🌿 Folk Prescriptions

Heel pain results from prolonged standing or walking under various stress directions, causing degeneration of muscles, tendons, bursae, fat pads around the heel, and changes in intramedullary pressure of the calcaneus. Clinical manifestations include pain around the heel, known as heel pain or calcaneodynia, classified as “bone arthralgia” in traditional Chinese medicine.
Prevention Before Illness
Preventive measures vary depending on the cause of heel pain.
1. Adolescent calcaneal epiphysitis mostly results from trauma or prolonged running/jumping. During this developmental stage, avoid running and jumping, especially jumping from heights. Early attention to this is crucial.
2. Elderly heel pain often stems from overuse, plantar fasciitis, calcaneal tuberosity bursitis, or fatty pad degeneration. Avoid prolonged standing or walking. Elevate heels to reduce load. Wear soft-soled shoes with a soft, round pad (central depression, height about 2–3 cm) to shift body weight forward, reducing pressure on the heel. Weight loss therapy is advised.
3. Heel pain due to flatfoot results from reduced or absent arch, causing the heel to tilt forward during walking. Use a soft pad (2–3 cm high) placed centrally under the foot, higher on the medial side and lower on the lateral side, sloping gradually from center to front and back, forming a ramp-like shape.
4. For rheumatoid calcaneal arthritis, first control rheumatoid disease, then use soft insoles.
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 and encourage early ambulation to prevent fat pad atrophy.
6. All the above methods aim to reduce heel loading. Early-stage heel pain can also be managed with external herbal fumigation: Notopterygium, Gentiana, Herba Siegesbeckiae, Sappan wood, Carthamus, Ganoderma, Prunus mume, Mugwort, Saposhnikovia. Oral herbal formulas include: Notopterygium, Taxillus, Saposhnikovia, Ligusticum, Codonopsis, Cinnamon twig, Chaenomeles, Glycyrrhiza, Clematis, Eucommia, Achyranthes, and Herba Spatholobus. Alternatively, crush herbs and pack into small bags placed under the foot to elevate the arch, altering heel load while allowing slow absorption for therapeutic effect. Formula: Ephedra, Aconite, Herba Siegesbeckiae, Carthamus, Dry Ginger, Cinnamon twig, Saposhnikovia, Chaenomeles, Notopterygium, Schizonepeta.
Post-Illness Prevention
For persistent pain preventing walking, adopt active treatment to avoid impact on daily life and labor. Common methods include:
1. Earth-made vinegar fumigation: Mix 1000ml vinegar with 30g each of Chaenomeles, Herba Siegesbeckiae, Carthamus, and Achyranthes, plus half pound of stones, place in a cloth bag, boil over fire, cool slightly, then place under the foot and on painful heel area. Twice daily, morning and evening.
2. Local infiltration: Inject 1–2% procaine mixed with 12.5mg 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, and vinegar iontophoresis.
4. If conservative treatment fails, surgical intervention may be considered. Surgical options include:① Calcaneal spur resection: For refractory heel pain confirmed by X-ray to have spurs, make an incision on the medial side of the calcaneus, access the bone, and completely file down the medial spur.② Calcaneal drilling: Suitable for high intramedullary pressure in the calcaneus. The goal is to reduce pressure and treat stubborn heel pain without spurs. Make an incision on the medial side of the calcaneus, drill 7–10 holes, achieving success rate of 90%.③ Calcaneal nerve section: For refractory, unexplained heel pain, this destructive procedure cuts the posterior tibial nerve branch and sural nerve branch.④ Calcaneal bursa excision: Removal of the calcaneal tuberosity bursa and subcalcaneal bursa.⑤ Calcaneal osteotomy for flatfoot: Aimed at increasing calcaneal angle, correcting valgus deformity, and establishing a good biomechanical support structure.<Heel Pain>