Heel pain is a common condition in middle-aged and older people. It is mostly caused by stimulation of soft tissues such as tendon synovium due to calcaneal bone hyperplasia or bone spur formation, or heel pain due to Achilles tendonitis, calcaneal and descending bursitis, plantar aponeurositis, bursal thickening, calcaneal fat pad degeneration and other diseases, affecting standing and difficulty walking. The hammering method can be used daily to treat the heel pain of the calcaneal spur, and the effect is relatively satisfactory.
Clinical symptoms and diagnostic criteria
The main symptoms of this disease are significant heel pain, accompanied by numbness, the pain is obvious at the beginning of standing or walking, especially when getting up in the morning and starting to stand or walk around the pain is severe, the pain is reduced after a period of activity, but the pain is aggravated after standing for a long time. When the heel is padded on a hard object such as a stone or tile, the pain is unbearable.
The location of the pain is generally localized, so there are often obvious tender points. Bone spurs or plantar aponeurositis in the basal tubercle of the calcaneus (where the plantar aponeurosis is attached) are mostly tendered medially anterior to the basilar tubercle of the calcaneus, degeneration of the calcaneal fat pad is mostly on the median or posterior edge of the calcaneal tuberosity, posterior and superior bone spurs of the calcaneal tuberosity tubercle (attachment of the Achilles tendon), or Achilles tendonitis and subcutaneous bursitis of the calcaneal skin, which is mostly above the posterior heel and on the calcaneal tuberosity. Occasionally, mild swelling of the soft tissues under the skin of the calcaneus or nodules of soft tissues such as thickened bursae, can be felt. X-rays of the calcaneal basal tubercle are usually seen with a rough spiny process or bony hyperplasia, which can also be seen in the calcaneal tuberosity tuberosity.
The size of the bone spur is disproportionate to the degree of pain and is related to the direction of the bone spur, which is less painful when the direction of the bone spur is parallel to the force plane and more severe when it is beveled. However, there are some patients, especially in the early stages, who have obvious clinical pain and no obvious bone changes on x-ray, which may be related to inflammation or degeneration of soft tissues, such as plantar aponeurositis, Achilles tendonitis, subcutaneous bursitis, or fat pad degeneration.
Treatment
Let the patient lie prone on the bed, the affected limb is flexed, so that the center of the foot is upward, the doctor holds the ankle of the limb with his left hand, uses the thumb of his right hand to find the tender point on the heel, and then rubs and scrapes the tender point after finding the tender point; then holds a small wooden hammer, rubber hammer, health care hammer, claw hammer, etc., and hammers the tender point 3~5 times, the force should be appropriate, the action should be accurate and brisk, if there is a subcutaneous nodule, the hammer will be used to spread it out, and then gently tap the surrounding area, and repeatedly pinch the Achilles tendon and calf to relieve the spasm and pain of the gastrocnemius muscle. Treat 1 time a week, if you have both feet with this disease, only one foot will be treated at a time.
Zhang, male, 64 years old, has pain in his right heel, which has gradually worsened for 1 year. The pain worsens when I get out of bed in the morning when I stand or walk, but after the activity improves slightly, I can't walk far, and I feel unbearable pain when I step on hard objects or when I am pressed on my heel by a stone or other object.
Examination: the basal tubercle of the right calcaneus was slightly raised and tender, and a large sac-like nodule of a bean grain could be palpated, and x-rays showed a rough spinous protrusion at the basal tubercle of the right calcaneus. He was diagnosed with right calcaneal spur and subcalcaneal tuberosity bursitis.
After 3 times of treatment with hammering, the pain disappeared, standing, walking, running and jumping were all free, the original capsule disappeared, there was no local tenderness, no percussion pain, and no recurrence was seen in the two years of follow-up.
This method is simple and effective, and its therapeutic mechanism is mainly to stimulate the soft tissues of the heel, so that it gradually adapts to the pain, and promotes its hypertrophic bursa or adhesion nodules to disperse, rather than knocking out the bone spurs. After healing, although the heel pain is completely gone, the bone spurs are still present on X-rays.
When hammering, aim at the tender points and use a moderate amount of force. If it is not well mastered, it will not work if the force is small, and the force may be aggravated or bruising may occur. But there is no need to worry, generally after 1 month of rest, the swelling and pain and blood stasis will disappear, there will be no sequelae, and the heel pain will be cured. When using this method for treatment, if you use hot water to scald your feet, or add some traditional Chinese medicine such as relaxing tendons and invigorating blood, dispersing wind and relieving pain, the effect is better.
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The author of this article is Jia Peiyan
Editor: Chaoyang