Painful fat hernia

　　Painful fat hernia is a painful pseudo-vesicle on the heel, which is related to pressure. The pathogenesis is not very clear, and it may be that the subcutaneous fat tissue and its blood vessels and nerves in the non-load-bearing part of the heel, under the action of external force, enter the dermis through the 'hernia hole' of the fascia layer to form a fat hernia. The vessels and nerves in it cause pain due to compression and ischemia. In addition, the occurrence of the disease seems to be related to the specific quality of the patient.

　　The complications of painful fat hernia mainly include pain nodules and urticarial urticaria. For patients with incarcerated hernia, local ischemia and necrosis may occur due to obstruction of blood supply to the fat tissue, which may be accompanied by infection. Therefore, clinical attention should be paid, and comprehensive judgment should be made by checking blood tests, C-reactive protein, and combining with B-ultrasound examination. If there is ischemia and necrosis, active surgical treatment should be carried out to relieve incarceration and avoid triggering systemic complications caused by infection.

　　The skin lesions of painful lipoma are distributed on the non-load-bearing part of the heel, such as the back and inner side of the heel. The lesions are soft and round, papular in color, with a diameter of 2-8mm, and the number varies from 10 to 40. The heel appears like a pebble, the lesions are obvious when standing, and there is pain. The pain increases with prolonged standing, carrying heavy loads, or walking for a long time. Once the load-bearing pressure is removed, the papules disappear, and the pain subsides. Patients generally have good health and no history of long-term heavy load injury.

　　Although the etiology of painful lipoma is a painful pseudo-papule on the heel related to pressure, it is closely related to the thickening of subcutaneous fat tissue, so the clinical preventive measures should be aimed at obesity. Active sports, dietary control, especially limiting the intake of greasy foods, can reduce the body mass index, reduce the deposition of fat tissue, and have an effective preventive effect on the disease. Avoiding long-term standing is an effective method to alleviate symptoms. In addition, methods to shift the load-bearing pressure on the heel, such as wearing high heels, can also partially alleviate the pain.

　　The main examinations for painful lipoma include blood tests, ultrasound, immunopathological examination, and histopathological examination. Histopathological examination shows dense dermal tissue, increased thickness, almost lacking fat tissue, collagen homogenization, and long-lasting damage can be seen in large areas of necrotic tissue and hemorrhage.

　　The diet of patients with painful lipoma should be light and easy to digest, with an emphasis on eating more vegetables and fruits, and a reasonable diet. Pay attention to adequate nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods.

　　The treatment of painful lipoma should be selected according to the size of the papule. For small papules with mild clinical symptoms, no treatment is needed. For larger papules, surgical excision of the papule can be considered. For papules caused by skin ulcers and infections, Baiduan'gang ointment can be used for topical treatment. Once the load-bearing pressure is removed, the body mass index is controlled, the papules disappear, the pain subsides, and the prognosis is good.