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Pain is the body with the heel of each side of the pain involved, there are multiple stArting point for plantar fasciitis tendon, calcaneal bursitis under the calcaneal fat pad inflammation, with the following bursitis, Achilles tendon laceration dead calcaneal epiphysis go far diseases [1] .2006 February -2008 In June, I used a small needle knife treatment of 104 patients with pain, and compared with the pArtial closure of therapy, are summarized as follows reported .
1 Materials and Methods
1.1 General Information
195 patients with pain patients were Chinese PLA General Hospital of Chengdu Military Region, out-patient cases. By treatment sequence number, data processing system using DPs completely randomized. Knife group of 104 patients, male 79 cases, 25 females, age 19 to 69 years, mean 45.7 years, 84 patients with unilateral disease (left 32, right side of the 52 cases), bilateral in 20 cases, the shortest duration of 10 d, up to 12 years, an average of 18 months. closed group of 91 patients , 71 male and 20 female: age 21 to 70 years, mean 44.5 years, 73 patients with unilateral disease (31 cases left, right = 42), bilateral in 18 cases, the shortest duration of 6 d, up to 10 years an average of 16 months .2 group sex, age, and no significant difference between duration (P> 0.05).
1.2 The inclusion and exclusion criteria
All patients showed lower heel pain, early morning or just after the break when the ground began to walk heavier, but after walking a while to reduce, X-rays were suggestive of different degrees of calcaneal spurs. Excluded from the calcaneus and by rheumatoid nodule Arthritis, ankylosing spondylitis, osteoArthritis, tendon terminal disease, and heel pain caused by gout, and also ruled out with severe heart and lung disease, severe diabetes, foot skin infections, fever and patients do not meet the treatment [2].
1.3 Treatment
1.3.1 knife set
Patient prone on the couch, heel up, front ankle pad for a soft pillow, regular disinfection, sterile hole shop towel, at the tenderness the most obvious place 2 mL of 1% lidocaine for local anesthesia, the right hand 4 "Han-chang" brand knife (knife and foot appear before the level of 60 °) fast piercing, the tip of bone spurs, bone spurs will be attached to the Ministry of cutting the ligament and the aponeurosis separation of 3 to 5 times, after a knife , after the blood out of a little band-aid can be affixed. supplemented by a small needle knife techniques against stretch after. Methods: suppress pain point with the thumb, forced plucked, and then a hand heel, toe the other hand the Ministry of force in the opposite direction so that the upturned dorsal to further loosen ligaments and repeated 4 to 6 times. after 48 h to keep clean and dry partial and 1 1 weeks of treatment, continuous treatment for 3 times [3]. both days on the company by ZM -C IF line treatment for physical therapy, every 20 min, 1 day, 7 d as a course of treatment, continuous treatment of 2 courses.
1.3.2 Closed Group
Position and preparation procedures were the same before taking betamethasone injection of compound 7 mg, 2 mL with 1% lidocaine diluted in tenderness quickly penetrate the most obvious place to do partial closure, 1 week of continuous treatment for 3 times. At the same time by days on the company ZM-C-IF-line treatment for physical therapy, with the needle-knife group.
1.4 Clinical Standards
Reference issued by the State Administration of Traditional Chinese Medicine <<TCM Syndrome Diagnostic efficacy of the standard>> [4] prepared. ① term effect (the last 1 week after treatment): heel pain, morning or walk normally for the cure, foot with significantly reduced pain, early morning walk a little pain, but running close to normal for the better, heel pain than before treatment slightly reduced or no improvement to be invalid. ② long-term effect (the last 24 weeks after treatment): foot pain no recurrence, X ray review no new cure for bone spurs, foot pain a little, clear morning, after walking ease, X ray review no new spur for the better, heel pain, swelling, or X ray inspection See additional spur to be invalid.
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[Keywords:] with the pain, a small needle knife surgery, partial closure
Pain is the body with the heel of each side of the pain involved, there are multiple starting point for plantar fasciitis tendon, calcaneal bursitis under the calcaneal fat pad inflammation, with the following bursitis, Achilles tendon laceration dead calcaneal epiphysis go far diseases [1] .2006 February -2008 In June, I used a small needle knife treatment of 104 patients with pain, and compared with the partial closure of therapy, are summarized as follows reported . [Keywords:] with the pain, a small needle knife surgery, partial closure
1 Materials and Methods
1.1 General Information
195 patients with pain patients were Chinese PLA General Hospital of Chengdu Military Region, out-patient cases. By treatment sequence number, data processing system using DPs completely randomized. Knife group of 104 patients, male 79 cases, 25 females, age 19 to 69 years, mean 45.7 years, 84 patients with unilateral disease (left 32, right side of the 52 cases), bilateral in 20 cases, the shortest duration of 10 d, up to 12 years, an average of 18 months. closed group of 91 patients , 71 male and 20 female: age 21 to 70 years, mean 44.5 years, 73 patients with unilateral disease (31 cases left, right = 42), bilateral in 18 cases, the shortest duration of 6 d, up to 10 years an average of 16 months .2 group sex, age, and no significant difference between duration (P> 0.05).
1.2 The inclusion and exclusion criteria
All patients showed lower heel pain, early morning or just after the break when the ground began to walk heavier, but after walking a while to reduce, X-rays were suggestive of different degrees of calcaneal spurs. Excluded from the calcaneus and by rheumatoid nodule arthritis, ankylosing spondylitis, osteoarthritis, tendon terminal disease, and heel pain caused by gout, and also ruled out with severe heart and lung disease, severe diabetes, foot skin infections, fever and patients do not meet the treatment [2].
1.3 Treatment
1.3.1 knife set
Patient prone on the couch, heel up, front ankle pad for a soft pillow, regular disinfection, sterile hole shop towel, at the tenderness the most obvious place 2 mL of 1% lidocaine for local anesthesia, the right hand 4 "Han-chang" brand knife (knife and foot appear before the level of 60 °) fast piercing, the tip of bone spurs, bone spurs will be attached to the Ministry of cutting the ligament and the aponeurosis separation of 3 to 5 times, after a knife , after the blood out of a little band-aid can be affixed. supplemented by a small needle knife techniques against stretch after. Methods: suppress pain point with the thumb, forced plucked, and then a hand heel, toe the other hand the Ministry of force in the opposite direction so that the upturned dorsal to further loosen ligaments and repeated 4 to 6 times. after 48 h to keep clean and dry partial and 1 1 weeks of treatment, continuous treatment for 3 times [3]. both days on the company by ZM -C IF line treatment for physical therapy, every 20 min, 1 day, 7 d as a course of treatment, continuous treatment of 2 courses.
1.3.2 Closed Group
Position and preparation procedures were the same before taking betamethasone injection of compound 7 mg, 2 mL with 1% lidocaine diluted in tenderness quickly penetrate the most obvious place to do partial closure, 1 week of continuous treatment for 3 times. At the same time by days on the company ZM-C-IF-line treatment for physical therapy, with the needle-knife group.
1.4 Clinical Standards
Reference issued by the State Administration of Traditional Chinese Medicine <<TCM Syndrome Diagnostic efficacy of the standard>> [4] prepared. ① term effect (the last 1 week after treatment): heel pain, morning or walk normally for the cure, foot with significantly reduced pain, early morning walk a little pain, but running close to normal for the better, heel pain than before treatment slightly reduced or no improvement to be invalid. ② long-term effect (the last 24 weeks after treatment): foot pain no recurrence, X ray review no new cure for bone spurs, foot pain a little, clear morning, after walking ease, X ray review no new spur for the better, heel pain, swelling, or X ray inspection See additional spur to be invalid.
1.5 Statistical Methods
The results were analyzed using statistical software SPSS13.0, count data using the percentage of that group compared with the χ2 test, P <0.05 was considered statistically significant.
2 Results
Knife set short and long term improvement in cure rates were 90.4% and 84.6%, partial closure group were 91.2% and 67.0%, the χ2 test, the recent recovery between the 2 groups was no significant difference in efficiency (P> 0.05) , needle-knife group of long-term cure rate was significantly higher than improved closure group (P <0.01). The short-term and long-term outcome group compared with needle-knife group was not statistically significant (P> 0.05), the difference was closed group significance (P <0.01). Table 1. Table 1, Group 2 Comparison of clinical efficacy in patients with pain (a little
3 Discussion
With the pain more common over the age of 40 elderly patients, its etiology is closely related with the strain and degradation, multi-node system around the heel pain caused by chronic fatigue, the insidious onset, longer course. Due to the long standing walking, vigorous activity, causing the heel fat pad, bursa, fascia, ligament injury by traction, local congestion and edema, resulting in aseptic inflammation, the course of time produce scar, contracture, local stress changes caused by calcaneal attachment point continued calcification, ossification, the formation of bone spurs. Second, the people to middle age, tissue degeneration and atrophy, with the role of decreased fat pad, buffer capacity to reduce the shock, in the long walk, long standing role of such incentives, coupled with the presence of bone spurs, easily lead to the periosteum of the calcaneus, bursa, fascia damage leading to local congestion, edema, hyperplasia and occurrence of aseptic inflammation, and then produce pain.
Currently, the clinical treatment of partial closure to use more drugs, oral drugs, physical therapy and acupuncture and massage and other treatment, but the effect is not so sure. Hormone drugs, although treatment can relieve the partial closure of the local inflammatory response in acute, but chronic inflammatory lesions change was not improved, it can still be curative effect, and long-term effect of poor, merely treating the symptoms, not causes. Therefore, the only fundamental solution to the formation of heel spurs and plantar hyperplasia long ligament, plantar fascia contracture of the pathological changes of adhesion, to achieve complete cure. small knife while minimally invasive surgery for the release of the pathological changes in a targeted manner into the lesion site, on the adhesion of tissue to be cut, peel, release, sustained traction to lift the state of high tension and eliminate muscle, fascia nervous spasms, reduce local soft tissue tension and restore biomechanical balance, supplemented by practices against the stretch, make contracture, further release the organization of adhesion [4]. In addition, a small needle knife surgery operations the process of human-caused local bleeding or congestive, but to improve the local blood supply, promote metabolism, accelerate the absorption of the role of inflammation.
The disease is a Chinese medicine "Arthralgia" category, is the invasion of wind cold dampness and other evils, in addition to strain accumulation, qi stagnation, collaterals Blockage. Small knife therapy can clear the veins, to "General non-pain" effect. This observation indicates that the use of small needle-knife treatment of heel pain, and its curative effect and no significant difference between the partial closure of therapy, but long-term efficacy is superior to partial closure of groups, small needle-knife therapy is similar to long-term effects and short-term effect, but partial closure group was significantly worse long-term outcome in the near future. prompt treatment with a small needle knife with the pain from the fundamental solution to the symptoms of change.
Reflections: various treatment options, even a small needle knife therapy, there are many cases of poor efficacy, or long-term pain (11 patients in this group), and even with pain relapse, X ray suggestive of new bone spurs were (6 patients in this group). I clinical observations, most patients have rheumatoid tendon terminal disease, gout and other rheumatic diseases, clinical examination immunoglobulins, erythrocyte sedimentation rate, C reactive protein, immune antibodies are positive diagnosis means more sign, with Medical treatment, better effect.
[References]
[1] Xu Shaoting, FORCES, Xu India Hum. Practical Orthopedics [M]. 3rd ed. Beijing: People's Medical Publishing House ,2005.1075-1076.
[2] Pengyun Guo, Chung Lai Ha. Small needle-knife treatment of heel pain in 51 cases [J]. Hunan Traditional Chinese Medicine, 2009, 25 (2) :55-56.
[3] Huang Kaibin, Hu Yin shortage. Chinese knife Science [M]. Beijing: World Medical Press ,2000.407-408.
[4] State Administration of TCM. TCM Syndrome Diagnostic efficacy of the standard [S]. Nanjing: Nanjing University Press ,1994.78-79.
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