Osteochondropathy of calcaneus: causes, symptoms and treatment
Osteochondropathy refers to degenerative-dystrophic diseases, as a result of which an aseptic appearance of necrosis of some bone structures develops. The most common pathology appears in the calcaneus and femur, apophyses of the vertebral bodies and in the large tibia.
Description of the disease
The heel bone disease affects most often in children during adolescence. If you do not engage in treatment, then in the future, osteochondropathy can develop into serious problems. In view of the increased load, it is the bones of the feet that are most often subjected to chondropathy. The disease is localized, as a rule, in the form of aseptic necrosis in the metatarsal, scaphoid and heel bones, in the tarsal and in the block of the talus.
It is not possible to establish the exact reasons for the appearance of bone-splitting. However, doctors put forward several versions of her etiology. If we talk about adolescents, the pathology often arises against a background of failure in the formation of bone tissue. In the case of adulthood, it is rather an increased physical load on the bone system of the body. Often the cause of the disease remains unclear. In this article, we will consider the types of osteochondropathy calcaneus.
Types of osteochondropathy
To understand the severity of this pathology and the degree of disturbance in the musculoskeletal system, it is necessary to consider the most common types of osteochondropathy. Most often necrotic feet suffer girls during adolescence. The disease in the head of the second metatarsal bone is localized, proceeds in a rather mild form and does not pose serious dangers to the child's health. Of the manifestations can be noted painful sensations with physical activity, light lameness and swelling. Therapy is carried out by conservative methods, the main condition for successful recovery is the immobility of the affected area.
Keller's disease is less common. It affects children of preschool age of different sexes. There are two types of this pathology:
1. Necrosis is subjected to the scaphoid bone in the center of the foot.
2. Disease, in which the head of the metatarsal bone, located at the base of the fingers on the foot, is under attack.
There is also osteochondropathy of the calcaneus, also with small swelling and redness of the skin, as well as painful sensations. The main areas of therapy are physiotherapy, vitamin support of the body and low intensity of the load on the aching leg.
Adolescents can also be prone to Haglund Schintz disease, or osteochondropathy calcaneus. In this case, the disorder occurs in the formation of bone tissue. As a consequence of such a malfunction in the cancellous part of the bone, necrosis of aseptic nature begins. The disease can affect both one and both limbs. Shinz's disease is manifested with severe swelling, numbness and atrophy of the muscles in the region of the shin. When exacerbation there is a strong painful syndrome, which does not allow the child to move.
Rarer species of
Rare species of osteochondropathy are lesions of sesamoid bones, otherwise called Mueller's disease. To the pathologies of the spinal column is the Sheyerman-Mau disease. The latter is most common among adolescents under the age of 18.Such a pathology leads to a curvature of the spine, which causes back pain and decreased efficiency. The defeat of the femur is called Legg-Calve-Perthes disease. The most likely causes of this disease include the resulting hip injury. They can disrupt the blood flow and lead to necrosis. Why does osteochondropathy of the calcaneus occur?
Above we mentioned that it is impossible to establish the exact causes of osteochondropathy, but physicians tend to believe that there are several factors that significantly increase the risk of developing this pathology. A special prerequisite is the genetic component. Quite often necrosis calcaneus begins in those children whose parents also had this osteochondropathy of any localization in the anamnesis. They could be affected by any kind of bones in the foot, including the scaphoid and metatarsal head, as well as the spine or other bone tissues of the lower limbs.
Children quite often face the fact that the heel hurts and it is painful to attack( how to treat, we will consider below), if they have endocrine disorders, malfunctions in the hormonal background or metabolic process. Bones are prone to the development of pathologies in the presence of congenital diseases associated with poor digestibility of various minerals and vitamins necessary for the child's body. In particular, this applies to calcium, since the condition of the joints and bones directly depends on it, and its deficiency causes brittleness and sensitivity of bone tissues.
Another possible factor leading to osteochondropathy of the calcaneus is the increased physical stress on the foot as a whole and in particular on the foot. Muscles tend to shrink intensively during exercise, which leads to the appearance of microtraumas, and this, in turn, can weaken the protective properties of joints and bone tissue. Such a decrease in resistant qualities may increase the risk of developing an inflammatory process. It affects the spongy bone structure, and intense physical activity affects the constriction of small vessels in it. The lower limbs of people with excessive weight and problems with metabolism experience increased stress.
The last factor that can cause osteochondropathy of the calcaneus( ICD) is called trauma. Because of the structure of the osseous system, it is the feet that are most at risk of injury. Most often this occurs as a result of squeezing bones when falling from a high altitude, as a result of an accident or damage in the workplace.
Symptoms of the calcaneus of the calcaneus bone
Because hormonal disorders are more common in girls, they are at risk of developing osteochondropathy. The main sign of pathology is intense pain in the area of the heel and fingers, as these areas of the foot are subject to the greatest load. As a result of the development of the disease, the patient's quality of life is significantly reduced, the legs are quickly tired, and gait disturbance occurs. The causes of osteochondropathy of the calcaneus are important to identify that the therapy was correct.
Pain syndrome usually occurs after a trauma to the heel, physical exertion - both during running and walking, and after a long standing in a standing position. If the pathology touches both legs, the child is peculiar to start walking on toes, since the emphasis on the heels causes severe pain. And since in this case the pressure on the fingers increases, without proper treatment, this can lead to valgus deformity of the thumb, flat feet or curvature of the feet.
The child has a heel, it hurts to attack. How to treat?
Active sports, like any other intensive exercise, are banned for children who have osteochondropathy of the calcaneus. This restriction can cause muscle and skin atrophy, as well as disrupt sensitivity. Quite often there are cases when not only the heads of metatarsal bones are affected, but also the heels, which prevents patients from moving in the natural mode, since the emphasis on the foot causes severe pain.2-3 metatarsals and the thumb most often suffer from osteochondropathy.
As the gait of a person changes in connection with the disease, the further progress of the pathology can cause pain in the ankle, calf and hip muscles, and also in the spine. The chance of a pathology of metatarsal bones increases if the patient has a flat foot. Treatment of osteochondropathy calcaneus should be timely.
The development of pathology can be divided into four stages, each with its own symptoms and severity of bone tissue damage.
The initial stage of lasts up to several months. At this stage, tissue necrosis occurs. The painful syndrome develops in the back and extremities. X-ray does not show pathological changes, which makes diagnosis of the disease at this stage quite difficult.
The duration of of the second stage of is about a year. During this time there are serious changes in the tissues of the bones, there is its slow dystrophy. Another name for this stage is the stage of the compression fracture. Most susceptible to the hip, spine and feet.
The third period of the ailment lasts up to three years. At this stage, the areas of bone tissue exposed to necrosis dissolve and are replaced by osteoclasts.
The fourth stage of is characterized by tissue regeneration. With proper and timely therapy, the cure takes place without further complications. In the absence of treatment, progressive osteoarthritis may develop.
Diagnosis of calcaneal bone calcaneus
If the child is anxious about the feet and complains of pain in the back or legs, you need to undergo an examination with an orthopedic surgeon. The optimal option for further successful therapy is timely diagnosis.
When determining the diagnosis, the physician relies on the symptoms of the disease and the results of various studies. At the initial stage, the patient is sent for an X-ray examination. In this case, the picture is taken not only by the heel bones, but also by the entire foot, since there is a possibility of complications or associated pathologies. X-ray photography can show trauma, arthrosis and other foot bone diseases.
In addition to the X-ray, ultrasound or magnetic resonance imaging is used to clarify the diagnosis. In some cases, the doctor may also appoint arthroscopy. This is necessary to exclude osteomyelitis, bone tuberculosis, bursitis or malignant neoplasms.
Conservative methods in the treatment of osteochondropathy are most often used. This includes the use of medication, the performance of special exercises of physiotherapy exercises and physiotherapy. Another method of treating Haglund's disease is surgery, which is prescribed only as a last resort, when conservative treatment has shown its inefficiency or in neglected form of the disease. The main disadvantage of surgery, as a rule, is called loss of heel sensitivity in the future.
Let's take a closer look at the methods of conservative therapy of osteochondropathy. A patient with this diagnosis is assigned to wear special footwear and orthopedic insoles, since this helps to reduce the painful syndrome and prevent the development of flat feet. The most common brands of orthopedic insoles, preferred by orthopedists, are "Ortmann" and "Solapro Viva".The latter are able to distribute the load from the affected heel to the entire foot, fixing the vaults and not allowing them to condense. In addition, such insoles improve blood circulation in the foot and relieve fatigue from the feet.
In addition to special shoes and insoles, patients with osteochondropathy are prescribed non-steroidal anti-inflammatory drugs that are used as pain medications. These include Nimesulide, Ibuprofen, etc.
The duration of therapy and the dosage of the drug, like its choice, are determined by the attending physician, since the disease is most susceptible to patients of childhood. In exceptional cases, with severe pain, a blockage of the heel area may be performed with "Lidocaine" or "Novocaine".Sometimes a plaster bandage or an orthosis may be required.
Therapy of osteochondropathy calcaneus in children must necessarily include a course of physiotherapy. As a rule, this is an electrophoresis using "Analgin" or "Novocaine" or ozokeritotherapy. No less effective use of compresses and trays with soda, salt and special herbal preparations. In complex therapy, vitamins and calcium are also prescribed. During the rehabilitation period, a course of massages and therapeutic physical training is held to restore the mobility of the feet.
Sometimes you may need an operation on the calcaneus.
Prophylaxis and possible complications of
If treatment of osteochondropathy is not started in time, the pathology can develop into a chronic form. In addition, there may be a threat of development of other joint degenerative-dystrophic pathologies. Platypodia, arisen against the background of osteochondropathy, does not go away even after a successful cure for this pathology.
Therapy of the disease in neglected form also does not pass without a trace. The development of necrosis reduces the sensitivity of the affected area, which does not go away even after a course of treatment or surgery. In addition, the calcaneal hillock may begin to deform and stick out, which makes it impossible to wear some types of footwear in the future.
One of the types of prevention of osteochondropathy among children is regular visits to the orthopedist, especially when the child complains of soreness in the foot area. Genetic predisposition involves conducting a course of preventive medical massage several times a year, as well as performing a certain set of physical exercises.
No less important is the choice of shoes. It is necessary to select comfortable shoes for the child, in size, to avoid excessive squeezing of the foot. Girls in adolescence are not allowed to wear high-heeled shoes. It is also necessary to regularly take vitamins and calcium to strengthen the bone structure.