Osteochondropathy refers to degenerative-dystrophic diseases, as a result of which an aseptic type of necrosis of some bone structures develops. Most often, pathology appears in the calcaneal and femoral bones, apophyses of the vertebral bodies and in the tibia.
Description of the disease
Heel bone disease affects most often in children during adolescence. If you do not engage in treatment, then in the future osteochondropathy can develop into serious problems. Due to the increased load, it is the bones of the feet that are most often subjected to chondropathy. The disease is localized, as a rule, in the form of aseptic necrosis in the metatarsal, scaphoid and calcaneal bones, in the tarsus and in the trochlea of the talus.
It is not possible to establish the exact causes of osteochondropathy of bones. However, doctors put forward several versions of its etiology. If we talk about adolescents, then pathology often occurs against the background of a failure in the formation of bone tissue. In the case of adults, it is more aboutincreased physical load on the skeletal system of the body. Often the cause of the origin 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 severity 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, necrosis of the foot affects girls in adolescence. The disease is localized in the head of the second metatarsal bone, proceeds in a rather mild form and does not pose a serious danger to the he alth of the child. Of the manifestations, pain during physical exertion, mild lameness and swelling can be noted. The therapy is carried out by conservative methods, the main condition for a successful recovery is the immobility of the affected area.
Keller's disease
Keller's disease is a little less common. It affects children of preschool age of different sexes. There are two types of this pathology:
1. The navicular bone in the center of the foot undergoes necrosis.
2. A disease in which the head of the metatarsal bone, located at the base of the toes on the foot, is under attack.
Osteochondropathy of the calcaneus is also manifested by slight swelling and redness of the skin, as well as pain. The main areas of therapy are physiotherapy, vitamin support for the body and low intensity load on the sore leg.
Shinz's disease
Teenagers may also be susceptible to Haglund Schinz disease, or osteochondropathy of the calcaneum. In this case, a violation occurs in the formation of bone tissue. As a result of such a failure, aseptic necrosis begins in the spongy part of the bone. The disease can affect one or both limbs. Shinz's disease is manifested by severe edema, numbness and muscle atrophy in the shin area. With an exacerbation, a severe painful syndrome appears that does not allow the child to move around.
Rare species
Rarer types of osteochondropathy are lesions of the sesamoid bones, otherwise known as Muller's disease. The pathologies of the spinal column include Scheuermann-Mau disease. The latter is most common among adolescents under 18 years of age. This pathology leads to a curvature of the spine, which causes back pain and decreased performance. A lesion of the femur is called Legg-Calve-Perthes disease. The most likely causes of this disease include the resulting hip injuries. They can disrupt blood flow and lead to necrosis. Why does osteochondropathy of the calcaneus occur?
Reasons
We mentioned above that the exact causes of osteochondropathy cannot be established, however, doctors tend to believe that there are several factors that significantly increase the risk of developing this pathology. A genetic component is considered a special prerequisite. Quite often, necrosis of the calcaneus begins in those children whose parents also had this osteochondropathy of any localization in history. They could have affected any type of bone in the foot, including the navicular and metatarsal head, as well as the spine or other bones of the lower extremities.
Children quite often face the fact that the heel hurts and it hurts to attack (how to treat, we will consider below), if they are diagnosed with endocrine disorders, disruptions 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 absorption 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 brittleness and sensitivity of bone tissues.
Another possible factor leading to osteochondropathy of the calcaneus is an increased physical load on the leg in general and in particular on the foot. Muscles tend to contract intensively during exercise, which leads to microtrauma, and this, in turn, can weaken the protective properties of joints and bone tissues. Such a decrease in resistance qualities can 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 overweight people with metabolic problems experience increased stress.
The last factor that can cause osteochondropathy of the calcaneus (ICD) is called trauma. Due to the structure of the skeletal systemThe feet are most at risk of injury. Most often this occurs as a result of squeezing the bones when falling from a great height, as a result of an accident or damage at work.
Symptoms of osteochondropathy of the calcaneus
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 these areas of the foot 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 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 while running and walking, and after a long standing position. If the pathology touches both legs, then the child tends to start walking on his toes, since the emphasis on the heels causes severe pain. And since in this case, pressure on the fingers increases, without proper treatment, this can lead to hallux valgus deformity of the big toe, flat feet or curvature of the feet.
The child's heel hurts, it hurts to step on. How to treat?
Active sports, like any other intense physical activity, are prohibited for children diagnosed with osteochondropathy of the heel bones. This restriction can cause muscle and skin atrophy, as well asbreak 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. The 2nd and 3rd metatarsals and thumb are the most commonly affected with 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 pathology increases if the patient has flat feet. Treatment of osteochondropathy of the calcaneus should be timely.
Stages
The development of pathology can be conditionally divided into four stages, each of which is characterized by its own symptoms and severity of bone tissue damage.
The initial stage lasts up to several months. At this stage, tissue necrosis occurs. Pain develops in the back and limbs. The x-ray does not show pathological changes, which makes the diagnosis of the disease at this stage quite difficult.
The duration of the second stage is about a year. During this time, there are serious changes in the tissues of the bones, its slow degeneration occurs. Another name for this stage is the compression fracture stage. The hip, spine and feet are most affected.
The third period of illness lasts up to three years. At this stage, areas of bone tissue that have been exposed to necrosis are resorbed.and are replaced by osteoclasts.
The fourth stage is characterized by tissue regeneration. With proper and timely therapy, the cure occurs without further complications. If left untreated, progressive osteoarthritis can develop.
Diagnosis of osteochondropathy of the calcaneus
If a child is worried about their feet and complains of pain in their back or legs, they should 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 an x-ray examination. In this case, the picture is taken not only of the bones of the heel, but of the entire foot, since there is a possibility of complications or comorbidities. An x-ray can show injuries, arthrosis, and other bone conditions in the foot.
In addition to x-rays, ultrasound or magnetic resonance imaging is performed to clarify the diagnosis. In some cases, the doctor may also prescribe arthroscopy. This is necessary to rule out osteomyelitis, bone tuberculosis, bursitis, or malignancy.
Treatment
Conservative methods in the treatment of osteochondropathy are used most often. This includes taking medications, performing special physical therapy exercises and physiotherapy. Another method of treating Haglund's disease is surgery, which is prescribed only as a last resort, when conservativetreatment has shown its ineffectiveness or in the advanced form of the disease. The main disadvantage of the operation, as a rule, is the loss of feeling 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 to reduce the pain 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, these 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 pediatric patients are most susceptible to the disease. In exceptional cases, with severe pain, a blockade of the heel area with "Lidocoin" or "Novocaine" can be performed. Sometimes a cast or orthosis may be required.
Therapy of osteochondropathy of the calcaneus in children must necessarily include a course of physiotherapy. As a rule, this is electrophoresis withusing "Analgin" or "Novocaine" or ozokeritotherapy. It is no less effective to use compresses and baths with soda, s alt and special herbal preparations. In complex therapy, vitamins and calcium are also prescribed. During the rehabilitation period, a course of massages and therapeutic physical culture is carried out to restore the mobility of the feet.
Sometimes heel surgery may be needed.
Prevention and possible complications
If you start treatment of osteochondropathy untimely, 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, which arose against the background of osteochondropathy, does not go away even after a successful cure for this pathology.
Therapy of a disease in an 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 heel tubercle may begin to deform and bulge, making 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. Genetic predisposition involves a course of preventive therapeutic massage several times a year, as well as performing a certain set of physical exercises.
Not less thanThe choice of shoes is important. It is necessary to choose comfortable shoes for the child, according to size, in order to avoid excessive squeezing of the foot. Girls in adolescence are contraindicated in wearing shoes with high heels. It is also necessary to take vitamins and calcium regularly to strengthen the bone structure.
