[Health Lecture] Elderly people are afraid to walk due to foot pain, most of which are related to plantar fasciitis

In order to ensure the popularization effect of learning health knowledge in the 3rd China Elderly Health Knowledge Competition, the organizers have collected various health science articles suitable for elderly people to learn from various hospitals. We will share them through the "Health Lecture Hall" column. Today, Gao Xinyue, deputy chief physician of the Anesthesiology and Pain Department of Pudong New District Punan Hospital in Shanghai, brought a popular science article about plantar fasciitis. Elderly friends are welcome to learn.

"Ouch, it hurts so much, doctor!" The old lady saw the doctor's hand touching her heel and couldn't help but screamed: "I am afraid to walk now. Doctor, have you ever had this disease? Do you know the pain?" "Your disease is too common. I don't have to have this disease, but I know the degree of pain and how to treat it!" The doctor said helplessly, thinking that to cure diseases and save lives, you must have this disease to have experience? "Doctor, that's not what I meant," the aunt realized that she was speaking inappropriately and quickly explained: "As long as I walk a few steps, my heel feels like it's cut by a knife. I am also afraid to come to the hospital for treatment. I just walked to the door of the hospital and was still hesitating whether to treat it?" "You do what I say, and I guarantee that your heel pain will get lighter and lighter." After the doctor told the patient confidently, he found that the aunt's eyes were shining with hope, and continued: "Do shock wave treatment first, and if it doesn't work, consider other treatments. The disease can always be cured." "It's great to meet you. I always don't know which department to go to for treatment?" The aunt said melancholy.

With the aging of the population and the increase in participation in physical fitness, the probability of heel pain is increasing, about 60%-80% of adults will experience it, among which the 40-70-year-old group has a high incidence. Most scholars believe that plantar fascia lesions are the root cause of heel pain (the incidence rate is about 11%-15%), mainly manifested as pain in the heel and sole, especially when suddenly touching the ground in the morning or after resting. The pain can be relieved by itself after a period of activity. The condition can last for months or even years. In severe cases, it can cause local thickening, adhesion or contracture of the plantar fascia, thus affecting the patient's daily work and life, especially for the elderly.

The plantar fascia is a band of connective tissue located deep in the fat layer of the sole of the foot. It starts from the inner side of the calcaneal tuberosity and extends forward to the metatarsophalangeal joint and adjacent toes. It is the attachment point of the internal muscles of the sole of the foot. It has a good protective effect on muscles, blood vessels and nerve tissues. It is also the main structure of the medial arch of the foot and plays an important role in stabilizing and maintaining the arch of the foot. In this structure, the human bone tissue is the main body of the "bow" and the plantar fascia is the "string", forming a structure similar to a "bowstring". If the "bowstring mechanics" is unbalanced, the plantar fascia is abnormally stressed, and bone spurs will form on the heel bone to relieve the symptoms of heel pain. If the symptoms continue to progress, adhesions, scars and contractures will gradually appear on the plantar fascia and its insertion points, eventually forming a three-dimensional network-like pathological structure.

Plantar fasciitis, also known as heel pain syndrome, is generally a sterile inflammation that is sometimes severe and persistent. The pathogenesis is not yet clear, and it is mostly related to long-term standing, walking or repeated traction stimulation and chronic injury accumulation. Studies have also shown that the disease is related to obesity, age, trauma, inappropriate shoes and other factors, among which obesity, flat feet, high arches, and excessive stimulation of the plantar fascia are the main risk factors. At the same time, with long-term walking, standing, running and jumping, the plantar fascia will undergo degenerative lesions, causing chronic inflammatory reactions of fibrous tissue, edema and thickening of the plantar fascia, etc. Therefore, plantar fasciitis is a syndrome in which inflammation and degeneration coexist and interact with each other.

At present, there are two clinical treatments for plantar fasciitis: non-surgical treatment and surgical treatment. Conservative treatment is the main treatment, including drug injection therapy, extracorporeal shock wave therapy, orthopedic insole therapy, stretching training and other treatment options. Many studies have reported that 90% of patients can achieve good treatment effects after conservative treatment. Among them, extracorporeal shock wave therapy has been widely used in the treatment of various soft tissue pains in recent years due to its advantages of non-invasiveness and convenient operation, and has achieved good results. Extracorporeal shock wave is a special form of mechanical wave with the characteristics of short cycle and high pressure. Its mechanism for treating plantar fasciitis has not yet been fully clarified. Some scholars believe that extracorporeal shock wave mainly exerts its therapeutic effect through mechanical effect, cavitation effect and analgesic effect, so as to loosen the adhesion of plantar fascia, eliminate the three-dimensional network pathological structure of the plantar, and create conditions for the self-recovery of plantar fascia tissue. Shock wave therapy can also improve the microenvironment and blood circulation of plantar lesions through various mechanisms. Many previous studies have shown that extracorporeal shock wave can effectively relieve pain and motor function for patients with chronic plantar fasciitis who are ineffective with conventional treatment, which is beneficial to the rehabilitation of patients.

After listening to the doctor's explanation, the aunt who had done the shock wave treatment smiled and said: "It was very painful when it was done, but now it doesn't hurt and I feel much more comfortable." "Auntie, you have to actively treat it and cooperate with us. You will recover soon, at least the pain will be relieved a lot." The doctor said with satisfaction. "As long as it doesn't hurt, I will be thankful. It has tortured me for several months." The aunt said gratefully: "I will treat it as scheduled, thank you."

As the saying goes, "control your mouth and move your legs." Walking can be said to be the best way for the elderly to exercise. The feet are the most important organs for the human body to bear weight and absorb the impact from the ground when walking. It is a very complex network structure composed of 26 bones, 33 joints, 126 ligaments, muscles and nerves. Once the elderly cannot walk normally, the dynamic balance supporting the center of gravity of the body is broken, which means that the quality of life is seriously reduced and the health of the body is seriously damaged. Therefore, once heel pain occurs, it needs to be treated in time, especially when the initial symptoms of plantar fasciitis are mild, timely treatment at the pain department can help you recover soon and move your legs!

References:

1. Li Ping, Wang Donghai, Guo Fangfang, et al. Clinical value of ultrasound-guided treatment of plantar fasciitis. Chinese Journal of Medical Imaging. 2019, 27(1): 46-49.

2. Duan Haoyang, Li Zhenlan, Liu Na, et al. Observation on the efficacy of extracorporeal shock wave therapy in the treatment of plantar fasciitis. Chinese Journal of Physical Medicine and Rehabilitation. 2019, 41(6): 445-446.

3. Song Xiubao, Shi Changzheng, Hong Qisheng. Study on the efficacy of extracorporeal shock wave therapy for plantar fasciitis. Chinese Journal of Physical Medicine and Rehabilitation. 2019, 41(6): 434-438.

4. Liu Ruilian, Qu Honglin. Research progress on plantar fasciitis and rehabilitation training in middle-aged and elderly people. Chinese Journal of Gerontology. 2015, 35(8): 4411-4414.

About the Author:

Gao Xinyue, associate chief physician, director of the Department of Anesthesiology and Pain Medicine, Pudong New District Punan Hospital, Shanghai