Osteochondropathy refers to degenerative-dystrophic diseases, due to which an aseptic form of necrosis of some bone structures develops. Most often, the pathology appears in the calcaneus and femur, apophyses of the vertebral bodies and in the tibia.
Disease Description
The calcaneus affects the disease most often in children during adolescence. If you do not deal with treatment, then in the future, osteochondropathy can develop into serious problems. Due to the increased load, it is the bones of the feet that most often undergo chondropathy. The disease is localized, as a rule, in the form of aseptic necrosis in the metatarsal, scaphoid and calcaneus bones, in the tarsus and in the talus.
It is not possible to establish the exact reasons for the appearance of otseochonropathy of bones. However, doctors put forward several versions of its etiology. If we talk about adolescents, then the pathology often occurs against the background of a malfunction in the formation of bone tissue. In the case of adulthood, we are more likely talking about increased physical activity on the skeletal system of the body. Often the cause of the origin of the disease remains unclear. In this article, we will consider types of calcaneus osteochondropathy .
Types of Osteochondropathy
To understand the severity of this pathology and the degree of violation in the musculoskeletal system, it is necessary to consider the most common types of osteochondropathy. Most often, foot necrosis affects girls in their teens. The disease is localized in the head of the second metatarsal bone, proceeds in a rather mild form and does not pose serious health risks for the child. Of the manifestations, painful sensations during physical exertion, slight lameness and swelling can be noted. Therapy is carried out by conservative methods, the main condition for a successful recovery is the immobility of the affected area.
Keller's disease
Slightly less often, you can meet Keller's disease. Preschool children of different sexes suffer from it. Two types of this pathology are distinguished:
1. The scaphoid in the center of the foot undergoes necrosis.
2. A disease in which under the blow is the head of the metatarsal bone, located at the base of the fingers on the foot.
Heel osteochondropathy is also manifested by small edema and redness of the skin, as well as pain. The main directions of therapy are physiotherapy, vitamin support of the body and low intensity of the load on the sore leg.
Sinz disease
Adolescents may also be affected by Haglund Schinz disease, or calcaneal tuber osteochondropathy. In this case, the violation occurs in the formation of bone tissue. As a consequence of such a malfunction in the trabecular part of the bone begins aseptic necrosis. The disease can affect both one and both limbs. Shinz's disease is manifested by severe edema, numbness and muscle atrophy in the lower leg. With exacerbation, a strong painful syndrome appears, which does not allow the child to move.
More rare species
Rarer types of osteochondropathy are lesions of the sesamoid bones, otherwise called Muller’s disease. Scheuermann-Mau disease is considered a pathology of the spinal column. The latter is most often found among adolescents under 18 years of age. Such a pathology leads to curvature of the spine, which causes back pain and decreased performance. Damage to the femur is called Legg-Calve-Perthes disease. The most likely causes of this disease include received hip injuries. They can disrupt blood flow and lead to necrosis. Why does calcaneus osteochondropathy occur?
Causes
We mentioned above that it is not possible to establish the exact causes of osteochondropathy, however, doctors tend to believe that there are several factors that significantly increase the risk of developing this pathology. A special prerequisite is considered a genetic component. Quite often, calcaneus necrosis begins in those children whose parents also had this history of osteochondropathy of any localization. They could have affected any kind of bone in the foot, including the scaphoid and metatarsal head, as well as the spine or other bone tissue of the lower extremities.
Children quite often face the fact that the heel hurts and it hurts to advance (how to treat, we will consider below) if they are diagnosed with endocrine disorders, malfunctions in the hormonal background or the metabolic process. Bones are susceptible to the development of pathologies in the presence of congenital diseases associated with poor digestibility of various minerals and vitamins necessary for the child's body. This is especially true for calcium, since the state of joints and bones directly depends on it, and its deficiency causes fragility and sensitivity of bone tissues.
Another possible factor leading to osteochondropathy of the calcaneus is increased physical activity 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 the protective properties of joints and bone tissues. Such a decrease in resistant qualities can increase the risk of developing an inflammatory process. It affects the spongy bone structure, and intense physical exertion affects the compression of small vessels in it. The lower limbs of people with overweight and metabolic problems experience an increased load on themselves.
The last factor that can cause osteochondropathy of the calcaneus (ICD) is called 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 a high height, as a result of an accident or damage to the workplace.
Symptoms of calcaneus osteochondropathy
Due to the fact that hormonal disorders are more common in girls, they are at risk of developing osteochondropathy. The main sign of pathology is intense pain in the heel and toes, since it is these areas of the foot that are subject to the greatest load. As a result of the development of the disease, the quality of life of the patient is significantly reduced, the legs quickly get tired, and gait is disturbed. It is important to identify the causes of calcaneus osteochondropathy so that therapy is correct.
Pain syndrome, as a rule, appears after a heel injury, physical activity - both during running and walking, and after a long time in a standing position. If the pathology hurts both legs, then it is common for the child to start walking on toes, as the emphasis on the heels causes severe pain. And since in this case the pressure on the fingers increases, without proper treatment, this can lead to hallux valgus deformity of the thumb, flat feet or curvature of the feet.
The child’s heel hurts, it hurts to advance. How to treat?
Active sports, like any other intense physical activity, are prohibited for children who are diagnosed with ostechondropathy of the calcaneus. Such a 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 in a natural mode, since the emphasis on the foot causes severe pain. 2-3 metatarsal bones and thumb most often suffer from osteochondropathy.
Since the gait of a person changes due to the disease, further progress in pathology can cause pain in the ankle, calf and thigh muscles, as well as in the spine. The chance of a pathology of the metatarsal bones increases if the patient has flat feet. Treatment of calcaneus osteochondropathy should be timely.
Stages
The development of pathology can conditionally be divided into four stages, each of which has its own symptoms and severity of bone tissue damage.
The initial stage lasts up to several months. At this stage, tissue necrosis occurs. Pain in the back and limbs develops. The x-ray does not show pathological changes, which makes the diagnosis of the disease at this stage rather complicated.
The duration of the second stage is about a year. During this time, serious changes occur in bone tissue, its slow degeneration occurs. Another name for this stage is the stage of compression fracture. The most affected are the thigh, spine, and foot.
The third period of the disease lasts up to three years. At this stage, areas of bone tissue exposed to necrosis dissolve and are replaced by osteoclasts.
The fourth stage is characterized by tissue regeneration. With proper and timely therapy, cure occurs without further complications. If untreated, progressive osteoarthrosis may develop.
Diagnosis of calcaneus osteochondropathy
If the child is anxious about the feet and complains of pain in the back or legs, you need to be examined by an orthopedist. The best option for further successful therapy is timely diagnosis.
When determining the 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 x-ray examination. In this case, the picture is taken not only of the heel bones, but also of the entire foot, since there is a likelihood of complications or combined pathologies. An X-ray may show injuries, arthrosis and other diseases of the foot bones.
In addition to x-rays, an ultrasound scan or magnetic resonance imaging is performed to clarify the diagnosis. In some cases, the doctor may also prescribe arthroscopy. This is necessary to exclude osteomyelitis, bone tuberculosis, bursitis or malignant neoplasms.
Treatment
Conservative methods in the treatment of osteochondropathy are most often used. This includes taking medication, performing special exercises of physiotherapy exercises and physiotherapy. Another method of treatment of Haglund's disease is surgery, which is prescribed only as a last resort, when conservative treatment has been shown to be ineffective or in an advanced form of the disease. The main drawback of the operation, as a rule, is called the loss of sensitivity of 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 to reduce the painful syndrome and prevent the development of flat feet. The most common brands of orthopedic insoles preferred by orthopedists are Ortmann and Solapro Viva. The latter are able to distribute the load from the affected heel to the entire foot, fixing the arches and not allowing them to condense. 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.
The duration of therapy and the dosage of the drug, as well as its choice, are determined by the attending physician, since children are most susceptible to the disease. In extreme cases, with severe pain, blockade of the heel area by Lidocoin or Novocain can be performed. A plaster cast or orthosis may sometimes be required.
Therapy of osteochondropathy of the calcaneus in children must necessarily include a course of physiotherapy. As a rule, this is electrophoresis using "Analgin" or "Novocaine" or ozokerite therapy. Compresses and baths with soda, salt and special herbal preparations are no less effective. In complex therapy, vitamins and calcium are also prescribed. During the rehabilitation period, a course of massages and therapeutic physical culture is performed to restore foot mobility.
Sometimes a calcaneal surgery may be necessary.
Prevention and possible complications
If you start treatment for osteochondropathy late, then the pathology can develop into a chronic form. In addition, there may be a threat of the development of other articular degenerative-dystrophic pathologies. Flat feet, arising against the background of osteochondropathy, does not pass even after a successful cure from this pathology.
Therapy of the disease in advanced form also does not pass without a trace. The development of necrosis reduces the sensitivity of the affected area, which does not go away even after a course of treatment or surgery. In addition, the calcaneal tubercle can begin to deform and bulge, which makes it impossible to wear some types of shoes in the future.
One of the types of prevention of osteochondropathy among children is regular visits to an orthopedist, especially when a child complains of pain in the foot area. A genetic predisposition involves conducting a course of preventive therapeutic massage several times a year, as well as performing a specific set of physical exercises.
Equally important is the choice of shoes. It is necessary to choose comfortable shoes for the child, in size, to avoid excessive squeezing of the foot. Girls in adolescence are contraindicated in wearing high-heeled shoes. It is also necessary to regularly take vitamins and calcium to strengthen the bone structure.