Osteochondropathy of the calcaneus: causes, symptoms and treatment. Symptoms and treatment of different types of osteochondropathy

In adults, cases of osteochondropathy calcaneus- an exception to the rule, affecting mainly older people. This disease also practically does not occur in children under 10 years of age, since their cartilage and bones are still soft. It is relevant for teenagers going through puberty, most often girls from 13 to 16 years old. In addition, pain in the heels is typical for physically active young people, especially those who are passionate about sports.

Provoking factors

The greatest loads when walking, running, jumping fall on the largest and most fragile heel bones of the feet. The muscles are attached to them by many ligamentous fibers. The most famous of them is the Achilles tendon, which can withstand loads of up to 400 kg. However, it suffers most often from injuries. In addition, behind this bone there is a bulge - the protrusion of the heel tubercle. He is also vulnerable to the disease, which is named after doctors Haglund and Schintz, who studied this pathology.

What is associated with osteochondropathy of apophyses - bone processes near their rounded ends of tubular tissue that form articular joint? Specific reasons causing disease, have not yet been established by scientists. Only the main factors that indirectly or directly provoke its development have been identified. Among them:

• systematic excessive stress on the leg muscles;
• multiple microtraumas of tendons;
• impaired blood flow in the heel bone;
• pathologies of the heart and blood vessels;
• endocrine diseases.

Osteochondropathy of the calcaneal tuberosity - Haglund-Schinz disease - most often results from:

• repeated foot injuries;
• past infections;
• neurotrophic abnormalities;
• significant metabolic disorders;
• hereditary predisposition.

The trigger mechanism for the disease is excessive physical exercise on the tuberosities of the heel bones, the Achilles tendon and the cords of the foot. Since the blood vessels are damaged, the normal blood supply to the bone tissue is disrupted. They don't get enough nutrients, and necrosis of the heel bones occurs, and in the absence of a pathogenic infection and inflammatory process. Their destruction occurs especially rapidly if blood vessels few or their openings are narrow from birth, which is due genetic characteristics body.

Stages of the disease

It is customary to distinguish 5 stages of Haglund-Schinz disease:

1. Aseptic necrosis. In this case, a focus of necrosis appears.
2. An impression (intra-articular) fracture is a “pushing through” of the dead part of the bone that cannot withstand the previous loads.
3. Fragmentation of bone - breaking it into separate fragments.
4. Resorption of dead tissue.
5. Reparation is the replacement of the necrotic area first with connective tissue and then with newly formed bone.

Manifestations of the disease

Characteristic symptoms of Haglund-Schinz osteochondropathy:

• pain in a standing position when resting on the heels, as well as when flexing and straightening the feet;
• slight bouncing of the patient when walking;
• swelling in the heel or entire foot;
• increased tactile sensitivity in the affected area;
• dystrophy of the lower leg muscles;
• lameness.

The course of the disease at an early stage can be either gradual, imperceptible, or sudden, with unbearable pain at the slightest load on the heel tubercle. Swelling appears above it, but there is no redness or burning. However, soon palpation of the foot becomes painful, especially when flexing and extending. Over time, a person begins to limp, as he is forced to transfer the center of gravity of the body to his toes when walking. At rest there is no pain.

A child may experience heel pain for a long time, sometimes until the end of puberty. Although it happens that as you grow older, the disease goes away on its own. An orthopedist makes a diagnosis of heel bone pathology taking into account the medical history, course of the disease and examination results.

Diagnostics

X-rays provide the most information. A picture is taken in a lateral projection, and the doctor determines the development of Haglund-Schinz disease by the compaction of the tubercle, the widened gap between it and calcaneus, uneven, spotty structure of the ossification nucleus (see photo).

Photo. Redness and swelling with Schinz's disease

In the later stages of the disease, the spongy substance of the new bone tissue. Comparative x-rays of the diseased and healthy feet help to understand complex cases. In this case, it is important to carry out differential diagnosis to exclude:

• any acute inflammatory processes;
• bursitis, periostitis of the heel;
• osteomyelitis;
• heel spur;
• bone tuberculosis;
• malignant tumors.

The absence of inflammation can be judged by the norms of leukocytes and ESR in a blood test. Bursitis and periostitis are observed, as a rule, not in adolescents, but in adults. Heel spurs elderly people suffer. Increased fatigue, irritability, characteristic of bone tuberculosis and cancerous tumors, do not occur in Haglund-Schinz disease.

A computer or magnetic resonance imaging scan of the heel bone helps the doctor to finally dispel doubts. In difficult cases, the orthopedist consults with a phthisiatrician or oncologist.

Treatment of the disease

Treatment is carried out on an outpatient basis under periodic medical supervision. Parents should not panic if a child is diagnosed with Haglund-Schinz pathology, since most often a complete recovery occurs without any dangerous complications. Treatment in children aims to reduce pain to a minimum and maximize fast recovery functions of the sore leg. The possibilities of conservative therapy are used if the pathology is not advanced.

Surgical intervention is practiced only in the most extreme cases. If conservative therapy measures do not bring the expected results and the pain remains acute, surgery is performed - neurotomy (excision) of the nerves in the foot area. However, you need to know: after this, not only the pain disappears forever, but also the tactile sensitivity of the heel is completely lost.

An important condition for effective conservative treatment is complete immobility of the foot throughout the entire period of exacerbation of the disease.

For this purpose, it is rigidly fixed with a splint. For acute pain, a plaster cast is applied briefly.

Analgesics, anti-inflammatory drugs, Milgamma injections, and ice packs help relieve a teenager of pain. Vasodilating medications are used to improve blood circulation. Muscle spasms remove with No-shpa, nicotinic acid.

Beautiful healing effect achieved through comprehensive physiotherapy. Procedures are prescribed after relief of acute pain. This:

• electrophoresis with Novocaine;
• ultrasonic and microwave therapy;
• ozokerite “boots”;
• exposure to a magnetic field;
• diadynamic therapy;
• sodium chloride baths;
• heliotherapy, etc.

After completing the main course of therapy further treatment consists of a significant reduction in physical stress on the heels.

To do this, select shoes with stable wide heels and orthopedic insoles-instep supports or gel heel pads. It must be worn constantly. Shoes with solid soles are not suitable; they delay recovery. When the pain subsides significantly, the load on the legs can be increased. The prognosis for Haglund-Schinz osteochondropathy is favorable. All painful symptoms, as a rule, disappear after 1.5–2 years.

Schinz disease in adults and children: causes, symptoms, treatment

Schinz's disease, or osteochondropathy of the calcaneus - few people known disease. Although it is not very common, it is quite common, especially in children aged 7-15 years.

This disease can also occur in adults who lead an active lifestyle or play sports. After all, such people have an increased risk of tendon injury, which can cause the development of the disease.

Schinz's disease is aseptic necrosis of the calcaneal tuberosity. The disease is named after the scientist who first described it in 1907.

Causes of the disease

Until now, the causes of the disease have not been fully established. Scientists can only guess what is the root cause of Schinz's disease. Most are inclined to believe that the disease occurs against the background of heavy loads on the heel or frequent, even minor injuries and injuries. With heavy loads on the heel, vascular tone worsens and the heel bone does not receive useful material in the required quantity.

Factors contributing to the development of the disease

A number of predisposing factors have also been identified:

• frequent or constant stress on muscles and ligaments;
• engaging in sports that involve increased stress on the tendons of the foot;
• illnesses endocrine system with hormonal imbalances;
• vascular diseases with circulatory disorders of the lower extremities;
• impaired absorption of calcium by the body;
• neurotrophic disorders;
• microtraumas of the heel, which lead to circulatory disorders;
• genetic predisposition.

Schinz's disease in childhood

As mentioned earlier, Schinz disease is common in children. After all, it is during this period that the body grows and the skeleton forms.

Most often in girls the disease manifests itself at 7-8 years of age, and in boys a little later - at 9-11 years of age. This may affect both legs or just one. Unilateral osteochondropathy of the calcaneus is more common.

Stages of the disease

There are 5 stages of the disease:

• Aseptic necrosis, in which there is a violation of the nutrition of the tissues of the heel, which leads to the appearance of a focus of numbness.
• Impression fracture. At this stage, dead tissue is not able to perform its functions and withstand normal loads. The area is being pushed through. In this case, wedging of one section of the bone into another section is observed.
• Fragmentation. Over time, the depressed area of ​​the bone is divided into several fragments.
• Resorption of necrotic tissue.
• Reparation - a new one is formed connective tissue at the site of necrosis. Gradually it is replaced by new bone.

Symptoms of the disease

In the first stages of development, the disease makes itself felt by pain in the heel, which appears when the heel bone is loaded (during walking, running or jumping). Other symptoms gradually appear:

• heel pain that continues after exercise;
• swelling of the heel;
• the appearance of sharp pain when pressing on the swelling;
• difficult process of extension and flexion of the foot;
• redness of the affected area;
• increased temperature at the site of injury;
• lameness when walking;
• pain subsides with prolonged horizontal position of the body;
• spread of pain to the site of attachment of the Achilles tendon to the heel bone;
• inability to stand on the affected leg and the need to lean on a cane or crutch to reduce the load;
• walking on the forefoot to reduce pain;
• sometimes there is atrophy of the lower leg muscles and hyperesthesia of the skin on the heel.

In all patients, symptoms may manifest with varying intensity. In some, osteochondropathy of the calcaneus is accompanied by minor pain that do not cause serious damage to the usual way the patient's life. For others, symptoms may be so severe that it becomes difficult to move around, and severe pain do not allow the body to rest properly.

The disease may develop slowly. Or maybe quickly. Therefore, if you experience pain in the heel area, you must immediately consult a doctor to determine the diagnosis and prescribe adequate treatment.

Diagnostics

An orthopedist can diagnose the disease. For staging accurate diagnosis he will need to interview the patient to collect anamnesis and a complete clinical picture, test results to exclude other diseases, as well as an x-ray examination. The most informative is a lateral view of the heel.

Already in the first stages of the disease, a thickening of the tubercle and an increase in the gap between it and the heel bone will be noticeable. In addition, in the later stages of Schinz's disease, spotting, areas of loosened bone, and signs of restructuring and the formation of a new tubercle become noticeable.

If there are still doubts, the patient may be additionally referred for an MRI of the calcaneus and a CT scan of the calcaneus.

It is very important not to make a mistake with the diagnosis and exclude the presence of other diseases (osteomyelitis, bursitis, bone tuberculosis, periostitis, acute inflammatory process and malignant neoplasms).

Treatment of Schinz disease in children and adults

Treatment is selected in each case separately, depending on the patient’s condition, the degree of Schinz’s disease, age, etc.

During exacerbations, the affected foot must be provided with absolute rest. To do this, it is fixed using a special plaster splint.

Treatment of Schinz disease in children and adults is most often carried out conservatively with the use of medications, physiotherapy, and compresses.

Drug treatment

To relieve the patient from unpleasant pain, nonsteroidal anti-inflammatory drugs may be prescribed. The safest drugs for treating Schinz disease in children are paracetamol and ibuprofen.

However, at an older age and in cases where these 2 drugs do not provide the required effect, diclofenac, ketoprofen, naproxen, nimesulide, etc. can be used. These drugs can only be prescribed by a doctor and taking into account the patient’s age and the presence of concomitant diseases.

In addition to NSAIDs, drugs are prescribed that improve blood circulation and tissue nutrition: pentoxifylline, berlition, dibazol, troxevasin, aminophylline.

Also appointed vitamin preparations, taking B vitamins is especially important.

Pain-relieving ointments are used locally, for example, Diklak, Dolobene, Deep Relief, Fastum Gel, etc. Before use, you also need to make sure that the ointment is approved for use in childhood.

Compresses with Dimexide give a very good effect. To do this, you need to moisten a gauze pad in a solution of Dimexide with water in a 1:1 ratio and apply it to the affected heel. Then cover with polyethylene and wrap warm cloth. The compress must be kept for 30-60 minutes.

Physiotherapy

Physiotherapy is a very important component of the treatment of this disease. Ultrasound with hydrocortisone, diathermy or electrophoresis with pyrogenal, brufen or novocaine may be prescribed.

Ozokerite applications are also highly effective, increasing peripheral blood flow and reducing muscle tone. Quite often they are prescribed before physiotherapy and massage.

Massage

Massage is also mandatory. It is prescribed not only to the foot, but to the entire body. At the same time, of course, increased attention turns out to be a problem area.

Physiotherapy

Physiotherapy exercises for this disease are prescribed to improve blood circulation in the injured limb and normalize the nutrition of the tissues of the foot. This helps reduce pain, strengthen ligaments and muscles.

The set of exercises is selected by the attending physician individually in each case.

Surgical intervention

Quite rarely, the disease does not respond to conservative treatment. In such cases it is necessary to carry out surgical intervention. The operation consists of transverse cutting of the saphenous and tibial nerve. In this case, often, along with the disappearance of pain, the usual sensitivity of the heel disappears. However, this does not affect the quality of walking.

ethnoscience

The main method in folk medicine for this disease is warm salt baths. For this 200-400 g sea ​​salt dilute with warm water and keep feet in it for at least 15 minutes. After the procedure, you need to rinse your feet clean water and wipe dry.

Schinz's disease with proper and timely treatment passes without a trace with complete restoration of the structure of the heel bone. If therapy is not started on time, the heel tubercle will forever remain enlarged and deformed. Although this will not particularly affect the functions of the foot, it will complicate the selection of comfortable shoes. Therefore, at the first suspicion of the disease, you should consult an orthopedic doctor.

Important fact:
Joint diseases and excess weight are always associated with each other. If you effectively lose weight, your health will improve. Moreover, this year it is much easier to lose weight. After all, a tool has appeared that...
A famous doctor tells >>>

Schlatter's disease of the knee joint: symptoms, treatment, full description of the pathology

Joint diseases often deprive our lives of the joy of movement. Moreover, problems can be found not only in adults, but also in children. Pathologies often lead to bone deformation. However, changes can remain for life. Osgood Schlatter disease is a specific pathology that is most often found in adolescents and is associated with the characteristics of their age development and growth.

general description

Another name for the disease is “osteochondropathy of the tibial tuberosity.” It is characterized by impaired bone formation. Osgood's disease is not transmitted from person to person because it does not have infectious nature. After damage to the joint, the tuberous area of ​​the tibia dies.

At its end there are growth horns, which are built from cartilage tissue, which is not particularly durable. It is its damage that causes pain and swelling of the joint. These same symptoms are also caused by ligament rupture, which also provokes Schlatter's disease.

In adults, Osgood Schlatter disease is diagnosed extremely rarely. It is more typical for children and adolescents from 10 to 18 years old. Moreover, Osgood's disease is common among athletes. With proper therapy, recovery is almost complete.

Important! More often the disease is diagnosed in boys.

Causes and possible complications

Schlatter's disease is a very unpleasant disorder of the knee joint that usually limits the mobility of the joint. There are the following causes of the disease:

• Too much constant physical stress on the knee;
• Strong mobility of the joint, which can be caused by weakness of the muscles and ligaments;
• Inflammatory bone disease;
• Infectious disease of the knee.

In children and adolescents, Schlatter's disease resolves without significant conservative or surgical treatment. However, in some cases it gives complications:

1. Go to chronic form, in which pain will be felt constantly. In this case, Osgood's pathology makes itself felt even after the child's growth has completed.
2. The appearance of a lump on the knee. It is small in size and practically does not interfere with movement, but it brings unpleasant sensations. However, if the lump does not resolve, it will remain forever.
3. Swelling of the knee joint. Osgood Schlatter's disease is characterized by a slight increase in size of the joint.

Osgood Schlatter disease in some complex cases still requires treatment. However, first you need to make a correct diagnosis.

Symptoms and diagnosis of pathology

Schlatter's disease manifests itself in different ways in children. The main symptoms are:

• Swelling of the knee joint;
• Painful sensations in the area of ​​the tibia;
• When the knee moves, the pain becomes stronger;
• Tension of the ligaments and muscles in the affected knee joint;
• Limited joint movement, which can significantly harm the athlete in achieving high results;
• Muscle wasting. In this case, the knee joint may become too mobile.

Osgood's disease can only manifest as pain. Other signs may be completely absent, which delays the patient’s visit to the doctor and also accelerates the development of the inflammatory process.

The intensity of symptoms may vary. Knee pain can be severe or mild, and muscle tension lasts quite a long time. Everything stops only after the joint stops forming and growing. Schlatter's disease usually affects only one joint present.

Therapy should be started only after a thorough diagnosis, which includes the following procedures:

1. External examination of the affected part of the body.
2. Assessing the sensations described by the adolescent in the knee joint of the bones.
3. Collection of data on previous infectious diseases, medications or dietary supplements taken, and knee injuries.
4. Determining the causes of the disease.
5. X-ray of the knee.
6. Computed tomography and ultrasonography.

Conservative and physiotherapeutic treatment

Therapy for the presented joint is most often limited to the use of a tight bandage or a special bandage that will secure the knee well. In this case, the patient should be provided with complete rest, and should also postpone sports training. You can't put any weight on your knee.

Also, treatment for Osgood's disease involves the use of anti-inflammatory ointments. In order to relieve pain in the knee joint, analgesics are used.

Advice! If tablets do not help, injections can be used.

Naturally, a teenager during the treatment period must eat a balanced diet so that the body gets everything essential vitamins, microelements. Additionally, it is necessary to give the patient multivitamin complexes.

As for physical therapy, the treatment of Osgood’s pathology depends on the results of the radiographic examination:

1. If the patient has the first X-ray group, he is prescribed magnetic therapy and UHF.
2. The second group involves treatment using electrophoresis together with lidocaine (2% solution).
3. To treat patients of the third group, the same electrophoresis is used, but with other additional drugs.

The duration of physical therapy can range from 3 to 6 months.

Features of the surgical operation

Schlatter's disease sometimes does not respond to conservative therapy and progresses rapidly. Then the doctor has the right to prescribe surgery. This can be done if the pathology has been too long or the patient is already 14 years old. You should not have surgery before.

The operation should be carried out according to the following principles: trauma after the intervention should be minimal and efficiency should be maximum. In this case, you can use an endoscope, which will provide penetration into the affected area with minimal damage to the skin and tissue.

After the operation, the patient must undergo a rehabilitation course. He must wear a pressure bandage for at least a month. With Schlatter's disease there is no need for plaster immobilization. After surgery, it is also necessary to undergo a course of medication and physiotherapeutic treatment to reduce the risk of developing consequences or complications.

Prevention of pathology

In order to prevent Schlatter's disease, you must follow these rules:

• If a teenager plays sports, it is necessary that he eats properly and alternates training with rest;
• In case of injury, it is imperative to treat it correctly and completely;
• At the first symptoms of a pathological process in the knee, you should contact a surgeon and orthopedist;
• Don't put too much stress on your joints.

These are all the features of the development and treatment of Osgood's disease. Remember, timely consultation with a doctor, following doctors’ recommendations, as well as compliance with preventive measures will help you avoid the development of this disease. Be healthy!

Treatment is conservative. Limit loads; use ozokerite applications and compresses at night; shoes with heels are prescribed. During acute pain, the limb is fixed with a splint. Basically, the disease progresses favorably, and after 2 - 3 years, pain and discomfort (as the bone tissue strengthens) stop. Not all authors recognize this localization of aseptic necrosis. Pain in the area of ​​the tubercle of the calcaneus in children aged 7-14 years, when the bone is usually damaged by aseptic necrosis, is interpreted by some doctors as manifestations of periostitis or bursitis. Treatment of aseptic necrosis of the heads of the metatarsal bones is conservative: rest the limb for 2-2.5 weeks, baths, massage, therapeutic exercises, physiotherapeutic treatment. When walking, it is recommended to use rational shoes, which should include orthopedic insoles that provide support for the longitudinal and transverse arches. If conservative treatment is unsuccessful, surgery is indicated - removing bone growths from the head deformed by arthrosis and giving it a spherical shape.​

The cause of aseptic necrosis of the navicular bone in adults is usually a foot injury, less often other causes (consequences of foot overload in athletes, physical workers, etc.). In this case, aseptic necrosis does not affect the ossification nuclei, but the already formed bone. Damage to the scaphoid bone is often combined with flat feet, deformation of the foot and fingers. The disease should be differentiated from a bone fracture, isolated tuberculous lesion, or inflammatory process.​

Why does this disease appear?

• ​Treatment of spinal osteochondropathy is aimed at relieving pain, as well as restoring mobility in all areas of the spine. In addition, specialists correct the patient’s posture and prevent osteochondrosis. Subsequently, physical activity is excluded, and in some cases, after an illness, a person wears a corset.​
• ​Osteochondropathy of the navicular bone of the foot, vertebral bodies or sesamoid bone of the metatarsophalangeal joint.​
• ​Osteochondropathies, in most cases, affect those people who lead a pseudo-healthy lifestyle (exclude vital important products), the percentage of the population that suffers from overweight, physically developed residents and people who exhaust their bodies with a variety of diets.​
• ​Treatment of osteochondropathy of the calcaneus can be carried out using a conservative method, but it is not always effective. The presence of acute pain syndrome requires complete rest, as well as immobilization of the limb with a plaster cast.​
• Osteochondropathy of the tibial tuberosity (Osgood-Schlatter b.) is a kind of bone necrosis in the knee area (necrosis). It often occurs after numerous injuries and damage in this area (more often in boys who play sports professionally, aged 10-15 years). Knee pain and swelling appear. It takes a long time to treat and goes away after growth has completely stopped.
• ​in the hand (lunate) – b. Kinbeka;​
• ​Very often the body is subjected to microtrauma.​

Types of disease

​The question often arises, what is it and who does it manifest itself in? WITH Greek language osteochondropathia means: osteo – bone, chondro – cartilage, pathia – disease, suffering.​
​An important differential diagnostic sign of the disease, which allows us to reject acute inflammatory processes, tuberculosis and malignant tumors, is the appearance of pain in the heel bone during loading and palpation and its absence at rest.​

​Sometimes there is a need for economical resection of the articular end of the proximal phalanx. You should never resect the head of the metatarsal bone - this is the loss of important support and the beginning of the collapse of the transverse arch (Kuslik M.I., I960].​

• ​Regardless of the cause of the disease, the clinical manifestations of aseptic bone necrosis are the same: there is strictly local pain when pressing in the area of ​​the bone and when walking; There is lameness and limited movement in the joints of the foot.​
• ​Treatment for osteochondropathy of the foot can vary from simple restrictions (rest, avoidance of physical activity) to the prescription of orthopedic medications and the use of special splints.​

​Tibial tuberosity (referred to as Schlatter's disease), calcaneal tuberosity, or sciatic joint.​

• ​Osteochondropathy of the spine, according to statistics, occurs most often in children 11-18 years old. It is based on damage to the discs and bodies of the thoracic vertebrae. In addition, damage to the endplates occurs. More susceptible areas of the body are the spine (thoracic region), the lumbar-thoracic region.​
• To reduce pain, the heel area is injected with novocaine. Subsequently, patients are prescribed a course of physiotherapeutic procedures: microwave therapy, electrophoresis of novocaine with analgin, ozokerite applications, medicinal baths and compresses.​
• ​Osteochondropathy of the spine (b. Scheuermann - May) is the destruction of the spine (discs, vertebrae, endplates). The thoracic region most often suffers from this disease (age 11-18 years). First, unpleasant sensations appear in the back area, then they intensify and with progressive development, kyphosis (curvature of the spine) and intervertebral neuralgia appear.
• ​in the wrist (scaphoid) – b. Praiser;​

​The limbs and spine are not in a natural position (most often among professional athletes).​

• ​Osteochondropathy is a series of painful manifestations that are more common in younger generation(children, teenagers).​
• ​Revealed following features diseases that can help establish correct diagnosis: heel pain occurs when vertical position the patient immediately or a few minutes after resting on the tubercle of the heel bone, walking with support on the heel bone becomes impossible due to the unbearable nature of the pain. Patients are forced to walk, loading the anterior and middle departments feet, using a cane or crutches. In most patients, skin atrophy, moderate swelling of soft tissues, increased tactile sensitivity, and skin hyperesthesia are detected on the plantar surface of the heel bone.
• The disease occurs mainly in women aged 15-30 years. Clinically characterized by pain of varying intensity under the head of the first metatarsal bone, which intensifies when walking, especially when extending the first finger. X-ray shows a change in the structure of the sesamoid bone, sometimes its fragmentation. In the differential diagnostic relation, it is necessary to take into account the fracture of this bone and arthrosis. Treatment of the disease is conservative (rest 2-2.5 weeks, thermal procedures, instep supports, orthopedic shoes, physiotherapy). If conservative treatment fails, removal of the sesamoid bone is indicated.​

​Treatment is as follows

Treatment of osteochondropathy of the calcaneus is based on both clinical and radiological data. The diagnosis is made with achillobursitis.

​Partial osteochondropathy elbow joint, hip and other joints.​

Scheuermann-Mau disease has not been fully studied by scientists and doctors. Osteochondropathy of the spine proceeds rather sluggishly and unnoticed, and does not have a pronounced pathological process. At the initial level, patients experience increased fatigue various parts of the spine, periodic pain in the back, which disappears after sleep.​

​Brufen, pyrogenal, and B vitamins have proven themselves well among medications.​

​Osteochondropathy of the calcaneus (B. Haglund-Shintz) - this disease manifests itself with unpleasant pain in the area of ​​the Achilles foot, heel, and swelling forms. Usually appears in girls after prolonged exercise (aged 12-16 years).​

How can this disease be detected?

​in the vertebral body – b. Calvet.​

How is it treated?

​This disease can be divided conditionally into IV groups, each type of manifestation has its own characteristics and individuality.​

VashaSpina.ru

Symptoms of the disease

​There is a change in the bone tissue of the musculoskeletal system (for example, in the apophysis of short tubular bones), the bone is deformed (it loses its strength), disruption and changes in the joints. A person with such a predisposition, standing on his hands, can easily break them. Bones can crumble under their own weight, even from muscle tension.​

Atrophy of the lower leg muscles often occurs. X-ray examination most often reveals damage to the apophysis of the calcaneus in the form of loosening of its bone structure, as well as loosening of the cortex under the apophysis. Specified signs are not absolute evidence of osteochondropathy, since they can occur with periostitis. Only the presence of sequestration-like shadows shifted to the side is convincing evidence. Otherwise, a complex X-ray picture may reflect the variability of the tubercle: a different number of ossification nuclei, a variety of their shapes and rates of ossification.​

Diagnostics

Features of treatment

​In children, they are limited to unloading the foot and maintaining rest (wearing orthopedic shoes, applying a plaster “boot” if indicated).​

​The basis of the disease is aseptic necrosis of areas of cancellous bone that are under conditions of the greatest mechanical load. Characteristic is damage to the epiphyses or apophyses of tubular bones, as well as the bodies of some small spongy bones of the foot and hand.​

​After an illness, a person diagnosed with “Perthes disease” develops arthrosis hip joint. And a patient who has suffered from osteochondropathy of the spine may develop osteochondrosis.​

​As the child grows, the pain syndrome intensifies, thereby contributing to the formation of a curved spinal column. As a result, the deformation of the spine shifts its apex to the X-thoracic vertebra, and a “flat back” is formed. The changes described above are continuously associated with varus deformation of the legs, as well as with flattening of the human chest.​

Prognosis for patients with the described diagnosis

​In the event that conservative treatment does not give the desired results, then surgical intervention, during which surgical intersection of the saphenous and tibial nerves with the branches that go to the heel is carried out.

​If your children complain of unpleasant pain in the foot, knee, spine, pelvis, then you should pay attention to this. Especially when the pain intensifies, you should consult a doctor. The disease is difficult to detect early stages, it is better to avoid complications. This disease takes a very long time to be treated and goes away completely when the body’s growth has stopped. It is better not to self-medicate. The doctor will make a diagnosis and prescribe treatment.​

sustaved.ru

Osteochondropathy - treatment, symptoms, types

​3. In the apophyses:​

​How is it distributed?​

​Conservative methods for this pathology are not always effective. However, treatment must begin with them: long-term unloading of the heel area when walking with the help of plaster splints with unloading stirrups, alcohol-procaine injections of soft tissue in the heel area, physiotherapeutic procedures (microwave therapy, electrophoresis of novocaine with analgin). Medications- brufen, pyrogenal, vitamins B12 and B6. If conservative treatment fails, neurotomy of the tibial and saphenous nerves with branches extending to the heel is indicated. This relieves patients from excruciating pain and allows them to safely load the tubercles of the heel bones when walking. The operation leads to the loss of not only pain in the heel area, but also to the disappearance of skin sensitivity.​

Spinal osteochondropathy

​A similar radiological picture can be observed with a non-union fracture of the tuberosity, persistent apophysis, accessory bone of Vesalius.​

​Thermal procedures and massage are used to relieve pain. Restoration of the bone structure occurs within 1.5-2 years. In adults, these measures may not be enough for recovery. In such cases, arthrodesis in the talonavicular joint is indicated.​

​Osteochondropathies​

​Osteochondropathy of the foot is observed mainly in children aged 1-10 years. A larger percentage of diseases occur between 3 and 7 years of age.​

​When severe course osteochondropathy of the spine, the patient experiences nervous disorders (a type of radicular syndrome). If the disease affects the lumbar spine, the person may not feel pain, and therefore, may not see a doctor. When osteochondropathy manifests itself as a pathology of the cervical vertebrae, every turn of the head causes pain, and without the intervention of a specialist, a person will not even be able to turn his head.​

Diagnosis of spinal osteochondropathy

​These treatment methods can relieve the patient of unbearable pain, but entail a loss of skin sensitivity in the heel area. If this disease is not diagnosed and treated in time, then the increase in the tubercle in the heel area will persist for the rest of your life, which in turn will lead not only to unpleasant sensations while walking, but will also create difficulties with wearing shoes.​

Osteochondropathy in children

​X-ray examination is prescribed: radiography, tomography, angiography. Thanks to this, we can distinguish 5 stages of this disease. At the initial stage, only cartilaginous necrosis appears, at the last stage a method of regeneration can occur ( full recovery) or further destruction, arthrosis.​

• ​in the tibia (its tuberosity) – b. Osgood-Schlatter;​
• ​1. In tubular bones (in the epiphysis):​
• ​Transmitted genetically.​
• ​Foot surgery​

​The disease occurs in children and adolescence with significant load on the foot. Clinically, there is thickening of the tuberosity of the fifth metatarsal bone, its pain on palpation, and moderate swelling of the soft tissues. Patients walk with a limp, loading internal department feet. The X-ray picture is characterized by a disruption of the structure in the ossification core and fragmentation of the apophysis, the appearance of areas of compaction in it. V.P.Selivanov and G.N.Ishimov (1973) described a radiological symptom characteristic of this disease, which was confirmed in our observations. Unlike the normal version of ossification from several additional points of ossification, in which they are located in one plane along the axis of the metatarsal bone, fragments of the apophysis in osteochondropathy of the tuberosity of the fifth metatarsal bone are located in two planes. The symptom of “two-plane arrangement of fragments” has absolute diagnostic significance only if there is clinical manifestations diseases. It is known that in any case, normal ossification is painless.​

Osteochondropathy of the foot

​According to the literature, aseptic necrosis of the heads of the metatarsal bones accounts for 0.22% of all orthopedic diseases. This is one of the most common localizations of osteochondropathy. Occurs at the age of 10-20 years mainly in women.​

​referred to as a disease of childhood and adolescence; adults rarely get sick. In most patients, the process is benign and has little effect on the general condition and function of the joints. Self-healing is often observed when only deforming arthrosis is evidence of a disease suffered in the past.​

​Bone necrosis can occur due to various kinds injury or physical overload. The symptom of the disease is pain in the medial part of the foot. Unpleasant sensations occur during walking when body weight is directed towards the affected leg. Sometimes osteochondropathy of the foot is accompanied by local swelling, and irritation or redness may also appear.​

​Limited movement of the spine may be caused by a decrease in the height of the spinal discs or the development of contracture of the rectus dorsi muscles.​

Osteochondropathy of the calcaneus

​Now let's look at what osteochondropathy is in general:​

​The treatment takes place in the constant presence of doctors. Each manifestation of osteochondropathy has its own therapeutic purpose. For example, with osteochondropathy of the knee joint (Osgood-Schlatter b.), the load on lower limbs(set up a splint), prescribe electrophoresis with P (phosphorus) and Ca (calcium), paraffin, and a good supply of vitamins to the body. This disease goes away within a year and a half.

Treatment of osteochondropathy

• ​in the heel bone (its tubercle) – b. Haglund - Schintz;​
• ​in femur(head) – Legg-Calvé-Perthes disease;​
• Hormonal balance is disrupted (especially in the functioning of the endocrine glands).

zdorovi.net

Osteochondropathies of the foot

​Doc​​Good results are achieved using conservative treatment methods (foot unloading for 3-4 weeks, massage, microwave therapy, calcium electrophoresis). The pain syndrome is relieved even in the absence of apophyseal synostosis. In addition to the typical localization of Köhler's disease II in the heads of the II and III metatarsal bones, sometimes there are atypical forms lesions (multiple, bilateral lesions of the head of the IV, I, V metatarsal bones). A feature of multiple lesions of the metatarsal heads is the presence in such patients of static foot deformities: longitudinal and transverse flatfoot, flat hallux valgus deformity foot, hallux valgus deformity of the first toe. Many patients also show signs of dysplastic development.​

The etiopathogenesis of the disease is not fully understood. It is believed that osteochondropathy is the result of local vascular disorders, occurring under the influence of various factors - congenital, metabolic, infectious, traumatic, etc. There are five stages in the development of the disease: 1) aseptic necrosis; 2) impression fracture and fragmentation; 3) resorption of necrotic bone tissue; 4) reparations (osteosclerosis); 5) inflammation, and in the absence of treatment - the development of deforming osteoarthritis.​

​Osteochondropathy of the foot is defined as follows: an X-ray examination shows the specialist a flattening of the navicular bone, on which there are many areas of irregular ossification.​

Osteochondropathies of the scaphoid (Köhler's disease I)

​Treatment of osteochondropathy is a long process that is based on X-ray images. On them, the specialist identifies rotation of the vertebrae, both in the thoracic and lumbar region, determines the unevenness or jaggedness of the apophyses (anterior, lower and upper edges of the vertebrae). In addition, the doctor determines the level of reduction of intervertebral discs, determines the percentage of flattening of the dorsoventral size of the vertebrae, and checks disc calcification and spondylolisthesis. The severity of this disease is characterized by the degree of deformation of the vertebral bodies. Treatment of osteochondropathy in adults is quite painful.

​Osteochondropathy is a disease of the osteochondropathy, consisting of impaired nutrition of bone tissue with the subsequent occurrence of aseptic necrosis. Osteochondropathy translated from Greek means “suffering of bones, cartilage.”​

​Osteochondropathy of the calcaneus most often occurs in girls aged twelve to sixteen years. This disease is characterized sharp pains, localized in the heel bone area. Pain usually occurs after physical activity. Gradually, patients with this diagnosis begin to limp and also move with support on their toes. In this case, playing sports becomes almost impossible.​

​in the apophyseal rings of the vertebrae – b. Scheuermann – May.​ ​in the 1st-3rd metatarsal bone (head), clavicle (its sternal end), fingers (their phalanges) - b. Köhler II.​

​Poor metabolism (difficult to absorb Ca and vitamins).​

​Osteochondropathy of the apophysis of the calcaneus was described by P. Haglund in 1907 and N. Schinz in 1922. The etiology has not been reliably elucidated. There is an opinion that the cause of osteochondropathy in adolescence may be the fact that the child’s skeleton begins to actively grow, muscles and ligaments develop, but the skeletal system does not have time to strengthen. Muscles and ligaments have active influence(“pulling” the periosteum), and the child experiences unpleasant pain in the area where large muscles attach to the bones. The disease is provoked by injury and excessive physical activity. Rarely occurs in children.​

Osteochondropathy of the metatarsal heads (Köhler's disease II)

​Refers to rare lesions talus. Most authors associate the occurrence of the disease with an injury to the ankle joint. The process is localized in the area of ​​the talus block and has the character of aseptic inflammation. An X-ray examination reveals a focus of destruction with scalloped contours and a cellular structure, delimited from the unchanged bone by a zone of sclerosis.​

Clinically, swelling and pain are detected in the area of ​​the heads of the metatarsal bones affected by the process; movements in the metatarsophalangeal joints are limited. The X-ray picture depends on the stage of the process. Destructive changes lead to the restructuring of bone tissue, its fragmentation, flattening and deformation of the heads. In the final phase of the disease, signs of deforming arthrosis are determined with typical bone growths in the area of ​​the head and smaller changes in the area of ​​the base of the phalanx.

​Typical sites of localization of the disease on the foot: navicular bone (Köhler disease I, Müller-Weiss syndrome), metatarsal heads (Köhler disease II), sesamoid bone of the first toe (Renander-Müller disease), tuberosity of the V metatarsal bone, trochlea of ​​the talus, tubercle of the calcaneus (Haglund-Schinz disease).​

​Many people believe that the disease develops due to the varied shape of the foot - this is a misconception. The reasons may be different: from physical activity to poor nutrition. They can not be recognized immediately, but within several months after the onset of the disease.​

Osteochondropathy in children has 4 stages of development:

​This disease occurs as a result of local circulatory disorders for the following reasons: trauma, heredity, etc. Osteochondropathy is dangerous disease, which cannot be detected in the early stages.​

A feature of this disease is a swelling that forms above the tubercle of the heel bone. Most patients report atrophy skin and moderate soft tissue swelling. The sensitivity of the skin in the area of ​​the heel bone and on the plantar surface of the foot also increases.​

Osteochondropathy of the sesamoid bone of the first metatarsophalangeal joint (Renander-Muller disease)

​4. In the surfaces of the joints - Koenig's disease.

Osteochondropathy of the fifth metatarsal tuberosity

​2. In short tubular bones:​

​Absence of interactions between the vascular network and bone tissue.​

​The disease begins with acute or gradually increasing pain in the area of ​​the heel tubercle, especially after exercise. Above calcaneal tubercle swelling occurs without signs of inflammation. When palpating or extending the foot, severe pain appears in this area. Patients walk with support on the forefoot.

In addition, thinning and protrusion of the endplate above the site of destruction is observed. At laboratory research no deviations from the norm are detected. The disease can occur as a bilateral lesion.​

Osteochondrosis dissecans of the talus

In many patients, clinically and radiologically the process ends with complete recovery. The transition of osteochondropathy to deforming arthrosis is not at all necessary if repeated foot injuries are excluded. Favorable outcome occurs in cases where primary necrosis is not complicated by a fracture. It is not always possible to avoid this.​

The disease occurs mainly in boys aged 3-10 years, sometimes older. Both unilateral and bilateral (most often) lesions of the scaphoid bone are observed. In adults, damage to the scaphoid bone is identified as an independent nosological form of aseptic necrosis, which is called Muller-Weiss syndrome (disease). There are differences in the pathogenesis of the disease in children and adults.​

Osteochondropathy of the calcaneus (otherwise known as Halgund-Schinz disease) most often occurs in children aged 12 to 15 years. Causes: severe physical exertion during sports, injuries, hormonal factors(for example, pathology of the function of the endocrine glands), impaired metabolism of vital substances.​

Osteochondropathy of the calcaneal tuberosity (Gaglund-Schinz disease)

​Osteochondropathy of the head of the femur (this disease is called Legga-Calvé-Perthes), as well as the heads of the 2nd and 3rd metatarsal bones (this disease is called Aljoan-Keller). This disease can manifest itself as an effect on the phalanges of the fingers or on the sternal end of the clavicle.​

​Failure to provide timely assistance from specialists leads to sufficient serious consequences, since the bone will break not only under external influence, but also under the influence of the gravity of one’s own body. This could be muscle cramps or normal muscle strain.​

When conducting an X-ray examination of Schinz's disease, the photo (image) shows a violation of the structural pattern of the apophysis, sequestration-like areas, fragmentation, as well as changes in the distance between the apophysis and the calcaneus. On the sore leg, the unevenness of the bone contours is significantly more pronounced than on the healthy leg.

​Osteochondropathy of the femoral head (Legg-Calvé-Perthes b.) is a lesion of the hip joint, most often its right side. It appears more in boys (5-10 years old). May have different stages of the disease (I-V). This disease first appears unpleasant sensations in the lower extremities, then in the pelvic area. The pain may not be at the site of the outbreak, but in the knee joint, and lameness begins. With a complex form of manifestation of this disease, the function of the hip joint is impaired, accompanied by severe pain, changes occur in the head of the femur.

​in the foot (scaphoid) - Köhler disease I;​

​Changes in the regulation of blood flow and nervous trophism.​

medbe.ru

What causes and what are the consequences of this disease? OSTEOCHONDROPATHY OF THE TUBE OF THE CALENA (SCHINZ-HAGLUND DISEASE)

​It is difficult to diagnose the disease X-ray due to the normal presence of 4 ossification nuclei, compaction of the central nucleus, the presence of jagged surfaces of the calcaneus and apophysis, various numbers nuclei on the right and left. Therefore, the diagnosis of the disease is based on clinical data and radiographically detected typical spotting in the area of ​​​​the compacted ossification nucleus.​

​When choosing a treatment method for osteochondrosis dissecans, take into account the severity painful symptoms. If the disease occurs with minor pain and a long latent period, good results can be achieved using conservative methods (physiotherapeutic procedures, limb unloading). In the presence of excruciating pain and X-ray picture severe destruction of bone tissue, an operation such as marginal resection is indicated to prevent the development of deforming arthrosis of the ankle joint.​
​Unilateral lesions of the metatarsal heads often lead to excessive load on the other foot, which sometimes causes pathological restructuring of the metatarsal bones (Deichlander's disease). Such patients learn about the Köhler II disease they once suffered many years later during an X-ray examination for foot pain caused by the development of Deutschlander’s disease.​
​Aseptic necrosis in children is explained by a disruption of the ossification process of the scaphoid bone, which is confirmed by radiographs: there is an increase in density and flattening of the ossification core, which consists of several fragments. Normally, the number of ossification nuclei of the scaphoid should not be more than two. Another characteristic sign of the disease is an increase in the interosseous space visible on radiographs, separating the scaphoid from the talus and sphenoid. The resolution of the space around the scaphoid is explained by a decrease in its size in the anteroposterior direction.​
​In this case, the pain manifests itself in the area of ​​the heel tubercle, it intensifies when walking. During palpation, you can feel swelling and unpleasant painful sensations. Osteochondropathy of the calcaneus can also occur in adults, but in fairly rare cases.​

Osteochondropathy refers to as a result of which an aseptic type of necrosis of some bone structures develops. Most often, pathology appears in the calcaneus and femurs, apophyses of the vertebral bodies and in the tibia.

Description of the disease

The disease most often affects children during adolescence. If left untreated, osteochondropathy can develop into serious problems in the future. Due to the increased load, it is the bones of the feet that are most often subject to chondropathy. The disease is localized, as a rule, of an aseptic nature in the metatarsal, navicular and calcaneal bones, in the tarsus and in the trochlea of ​​the talus.

It is not possible to establish the exact causes of bone osteochondropathy. However, doctors put forward several versions of its etiology. If we talk about teenagers, then pathology often occurs against the background of a failure in the formation of bone tissue. In the case of adulthood, we are more likely talking about increased physical stress on the skeletal system of the body. Often the cause of the disease remains unclear. In this article we will look at the types of osteochondropathy of the calcaneus.

Types of osteochondropathy

To understand the seriousness of this pathology and the degree of impairment in the musculoskeletal system, it is necessary to consider the most common types of osteochondropathy. Most often, girls suffer from foot necrosis during adolescence. The disease is localized in the head of the second metatarsal bone and proceeds in quite mild form and does not pose a serious risk to the child's health. Manifestations include pain during physical activity, mild lameness and swelling. Therapy is carried out using conservative methods; the main condition for successful recovery is immobility of the affected area.

Keller's disease

Keller's disease is a little less common. Children suffer from it preschool age different genders. There are two types of this pathology:

1. Necrosis occurs in the center of the foot.

2. A disease in which the head of the metatarsal bone, located at the base of the toes, is affected.

Osteochondropathy of the calcaneus also manifests itself as slight swelling and redness of the skin, as well as pain. The main directions of therapy are physiotherapy, vitamin support for the body and low intensity load on the sore leg.

Schinz's disease

Teenagers may also be susceptible to Haglund Schintz disease, or osteochondropathy of the calcaneal tuberosity. In this case, a violation occurs in the formation of bone tissue. As a consequence of such a failure, aseptic necrosis begins in the spongy part of the bone. The disease can affect one or both limbs. Schinz's disease manifests itself severe swelling, numbness and muscle atrophy in the lower leg area. During an exacerbation, a severe painful syndrome appears that does not allow the child to move.

Rarer species

Rarer types of osteochondropathy are lesions of the sesamoid bones, otherwise called Müller's disease. Scheuermann-Mau disease is considered a pathology of the spinal column. The latter is most common among adolescents under 18 years of age. This pathology leads to curvature of the spine, which causes back pain and decreased performance. Damage to the femur is called Legg-Calvé-Perthes disease. The most likely causes of this disease include injuries to the hip. They can disrupt blood flow and lead to necrosis. Why does osteochondropathy of the calcaneus occur?

Causes

We mentioned above that the exact causes of osteochondropathy cannot be established, but doctors are inclined 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 of the calcaneus begins in those children whose parents also had a history of this osteochondropathy of any localization. They could have any type of bone in the foot affected, including the navicular and metatarsal head, as well as the spine or other bone tissue in the lower extremities.

Children quite often experience heel pain and painful stepping (we’ll look at how to treat it below), if they are diagnosed with endocrine disorders, failures in hormonal background or metabolic process. Bones are susceptible to the development of pathologies in the presence of congenital diseases associated with poor absorption of various necessary for child's body minerals and vitamins. This is especially true for calcium, since the condition of joints and bones directly depends on it, and its deficiency causes fragility and sensitivity of bone tissue.

Another possible factor leading to osteochondropathy of the calcaneus is increased physical stress on the leg in general and especially on the foot. Muscles tend to contract intensely during exercise, which leads to the appearance of microtraumas, and this, in turn, can weaken protective properties joints and bone tissue. This decrease in resistance qualities may increase the risk of developing an inflammatory process. It affects the spongy bone structure, and intense physical activity affects the compression of small vessels in it. The lower limbs of people who are overweight and have metabolic problems experience increased stress.

The last factor that can cause calcaneal osteochondropathy (OCD) is injury. Due to the structure of the skeletal system, it is the feet that are most at risk of injury. Most often this occurs as a result of compression of the bones when falling from high altitude as a result of an accident or damage at work.

Symptoms of osteochondropathy of the calcaneus

Due to the fact that hormonal disorders They are more common in girls, and they are at risk of developing osteochondropathy. The main sign of pathology is intense pain in the heel and toes, since these are the areas of the foot that are subject to the greatest stress. As a result of the development of the disease, the patient’s quality of life significantly decreases, the legs quickly get tired, and gait disturbance occurs. It is important to identify the causes of osteochondropathy of the calcaneus so that the therapy is correct.

Pain syndrome, as a rule, appears after a heel injury, physical activity - both during running and walking, and after a long stay in a standing position. If the pathology affects both legs, then the child tends to start walking on his toes, since resting on the heels causes severe pain. And since in this case the pressure on the toes increases, without proper treatment this can lead to hallux valgus, flat feet or bowed feet.

The child's heel hurts and it hurts to step on it. How to treat?

Active sports, like any other intense physical activity, are prohibited for children who have been diagnosed with osteochondropathy of the calcaneus. Such restriction can cause muscle and skin atrophy, as well as impair sensitivity. Quite often there are cases when not only the heads of the metatarsal bones are affected, but also the heels, which does not allow patients to move naturally, since placing emphasis on the foot causes severe pain. 2-3 metatarsals and thumb most often suffer from osteochondropathy.

Since a person’s gait changes due to the disease, further progress of the pathology can cause pain in the ankle, calf and thigh muscles, as well as in the spine. The chance of metatarsal bone pathology increases if the patient has flat feet. Treatment of osteochondropathy of the calcaneus should be timely.

Stages

The development of pathology can be divided into four stages, each of which is characterized by its own symptoms and severity of bone tissue damage.

First stage lasts up to several months. At this stage, tissue necrosis occurs. Pain syndrome develops in the back and limbs. X-rays do not show pathological changes, which makes diagnosing the disease at this stage quite difficult.

Duration second stage is about a year. During this time, serious changes occur in the bone tissue, and its slow degeneration occurs. Another name for this stage is the stage compression fracture. The hips, spine and feet are most affected.

Third period The illness lasts up to three years. At this stage, areas of bone tissue that were exposed to necrosis are resorbed and replaced by osteoclasts.

Fourth stage characterized by tissue regeneration. With proper and timely therapy, cure occurs without further complications. If left untreated, progressive osteoarthritis may develop.

Diagnosis of osteochondropathy of the calcaneus

If your child is concerned about their feet and complains of back or leg pain, they should be examined by a podiatrist. The best option for further successful therapy is timely diagnosis.

When determining a diagnosis, the doctor 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 image is taken not only of the heel bones, but also of the entire foot, since there is a possibility of complications or combined pathologies. An x-ray can show injuries, arthrosis and other diseases of the bones of the foot.

In addition to x-rays, to clarify the diagnosis, ultrasonography or magnetic resonance imaging. In some cases, the doctor may also prescribe arthroscopy. This is necessary to exclude osteomyelitis, bursitis or malignant neoplasms.

Treatment

Conservative methods in the treatment of osteochondropathy are most often used. This includes taking medications, performing special exercises physical therapy and physiotherapy. Another method of treating Haglund's disease is surgery, which is prescribed only in as a last resort when conservative treatment has shown to be ineffective or in neglected form diseases. The main disadvantage of the operation, as a rule, is the loss of sensation in the heel in the future.

Let's take a closer look at the methods of conservative treatment of osteochondropathy. A patient with this diagnosis is prescribed to wear special shoes and orthopedic insoles, as this helps 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 arches and preventing them from compacting. In addition, such insoles improve blood circulation in the foot and relieve fatigue from the legs.

In addition to special shoes and insoles, patients with osteochondropathy are prescribed non-steroidal anti-inflammatory drugs, which are used as painkillers. These include Nimesulide, Ibuprofen, etc.

Duration of therapy and dosage medicine, as well as his choice, are determined by the attending physician, since patients are most susceptible to the disease childhood. IN exceptional cases in case of severe pain, the heel area can be blocked with Lidocoin or Novocaine. Sometimes a plaster cast or orthosis may be required.

Therapy for osteochondropathy must necessarily include a course of physiotherapy. As a rule, this is electrophoresis using Analgin or Novocaine or ozokerite therapy. It is no less effective to use compresses and baths with soda, salt and special herbal mixtures. In complex therapy, vitamins and calcium are also prescribed. During the rehabilitation period, a course of massages and physical therapy is completed to restore foot mobility.

Sometimes surgery on the heel bone may be necessary.

Prevention and possible complications

If treatment for osteochondropathy is not started in a timely manner, the pathology can develop into a chronic form. In addition, there may be a threat of developing other articular degenerative-dystrophic pathologies. Flat feet that arise against the background of osteochondropathy do not go away even after successful treatment of this pathology.

Treatment of the disease in its advanced form also does not go away without leaving 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 heel tubercle may begin to deform and bulge, making it impossible to wear certain types of shoes in the future.

One of the types of prevention of osteochondropathy among children is regular visits to an orthopedist, especially when the child complains of pain in the foot area. Genetic predisposition involves a course of preventive therapeutic massage several times a year, as well as performing a certain set of physical exercises.

The choice of shoes is equally important. It is necessary to select comfortable shoes for the child in size to avoid excessive compression of the foot. Girls in adolescence are contraindicated from wearing high-heeled shoes. It is also necessary to take vitamins and calcium regularly to strengthen the bone structure.

Osteochondropathy of the calcaneus is much more common in children than in adults. At risk are girls seven to eight years old and boys nine to eleven. Professional athletes and adults actively involved in sports are susceptible to pathology.

The main reason for the development of Schintz's disease is malnutrition of bone tissue and aseptic neurosis. Doctors associate secondary manifestations with the resorption of individual sections of bones and their subsequent replacement. Osteochondropathies account for 2.7% of orthopedic pathologies. Schintz's disease was first described by the Swedish surgeon Haglundd at the beginning of the last century.

So far, doctors do not have a consensus on why exactly osteochondropathy of the calcaneus occurs, but common factors can be identified. Among them:

• improper functioning of the endocrine glands;
• metabolic disorders (especially metabolic processes of substances essential for the normal functioning of the body);
• poor absorption of calcium;
• injuries;
• increased physical activity.

Although the disease most often appears in children, it can also affect adults. Especially if they are active in sports (and prone to injury) or have certain problems with health (bones do not absorb calcium well, nutrient metabolism is impaired, and so on).

Symptoms

Osteochondropathy of the calcaneal tuberosity can develop in different ways - in some people the disease immediately takes on an acute form, in others it can be sluggish for a long time, almost asymptomatic. The acute form is characterized by severe pain, which is localized in the heel area and intensifies after physical activity.

Other possible symptoms:

• swelling in the affected area;
• problems with flexion and extension of the foot;
• soreness of the affected area upon palpation;
• fever, redness;
• limping when walking, sometimes it is difficult for the patient to stand on the affected leg without leaning on a cane, table or arm of a chair;
• pain at the attachment point of the Achilles tendon to the heel bone;
• subsidence of pain in a horizontal position (if the symptoms described above occur during the daytime, and at night during sleep they subside or disappear altogether - we are talking about Schinz’s disease)

Atrophy, skin hyperesthesia in the heel area, and atrophy of the lower leg muscles are rarely observed, but this possibility cannot be completely excluded. Symptoms persist for a long time, and in children they may disappear after the growth process is completed.

How is the disease diagnosed?

To diagnose osteochondropathy, an x-ray is taken. In the photograph, disturbances in the structural patterns of the apophysis, fragmentation, and distorted distances between the heel bone and the apophysis are clearly visible. On a sore leg, the unevenness of the contours will be more pronounced than on a healthy leg. Before sending the patient for an x-ray, the doctor examines the legs and listens to complaints.

At severe forms Schinz's disease (calcaneal) the x-ray will clearly show separation of parts marginal bone. Also this pathology always accompanied by an increase in the distance between the apophysis and the heel bone.

In some cases, the doctor prescribes differential diagnostics. Its completion will allow us to exclude the presence of other pathologies with similar symptoms and similar changes in the bone.

Treatment

The doctor prescribes treatment for osteochondropathy of the calcaneus in children and adults after examination, taking into account individual characteristics clinical picture - the complexity of the pathology, the patient’s condition. IN acute stages complete rest of the affected foot is shown.

The main methods of treating Schinz disease (calcaneus):

1. Conservative – the load on the bone is reduced through the use of a special splint with stirrups. If you are used to walking in shoes with flat soles, you will need to replace them with boots or shoes with low (but not high!) heels, or better yet, buy an orthopedic pair.
2. Physiotherapy procedures include ultrasound and electrophoresis.
3. Warming compresses – they are convenient to use at home.
4. The use of anti-inflammatory and analgesic ointments.
5. Warm baths.
6. Ozokerite applications.

And remember that the treatment must be prescribed to you by a doctor - only in this case will it be effective and give the desired results.

Osteochondropathy is a disease of children and adolescents in which a degenerative-dystrophic process develops in the bones.

With osteochondropathy, the calcaneus, femur, apophyses of the vertebral bodies, and the tibial tuberosity are most often affected.

Reasons for appearance

Today, the causes of the disease are not fully understood, but several decisive factors are identified:

• congenital or family predisposition;
• hormonal factors - the disease develops in patients with pathology of the function of the endocrine glands;
• metabolic disorders of essential substances. Osteochondropathy is often caused by impaired absorption of calcium and vitamins;
• traumatic factors. Osteochondropathy occurs after excessive physical exertion, incl. increased muscle contractions, frequent injuries. Initially, these types of loads lead to progressive compression, and then to narrowing small vessels spongy bones, especially in areas of greatest pressure.

Symptoms of osteochondropathy

Osteochondropathy of the calcaneus (Haglund-Schinz disease) develops most often in girls 12-16 years old, characterized by gradually increasing or acute pain in the tubercle of the calcaneus that occurs after exercise. There is swelling at the site of attachment of the Achilles tendon, above the calcaneal tubercle. Patients begin to walk, leaning on their toes, and playing sports and jumping become physically impossible.

Spinal osteochondropathy (Scheuermann-Mau disease) develops most often in boys 11-18 years old. The first stage is characterized by increased thoracic kyphosis (curvature of the spine in its upper part), the second – by back pain (especially with prolonged walking or sitting), fatigue and weakness of the spinal muscles, increased thoracic kyphosis. At the third stage of spinal osteochondropathy, complete fusion of the apophyses with the vertebrae is observed. Over time, osteochondrosis develops with increasing pain.

Osteochondropathy of the femur (Legg-Calvé-Perthes disease) develops in most cases in boys 4-12 years old. At the beginning of the disease there are no complaints, after which pain appears in the hip joint, radiating to the knee. Pain occurs after exercise and goes away after rest, so children do not always complain about it. The movements of the hip joint are gradually limited, muscle atrophy develops, and the thigh on the affected side loses weight.

Osteochondropathy of the tibial tuberosity (Schlatter's disease) develops in boys 12-16 years old, especially in those who engage in ballet, competitive dancing, and sports. The patient complains of pain under the patella and swelling. When the quadriceps femoris muscle is tense, when squatting, or climbing stairs, the pain intensifies.

Diagnosis of the disease

To determine osteochondropathy of the calcaneus, they are based on clinical data and results x-ray examination(fragmentation, compaction of the apophysis, “roughness” on the tubercle of the calcaneus are noted). A differential diagnosis of osteochondropathy with heel spur (in older patients) and achillobursitis is also carried out.

Diagnosis of spinal osteochondropathy occurs on the basis of examination data (increased thoracic kyphosis) and x-ray examination (the pictures show that the shape of the vertebrae has been changed - they become wedge-shaped).

Osteochondropathy of the femur is also determined by X-ray images. Five stages of change in the femoral head have been identified.

Treatment of osteochondropathy

Therapy for osteochondropathy of the calcaneus consists of prescribing non-steroidal anti-inflammatory drugs (if severe pain), physiotherapeutic procedures, and reducing physical activity. To relieve the load on the heel bone, special insoles-instep supports are used.

Spinal osteochondropathy is treated with massage, swimming, underwater stretching, and physical therapy. In some cases, if posture is severely impaired, surgery is prescribed.

Treatment of osteochondropathy of the femur can be surgical or conservative. Various osteoplastic surgeries are prescribed depending on the stage of the disease. Conservative treatment osteochondropathy consists of bed rest (the patient cannot sit), foot massage, and physiotherapeutic procedures. They practice skeletal traction on both hips.

To treat osteochondropathy of the tibial tuberosity, physiotherapeutic procedures and heat are prescribed. If the pain is severe, apply a plaster cast. Sometimes they resort to surgery - a fragment of the tuberosity is removed. Loads on the quadriceps femoris muscle are excluded.

Disease prevention

To prevent osteochondropathy of the calcaneus, it is recommended to wear loose shoes.

Prevention of spinal osteochondropathy involves physical therapy exercises to create a muscle corset. Strenuous physical activity should be limited. Wearing a corset for this disease is ineffective.

A good prevention of osteochondropathy of the femur is massage and swimming.

To prevent osteochondropathy of the tibial tubercle, athletes are recommended to sew 2-4 cm thick foam pads into their uniform during training.

Video from YouTube on the topic of the article: