What Is the Differential Diagnosis of Heel Pain?

Painful heel refers to pain on one or both sides of the heel, not red and swollen, and inconvenience in walking. Also known as heel pain. It is caused by diseases of the heel bone, joints, bursa, and fascia. The most common is patellar fasciitis, which often occurs in people who have been standing or walking for a long time and caused chronic chronic injuries. Lateral X-rays show calcaneus spurs. But bone spurs do not necessarily have heel pain, and patellar fasciitis does not necessarily have bone spurs. Treatment can use surgery, physical therapy and drugs.

Basic Information

nickname

Heel pain

English name

heel pain

Visiting department

orthopedics

Common locations

Heel

Common causes

Heel spurs, plantar fasciitis, heel pad pain, posterior calcaneal bursitis, Achilles tendonitis, etc.

Common symptoms

Heel pain on one or both sides, not redness or swelling

Causes of heel pain and common diseases

Heel spur

Bone hyperplasia caused by degenerative changes in the calcaneus, or "bone spurs", is also one of the common causes of heel pain. When the "bone spurs" exist for a long time, and the calcaneus with long "bone spurs" has long-term or excessive weight bearing, causing local congestion and aseptic inflammation, the nerves in the affected area will be stimulated and the heel will be painful.

2. Patella fasciitis

It is one of the most common causes of heel pain. It often occurs in workers who are standing or walking for a long time. It is a disease caused by long-term, chronic, and minor trauma accumulation. It is manifested as rupture of fascial fibers and its repair process. Heel pain caused by patellar fasciitis can be cured naturally. Raising the heel, reducing the tension of the Achilles tendon to the calcaneus, forefoot flexion, and alleviating the tension of the plantar fascia can alleviate the symptoms.

3. Pain pain

It often occurs in the elderly. The heel pad is an elastic pad formed by adipose tissue and elastic fibers under the calcaneus. The youth pad is strong in elasticity and can absorb oscillations. In old age, the elasticity of the heel pad decreases, and the calcaneus bears weight without a cushion. In severe cases, scars and calcium deposits can form, causing heel pain.

4. Posterior calcaneal bursitis

The bursa, which is most likely to occur between the Achilles tendon and the skin, is caused by frictional injuries caused by inappropriate high-heeled leather shoes. The wall of the bursa can become hypertrophic, the bursa is full of synovial fluid, local swelling, and tenderness.

5. Calcaneal Osteitis

It usually occurs in boys 8 to 12 years of age. The lesions are similar to calf tibial tuberculous osteitis. It is a symptom caused by the tendon stretch in the unhealed epiphysis during development. The pain is below the Achilles tendon attachment point and can be bilateral. At the same time. Running and standing on toes can make symptoms worse. After the epiphysis healed, the symptoms disappeared naturally.

6. Subtalar arthritis

It usually occurs after a calcaneal fracture and is a form of traumatic arthritis. On the X-ray picture, the pain increased with weight bearing.

7. Calcaneal periostitis

Periostitis is an infectious periosteal injury caused by periosteum and periosteum vasodilation, congestion, edema, or subperiosteal hemorrhage, hematoma mechanization, periosteal hyperplasia, and inflammatory changes.

8. Abnormal development of arch structure

Developmental abnormalities such as high arched feet, flat feet or varus feet.

9. Achilles tendinitis

Excessive use for various reasons can cause chronic damage to the fibers in the Achilles tendon, such as overloaded exercise, frequent running on hard ground such as highways, mountain climbing, etc., can cause Achilles tendinitis.

Differential diagnosis of heel pain

Calcaneal osteomyelitis

Although calcaneal osteomyelitis has the symptoms of heel pain, there may be obvious signs of acute infection such as redness, swelling and pain in the local area, and severe cases are accompanied by systemic symptoms such as high fever. Laboratory and X-ray examinations can establish a diagnosis.

2. Calcaneal tuberculosis

The disease is more common in adolescents, with obvious local symptoms, a wide range of swelling and pain, poor general condition, and low fever, night sweats, fatigue, and loss of appetite, which can be identified by laboratory tests and X-rays.

Heel Pain Treatment Principles

1. Surgical treatment

(1) Heel bone spur resection For refractory calcaneal pain, X-rays have confirmed bone spurs.

(2) The calcaneal drilling is suitable for those with high internal calcaneal pressure. The purpose is to reduce the increased internal calcaneal pressure and treat refractory spur-free heel pain.

(3) This method can be used for calcaneal neurotomy for unexplained refractory heel pain.

(4) Calcaneal bursectomy is the removal of the calcaneal tuberosity bursa and the calcaneus bursa.

(5) The purpose of flat foot calcaneus osteotomy is to increase the calcaneal angle by calcaneal osteotomy, and to straighten the calcaneus to make the calcaneus a good biological scaffold.

2.Physiotherapy

3. Drug treatment

Oral non-steroidal anti-inflammatory and analgesic drug treatment; Prednisone acetate injection at the tender point, once a week, often cured 2 to 3 times. Follow-up bursitis often occurs between the Achilles tendon and the skin, caused by frictional damage, showing effusion in the capsule, swelling and tenderness. Avoid friction and intravesical injection of prednisolone acetate is effective.