Outline:  
Calcaneodynia mainly means the disease characterized by pain and impaired walking due to chronic injury of the base of calcaneus. It mostly occurs in fat and old people. In old people whose liver and kidney are insufficient or in people with general weakness due to protracted disease, qi and blood are deficient, and muscles and tendons are relaxed and weak. What is more, because of fat build and weight gaining, and continuous and too much walking and standing, it will give an excessive load to subcutaneous fat of the heel and plantar fascia, causing strain and degeneration, thus calcaneodynia develops. The disease may also occur in the case that calcaneal spur at the anterior border of tuberosity of calcarneus on its basic aspect damages the attaching points of plantar fascia and short muscle of toe, which leads to a chronic inflammation and resultant pain.

Major points for diagnosis  
1. The onset is slow, and generally in one side. There is pain in the heel. The pain is worsened when standing or walking after the patient gets up in the morning. After a while of walking, the pain gets relieved, and a long period of walking again makes it deteriorated.
 
2. Usually there is no swelling in the heel, but tenderness on the plantar aspect and lateral aspect of calcaneus. In the case of big calcaneal spur, a bony eminence will be felt.

3. X-ray film can show calcaneal hyperosteogeny, but its severity is not directly proportional to the clinical manifestations.


Treatment  
Tendon-smoothing manipulation:   
First, knead and massage the heel for 3 to 5 minuets to make the local hot, then press the painful points of the heel for 3 to 5 times, the strength of pressing should be adjusted according to the patients' tolerance. This treatment is performed once a day.

Herbal therapy  
Internal treatment based on syndrome differentiation  
(1) Syndrome of collateral disharmony  

Main symptoms and signs:
Pain in the heel obvious when walking after getting up in the morning and aggravated by weight bearing, even intolerance of the heel touching the ground, pale tongue with thin coating, stringy or thready-choppy pulse.
 
Therapeutic methods:
Relaxing tendons and activating collaterals.

Recipe and herbs:
Modified Huoxue Shujin Decoction. Specifically, Qianghuo (Rhizoma seu Radix Notopterygii )6 g, Jingjie ( Herba Schizonepetae )6 g, Honghua ( Flos Carthmi)6 g, Zhike ( Fructus Citri Aurantii)6 g, Duhuo (RadixAngeticaePubescentis)10 g, Fangfeng (Radix Ledebouriellae Divaricatae)10g, Niuxi (RadixAchyranthis Bidentatae)10 g, Wujiapi (Cortex Acanthopanacis )10 g, Duzhong ( Cortex Eucommiaeulmoidis)10 g, Danggui (Radix Angelicae Sinensis )12g, Xuduan (Radix Dipsaci)12 g, Guizhi (Ramulus Cinnamomi Cassiae)5 g and Gancao (Radix Glycyrrhizae)3 g.
 
(2) Syndrome of insufficiency of the liver and kidney
 
Main symptoms and signs:
Aching and dull pain in the heel induced by a little exertion, muscular atrophy, soreness of the waist and knee, pale tongue with little coating, thready and weak pulse.

Therapeutic methods:
Tonifying the liver and kidney, and strengthening tendons and bones.
 
Recipe and herbs:
Modified Bushen Zhuangjin Decoction. Specifically, Shudihuang (Radix Rehmanniae Praeparata )12 g, Danggui (Radix Angelicae Sinensis )10 g, Fuling (Poriae)10 g, Baishaoyao (RadixPaeoniae Alha)10 g, Shanzhuyu ( Fructus Corni Officinalis )10 g, Niuxi ( Radix Achyranthis Bidentatae )10 g, Qingpi (Pericarpium Citri Reticulatae Viride )10 g, Xuduan ( Radix Dipsaci )10 g, Duzhong ( Cortex Eueommiaeulmoidis )10 g, Wujiapi ( Cortex AcanthoPanacis)10 g, Weilingxian (Radix Clematidis)10 g and Gancao (Radix Glycyrrhizae )5 g.

External therapy:    
Shangke Xiaoyan Paste is externally applied; or hot compress with Yunfeng Powder is used; Baxian Xiaoyao Decoction may also be used for fumigating and bathing the sick foot. Recipe: Fangfeng ( Radix Ledebouriellae Divaricatae )3 g, Jingjie (Herba Schizonepetae)3 g, Chuanxiong (Rhizoma Ligustici Chuanxiong)3 g, Danggui (Radix Angelicae Sinensis)6 g, Cangzhu ( Rhizoma Atractylodis )6 g, Mudanpi (Cortex Mountan Radicis )10 g, Chuanjiao ( Pericarpium Zanthoxyli Bungeani ) 10 g, Kushen (Radix Sophorae Flavescentis )15 g, Huangbai ( Cortex Phellodendri)6 g and Gancao ( Radix Glycyrrhizae )3 g. This treatment is given twice or thrice a day.
 
Hydro-acupuncture therapy:     
Two to four millimeters of 1% procaine plus 25 mg prednisolone is used for injection at the painful point. Insert the needle from the lateral side and then inject liquid to the surface of periost.

Physical therapy:     
Infrared, magnetic, ultrashort wave, or Chinese herbal ion-introduction therapy may be chosen in combination with other therapies.