Bones, muscles, ligaments

Fragmentation of the calcaneal tuberosity. Osteochondropathy of the calcaneus. Prevention and complications

Osteochondropathy calcaneus It occurs much more often 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. Secondary manifestations doctors associate it with resorption individual areas 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.

There are no doctors yet consensus about why exactly osteochondropathy of the calcaneus occurs, but common factors it is possible to highlight. Among them:

incorrect operation endocrine glands;
metabolic disorders (especially metabolic processes essential for normal operation body of substances);
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 actively involved in sports (and are susceptible to injury) or have certain health problems (bones do not absorb calcium well, metabolism is impaired nutrients 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 long time may proceed sluggishly, almost asymptomatically. Acute form 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 chair arm;
pain where the Achilles tendon attaches to the heel bone;
subsiding of pain in horizontal position(if the symptoms described above are present in daytime, and at night during sleep they subside or disappear altogether - we're talking about about Schinz's disease)

Atrophy, hyperesthesia of the skin in heel area, atrophy of the lower leg muscles is 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 picture, 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) on x-ray the separation of parts will be clearly expressed 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 diagnosis. 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– 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):

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.
Physiotherapy procedures include ultrasound and electrophoresis.
Warming compresses – they are convenient to use at home.
The use of anti-inflammatory and analgesic ointments.
Warm baths.
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.

A pathology such as osteochondropathy of the calcaneus in children is diagnosed in adolescence, during the period of perestroika hormonal levels. The disease is characterized by degenerative disorders in the bone structure, which lead to deformation changes in individual areas of the foot. In this case, the affected areas of the bone succumb to necrosis and become fragile, which increases the risk of a fracture at the slightest impact.

Reasons for the development of osteochondropathy

As a rule, the initial stage of pathology formation provokes aseptic necrosis scaphoid foot, which causes a fracture and is accompanied by separation of bone tissue fragments. Next, the pathologically changed tissues are reabsorbed. With timely treatment, the affected areas are completely restored. IN advanced cases an inflammatory process develops, which leads to complex deformations. The main reason for the formation of the pathology has not been established. Injuries can trigger the development of degenerative disorders. heavy loads on the bones and soft tissues of the foot, as well as associated systemic diseases.

Basically, necrosis of the scaphoid bone occurs due to impaired blood circulation and tissue nutrition. In the initial stages, osteochondropathy does not manifest itself. Diagnosed when there is a pronounced inflammatory process in the affected areas of the bone.

The pathology may be hereditary.

There are a number negative factors, which can accelerate bone tissue degeneration:

genetic predisposition;
dysfunction of the endocrine system;
systematic inflammatory processes;
disturbance of phosphorus-calcium metabolism;
pathology vascular system with changes in the circulatory process.

How to recognize?

Bright severe symptoms lesions of the calcaneus are observed in girls during the formation of hormonal levels. The main symptom of the disease is pain, which leads to changes in gait and fatigue muscle tissue. Pain occurs acutely during physical activity and even long stay in a static position. If there is bilateral damage to the legs, the child stops leaning on his heels when walking and places emphasis on his toes. In this case, excessive loads occur on the forefoot, which can provoke the development of flat feet and deformation of the toes.

The disease provokes severe degenerative damage to bone tissue.

With the development of osteochondropathy of the calcaneus, children are limited in physical activity, which leads to atrophy muscle fibers and a decrease in their tone. This condition manifests itself muscle weakness And aching pain V soft tissues. Changes in gait have a pathological effect not only on the feet, but also on other parts lower limbs. The disease can spread to the area of the talus of the ankle, hip and spinal column. The risk of developing pathology increases sesamoid bone first metatarsophalangeal joint. If Schinz's disease or osteochondrosis of the calcaneus occurs, the symptoms are complemented by an increase in local temperature, swelling and hyperemia of the skin, as well as an increase in the intensity of pain and a significant impairment of mobility in the affected areas.

Diagnosis of osteochondropathy of the calcaneus in children

To put accurate diagnosis and differentiate osteochondropathy from other pathologies degenerative nature, the doctor collects an anamnesis of complaints, a history of concomitant diseases of the child, and conducts visual inspection stop. Further diagnostics boils down to the application of a number of studies presented in the table:

How is the treatment carried out?

The device has a shock-absorbing effect on the foot.

First of all, use conservative treatment, which consists of drug therapy, orthopedic correction and means physical rehabilitation. Surgical intervention in childhood is carried out extremely rarely. To relieve pain in osteochondropathy, non-steroidal anti-inflammatory drugs (Ibuprofen, Nurofen) are used in minimal dosages that are acceptable for children of a certain age. Mineral-vitamin complexes are prescribed to saturate tissues with B vitamins and calcium. To normalize blood circulation and correct gait, use orthopedic insoles. If necessary, fix the leg with a plaster or bandage. Good therapeutic effect provide folk remedies in the form of warm compresses and warm baths with the addition of sea salt.

To improve blood circulation and strengthen muscles, physical rehabilitation means such as exercise therapy and massage are used. Physiotherapeutic procedures have an analgesic and anti-inflammatory effect. For this purpose the following is used:

drug electrophoresis;
magnetic therapy;
mud applications;
phonophoresis.

Consequences of osteochondropathy

IN neglected form pathology acquires chronic nature and provokes the development of concomitant degenerative disorders, which often leads to disability of the child. Long-term therapy for late stages osteochondropathy provokes a violation of the sensitivity of the skin and soft tissues.

Prevention

Preventive measures involve regular examination by a doctor in order to diagnose disorders on early stages. It is important to ensure that the child alternates physical activity and rest. Courses have a good preventive effect therapeutic massage. To protect your baby’s feet from deformation changes, you need to choose comfortable shoes. It is recommended to take vitamins periodically as prescribed by your doctor.

Reduced blood circulation in the heel bone contributes to destructive changes and destruction of spongy tissue. This pathological disorder is called osteochondropathy of the calcaneus, osteochondrosis of the calcaneal tuberosity, as well as Schinz's disease. The risk group includes children and adolescents. The disease is most often observed in children 7-12 years old, it is equally common in both sexes, but girls get it earlier (7-9), and boys later (10-11).

With this pathology, the blood supply to the heel bone is disrupted, which leads to the fact that the process of ossification of the heel tubercle does not occur. Often a unilateral injury is diagnosed, although in medical practice bilateral damage also occurs.

What it is

The calcaneus is the largest bone in the human foot. Structurally it is spongy bone and it is she who is most exposed heavy loads when walking, practicing sports, dancing and other active movements.

Tendon nodes and ligaments are attached to it, and on the back surface there is a heel tubercle, to which it is attached Achilles tendon located in constant voltage while driving. With such a load, bone tissue does not receive enough blood and starves, which contributes to a change in their structure.

What causes pathology

The main reason causing disease has not been established, but doctors consider the main driver of the development of pathology to be increased load on the heel bone, Achilles tendon, as well as frequent injuries heels. Such phenomena are typical for children involved in dancing, ballet, and also active species sports. In childhood, the skeleton and circulatory system are not fully formed, and constant load leads to insufficient blood supply to bone tissue. They are poorly nourished, and gradual death (necrosis) occurs, loosening of bone surfaces that are often subject to stress, in in this case calcaneal tubercle.

Other factors that provoke the development of the disease are:

heredity;
microtraumas;
systemic diseases;
calcium absorption disorder;
endocrine pathologies.

Frequent infectious diseases together with hereditary factor give impetus to the development of osteochondropathy of the heel. If a child has a hereditary history of a small number or narrowed capillaries supplying blood to the heel, then infectious lesion and injuries contribute to their destruction. This leads to decreased blood circulation in the heel bone and impaired ossification.

Phases of development

The destruction of the heel bone occurs gradually. And if you spend timely treatment, then you can stop the development of osteochondropathy by initial stage development. But in the absence therapeutic procedures the outcome of the disease is unfavorable.

Phase aseptic necrosis is the first stage in the development of the disease. It is characterized by a violation of the blood supply to bone tissue caused by one or more reasons. Due to poor nutrition, tissue cells die. This process lasts up to six months and does not manifest itself in any way.

The second phase is impression. Unlike the first, when no one suspects the disease due to the absence of signs, this degree can be diagnosed using an x-ray. In the second phase, a depressed fracture occurs when, under load, parts of the bones fit into others. This period also lasts six months.

In the fragmentation phase, the bone is divided into parts. Such pathological changes clearly visible on x-ray. This makes it possible to diagnose osteochondropathy in a child.

The resorption phase is characterized by the appearance inflammatory process in the heel bone. Dead areas are dissolved by the body.

The last stage is reparation. During this period, the remaining parts of the heel bone are connected with cords from connective tissue. The process is clearly visible on x-rays. During this phase it is very important to correct treatment, the future health of the child’s feet depends on it.

Clinical picture

The initial stage of the disease is asymptomatic. Later as it progresses degenerative changes the child appears:

limping;
swelling of the heel tubercle area;
limited movement of the foot.

Initially, the child’s pain appears after severe physical activity. The syndrome is characterized acute pain, which subsides at rest and resumes after exercise. It is not difficult to notice abnormalities in a child. He has a limp and tries not to put any weight on his heel, so he walks on his toes.

Above the heel tubercle you can find a swelling that hurts when pressed, but visible changes no (hyperemia, local temperature). Upon examination, slight atrophy of the lower leg muscles is noted, as well as increased sensitivity of the skin in the damaged area. Due to pain, foot movement is impaired. In more late phase As the disease progresses, deformation of the heel bone is observed.

An important feature that distinguishes osteochondropathy from other leg diseases is the appearance of sharp pain immediately after resting on the heel. The pain does not go away after the patient “disperses”, but rather intensifies during the process of movement.

Diagnostic procedures

The diagnosis is made by an orthopedist based on:

survey;
inspection;
X-ray examination;

X-ray of the calcaneal tuber, its lateral projection is the most informative. In the initial phase, the image shows compaction of the bone tissue of the heel tubercle. Also noted heterogeneous structure ossification. At later stages, the presence of a depressed fracture, bone fragments, and the formation of new spongy substance of the damaged bone are determined.

To determine the extent of the disorder, an x-ray of both legs is taken and the images are compared. To clarify the diagnosis, an x-ray of the vascular system of the feet is taken. This makes it possible to determine the degree of circulatory disturbance in the bone tissue of the heel tubercle.

The technique is performed using contrast agent. After confirmation of violations of the vascular structure, treatment is carried out aimed not only at restoring the heel, but also at eliminating the cause that caused the pathology.

In addition, the orthopedist conducts differential diagnostics to distinguish osteochondropathy from other diseases of the skeletal system:

bursitis;
periosteum;
osteomyelitis;
tuberculosis lesions;
inflammation;
oncology.

The absence of inflammation confirms normal color skin in the damaged area, and a blood test shows ESR and leukocytes are normal. Tuberculosis and oncology can be excluded by the absence of:

fatigue;
decreased activity;
lethargy.

This disease is distinguished from bursitis and periostitis by the nature of the pain. In the first case, pain occurs after a period of rest and stops when the patient “disperses” a little. With osteochondropathy, pain always appears after exercise.

Healing procedures

For this disease, conservative treatment is carried out, which includes:

bed rest;
restriction of movements;
use crutches or a cane if necessary;
physiotherapy;
vitamin therapy.

At severe pain that cannot be relieved with painkillers, dissection is performed nerve ending, painful. This gives the patient some freedom of movement, but does not eliminate the cause. After this surgical intervention There may be a disturbance in the sensitivity of the skin in the affected area.

Treatment is carried out on an outpatient basis. To the patient for removal sharp pain a plaster splint is applied, and it is also recommended to use gel pads or orthopedic insoles when walking. Non-steroidal and vasodilators. Very important. You should not treat yourself because use of NSAIDs should only be prescribed by a doctor due to serious contraindications for use.

Using non-steroidal drugs You must strictly adhere to the recommended dosage and duration of treatment. For local application use ointment Voltaren, Traumeel. They relieve inflammation from the heel tubercle and reduce pain.

To improve the condition blood vessels B vitamins (B6, B12) are used. After removal acute symptoms patients resume putting weight on their legs, but doctors recommend walking in shoes with wide, stable heels, since a flat sole increases the load on the heel.

Physiotherapy includes the use of:

electrophoresis with lidocaine;
ozokerite applications;
ultrasound;
microwave therapy.

Traditional medicine uses contrast baths and compresses. Add to bath water medicinal herbs And essential oils. Are effective salt baths, which have an antibacterial effect. Good result apply compresses with dimexide. Medicine You can easily buy it at a pharmacy. Dilute the medicine in half with water, moisten a napkin there and apply it to the damaged area. Attach as a compress, wrap in woolen cloth. Keep the compress for half an hour.

Traditional methods are additional method treatment to the therapy prescribed by the doctor, because when the disease is diagnosed in children or in adolescence, the manifestations of the disease may go away on their own over time (after the foot has fully formed). But when the pathology is detected in adults, then without qualified treatment not enough.

Treatment of heel osteochondropathy in children

Therapy for osteochondropathy in children depends on the degree of damage to the heel tubercle. If the disease is detected in the first phases of development, then drug treatment is not carried out. Doctors advise reducing stress on the injured foot. In this case, active sports, dancing or ballet are excluded. You need to choose the right shoes.

Buy your child comfortable shoes without hard backs, use special orthopedic insoles. The orthopedist advises you to monitor your gait and not transfer your body weight to injured leg. In case of severe pain, a plaster splint may be applied to the foot. Of the medications used to relieve severe pain syndrome in pediatric practice (after 14 years) diclofenac and nimesulide are used. If children are younger than this age, then use ibuprofen.

The child is prescribed physiotherapy, including electrophoresis with novocaine or brufen. A massage of the sore foot is required. The exercise therapy doctor is developing special complex exercises that help improve blood circulation in the sore leg. At home, baths with sea salt, paraffin applications. After these procedures, foot pain should completely disappear within 2 years. Some pain persists until the end of the foot formation process. After this, no discomfort is felt.

After removal acute symptoms The child is allowed to return to normal physical activity and sports. But this needs to be done gradually. You should not strain your leg too much immediately after relieving the pain, as this causes a relapse of the disease.

Disease prognosis

If the disease is detected in a child on time, then after conservative treatment, as well as after the end of the growth period of the foot, no disturbances or changes are observed. IN in some cases, at untimely treatment When serious deformations of bone tissue have occurred, the deformation remains forever. This complicates the process of movement, causes mild pain and makes it difficult to select shoes.

The diagnosed pathological process in adults does not go away on its own and requires medical care, which involves the use of medications or surgery. After therapeutic manipulations The prognosis of the disease is positive and if the orthopedist’s recommendations are followed, relapses of the disease are very rare.

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 bone, cartilage.”

This disease occurs due to local circulatory disorders due to following reasons: injuries, heredity, etc. Osteochondropathy is dangerous disease, which is on early stages impossible to detect.

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 gravity own body. It can be muscle cramps or ordinary muscle strain.

In most cases, osteochondropathy affects 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 various diets.

Spinal osteochondropathy

Spinal osteochondropathy, 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. The more susceptible areas of the body are the spine (its thoracic region), thoracolumbar region.

Scheuermann-Mau disease has not been fully studied by scientists and doctors. Osteochondropathy of the spine proceeds rather sluggishly and unnoticed, has no pronounced pathological process. At the initial level, patients experience increased fatigue various departments spine, periodic painful sensations in the back area, which disappear after sleep.

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 towards X-thoracic vertebra, and a “flat back” is formed. The above changes are continuously associated with varus deformation of the legs, as well as with flattening chest person.

At severe course osteochondropathy of the spine occurs in the patient nervous disorders(type 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, the person will not even be able to turn his head.

Limited spinal movement may be caused by decreased height of the spinal discs or the development of contracture of the rectus dorsi muscles.

Diagnosis of spinal osteochondropathy

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. Heaviness of this disease characterized by the degree of deformation of the vertebral bodies. Treatment of osteochondropathy in adults is quite painful.

Osteochondropathy in children

Osteochondropathy in children has 4 stages of development:

Osteochondropathy of the head femur(this disease is called Legga-Calvé-Perthes), as well as heads 2 and 3 metatarsal bones (this disease is called Alloan-Keller). This disease can manifest itself as an effect on the phalanges of the fingers or on the sternal end of the clavicle.
Osteochondropathy of the navicular bone of the foot, vertebral bodies or sesamoid bone of the metatarsophalangeal joint.
Tuberosity tibia(referred to as Schlatter's disease), calcaneal tubercle or pubosciatic joint.
Partial osteochondropathy elbow joint, hip and other joints.

After past 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.

Osteochondropathy of the foot

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.

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 to the affected leg. Sometimes osteochondropathy of the foot is accompanied by local swelling, and irritation or redness may also appear.

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.

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 of the calcaneus

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.

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.

Treatment of osteochondropathy

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

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Osteochondropathy is degenerative disease, which affects bone tissue, causing its destruction. Usually the pathology is diagnosed in children and adolescents, most often in girls from ten to sixteen years old.

Osteochondropathy of the calcaneus requires mandatory consultation with a specialist. The pathology is very painful for the patient and, if untreated, causes difficulties in adult life. A bone mound forms on the heel, which constantly hurts and interferes with movement.

Osteochondropathy of the heels

Osteochondropathy of the calcaneal tuberosity occurs for the following reasons:

for pathologies of the endocrine system;
for problems with calcium absorption;
as a complication after injury;
due to metabolic disorders;
in case of circulatory disorders.

Doctors have not yet established the exact cause of the pathology, especially since the disease affects different people age groups goes differently. In adults, the hyaline cartilage is destroyed, and in children, the epiphyseal zone. Children in the first years of life most often suffer from central part bones.

Osteochondropathy of the calcaneus in children

Osteochondropathy of the left or right calcaneus is accompanied by characteristic symptoms:

severe heel pain;
swelling above the tubercle of the heel bone;
lameness due to pain;
atrophy of the skin around the affected area.

Symptoms of osteochondropathy develop gradually, at first the pain is mild and bothers you during prolonged physical activity. At this time, aseptic (non-infectious) necrosis of bone tissue occurs.

When a bone becomes too thin, it breaks, which is accompanied by very severe pain. If measures are not taken at this stage, the destroyed tissues will begin to gradually dissolve and the pain will subside, but the bone will remain deformed, which will provoke complications in the form of inflammation and osteoarthritis of the foot.

At competent therapy in children it is possible to restore the heel bone, and the child returns to normal life without the consequences of the disease.

Treatment of osteochondropathy of the calcaneus in children

Osteochondropathy of the calcaneus initial stage It is asymptomatic, so it is very rarely diagnosed in a timely manner. Usually the child is brought to the doctor only when bone collapsed and a fracture occurred. At the appointment, the doctor examines the sore leg and prescribes an x-ray.

Treatment for children is conservative, since a small organism is capable of rapid recovery. Therapy consists of the following activities:

bed rest;
taking painkillers;
taking anti-inflammatory drugs;
physiotherapeutic treatment, compresses and baths;
balanced diet.

If conservative treatment does not help, the patient may be recommended to undergo surgery.

After pain and inflammation are relieved, a rehabilitation period is prescribed, which includes massage and simple exercises for the foot. It is also recommended to continue physical therapy treatment for a speedy recovery.