or calcaneodynia. Belongs to the category of "Bone Bi" in traditional Chinese medicine.
Prevention Before Illness
Preventive measures for heel pain vary depending on the cause.
1. Heel epiphysis inflammation in adolescents is mostly due to trauma or prolonged running and jumping. During this stage, since the heel epiphysis is still developing, avoid running and jumping, especially jumping from heights. Early attention should be given to this issue.
2. Senile heel pain is often due to overuse, plantar fasciitis, calcaneal bursitis, or fat pad degeneration. Avoid prolonged standing or walking. Elevating the heels reduces load on the heel. Wear soft-soled shoes with a soft, round pad placed at the heel, with a central depression, height of about 2–3 cm, shifting body weight forward and reducing pressure on the heel. Weight reduction therapy is also beneficial.
3. Heel pain caused by flatfoot results from reduced or absent arch, causing the heel to tilt forward, leading to pain during walking. Place a soft pad under the foot’s center, 2–3 cm high, with the inner side higher than the outer side, central part highest, sloping gradually toward front and back, forming a slope.
4. For rheumatoid heel arthritis, first control rheumatoid disease with medication, then place soft padding inside shoes.
5. Traumatic heel pain often results from improper plaster immobilization. When making plaster casts, press wet plaster firmly toward the sole to prevent flat soles and loss of arch. Minimize bed rest time and start walking exercises as soon as possible. Prevent fat pad atrophy.
6. All the above methods aim to reduce heel loading. For early heel pain, external herbal fumigation can be used: Du Huo, Qin Jiao, Tou Gu Cao, Su Mu, Hong Hua, Ling Zhi, Wu Mei, Ai Ye, Fang Feng. Oral herbal decoctions include: Du Huo, Sang Ji Sheng, Fang Feng, Chuan Xiong, Dang Shen, Gui Zhi, Mu Gua, Gan Cao, Wei Ling Xian, Chuan Duan, Niu Xi, Sheng Jin Cao. Grinding these herbs into powder and placing them in small bags under the foot can elevate the arch, alter heel loading, and allow slow absorption of herbs to treat the condition. Formula: Ma Huang, Fu Zi, Tou Gu Cao, Hong Hua, Gan Jiang, Gui Zhi, Fang Feng, Mu Gua, Qiang Huo, Jing Jie, Du Huo.
After Illness Prevention of Progression
For persistent pain preventing walking, adopt active treatment to avoid impact on life and labor. Common methods include:
1. Earth-made vinegar fumigation: Add 1000 ml vinegar, 30 grams each of Mu Gua, Tou Gu Cao, Hong Hua, Niu Xi, and half a pound of stones into a cloth bag, boil over fire, remove when not too hot, place under foot and on painful heel area. Twice daily, once in the morning and once in the evening.
2. Local infiltration: Inject 1–2% procaine mixed with 12.5 mg prednisolone acetate into the painful site. Most effective for plantar fasciitis; also applicable for calcaneal bursitis and calcaneal tuberosity bursitis.
3. Physical therapy: Include physiotherapy, local heat application, vinegar iontophoresis.
4. If conservative treatments fail, surgery may be considered. Methods include:① Heel spur excision: For refractory heel pain, confirmed by X-ray to have spurs, make an incision on the medial side of the heel, enter the bone, and completely file down the spur.② Heel drilling: Suitable for high internal heel pressure. Goal is to reduce elevated internal heel pressure, treating stubborn non-spur heel pain. Make an incision on the medial side of the heel, drill 7–10 holes into the medial aspect, effectiveness reaches 90%.③ Heel nerve section: For intractable heel pain without clear cause, this destructive procedure involves cutting the posterior tibial nerve branch and sural nerve branch.④ Heel bursa excision: Removal of calcaneal tuberosity bursa and subcalcaneal bursa.⑤ Calcaneal osteotomy for flatfoot: Purpose is to increase calcaneal angle, correct valgus deformity, providing a good biomechanical support structure.
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