TALALGIA FOOT, heel spurs | by Dr. Ugo Perugini |
vary according to the affected areas, namely:
- the soft areas (inflammation of the tendon, fasciitis, bursitis, etc.).
- areas bones (stress fractures, heel spurs, arthritis astragalus-calcaneus, tumors, etc.).
It is not uncommon that even the pain occurs due to postural alterations that somehow alter the structure of the breech and loading area. This can happen for various reasons such as overweight or obesity, unsuitable footwear, sports.
sports most at risk are running, soccer, volleyball, basketball, walking and all those disciplines which involve considerable effort to the heel region. Do not underestimate the shoes used for these sports to be equipped with a special heel, called shocks absorber, capable of reducing vibration and stress from the impact. Women who change from shoes high-heeled shoes with low heel may suffer because the pressure on the heel bone and ligaments increases in relation to the reduction in height of the heel.
Different types of heels
The heel strikes may be located at the longitudinal arch, with or without concomitant pain in the heel, and this is known as plantar fasciitis . Typically, the pain originates in the middle part of the arch and by palpation can also detect nodules in turn painful. The pain appears in the morning when you start to walk go after, even if it can resume suddenly during the course of the day. One of the most frequent causes of plantar talalgia , however, is the heel spurs, also called heel spur , a bony protrusion of the heel that may be of congenital origin or formed later. The heel spur is generated because, for various reasons that will be seen below, the pronation, ie the support of the foot during walking is impaired, and this causes inflammation through a continuous traction of the plantar fascia at the point of insertion on the calcaneus.
There are many causes of this disease and of key physical activity that increases the stress and repeated microtrauma possible - perhaps turning wears inadequate (narrow or hard edges) or moving on land not suitable - which increases the pressure el 'cause bruising and irritation on the heel of the plantar surface of the foot. Not to mention, the overweight or erroneous and misleading positions.
But, of course, the disease can also be caused by systemic and metabolic diseases, among which are worth mentioning:
- rheumatoid arthritis
- gout
- the collagen
- rheumatic diseases, etc..
The calcaneus, where there is a secondary center of ossification on where you put the tendon calcaneus (Achilles tendon) may also be exposed to osteochondrosis, a disease that is characterized from a degenerative-necrotic nuclei of ossification in growth. It is striking, in fact, young people between 8 and 13 years, with localized pain in the back of the heel, particularly after a long journey. Evolution is not always benign and cause deformities even if local the duration of the condition can be quite long. In these cases, just a foot that limits the rear-end collision, giving at times when the pain becomes more acute anti-inflammatory drugs. In the elderly, the cause of the heel strikes may be sought, however, the progressive atrophy of the fat pad infracalcaneare, due to the aging of tissues.
Haglund's deformity and bursitis. Diagnosis
The heel spurs, also called Haglund's deformity or "pump bump" is a exostoses , which is a congenital bone excrescence that most often appears at the posteromedial side of the bone.
This form of bone changes very frequently due to bursitis, which is inflammation of the bursae anterior to the Achilles tendon and back of the heel, since it causes abnormal pressure on the point where it is and resulting in pain.
The doctor, having collected from the patient all the information needed to classify the disease, since the mode of onset, making an objective examination of the party concerned, requesting the support of X-rays, ultrasound, magnetic resonance, able to detect the presence of spurs or bone deformities. The
bursitis back of the Achilles tendon can be diagnosed either by radiographic, which directly verifying the painful part that usually has a diffuse swelling and the formation of a thick callus on the back surface of the calcaneus. Possible therapies
course the treatment depends largely on the nature and extent of any damage talalgia of the heel bone. Remember that a mild disease heals within a few days. If pain persists beyond two weeks is necessary to use a specialist visit.
The main board, especially if the patient is involved in physical activity continues, is to immediately suspend, waiting to resume its normal function. The heel pain, in fact, should not be underestimated under any circumstances, but above all we must avoid the risk of possible deterioration that can occur if you do not suspend the motor activity, because of what are called compensatory paramorphism. People who suffer from heel strikes tend to limit the load on the sore foot, but by adopting a particular posture or incorrect change in an unnatural gait. Which, in the long run, it might cause problems, even serious, pelvis, spine and knees.
The first intervention during the acute phase of illness is, as always, the application of a bag of ice on the painful area. In cases of plantar fasciitis can be effective to undergo stretching exercises, in addition to the plantar fascia, involving the calf and the Achilles tendon. Then, we may resort to the use of orthotics, the so-called "discharge", guardians night, knee-highs that promote walking and, in cases where the pain is particularly intense, it may be advisable the use of crutches. Profits also physiotherapy, possibly also using crioultrasuoni , a recent therapy that has proven effective in many cases, and iontophoresis. It is clear that if the heel does not resolve within a period of two weeks, it is necessary to conduct further investigations and clinical examinations.
In the case of heel spurs overt can proceed immediately to treatment with infiltrative local injections of a corticosteroid and an anesthetic on a weekly basis, with the utmost care to avoid injecting directly into the Achilles tendon, until the complete resolution of pain.
addition, to ensure that the tension on the plantar fascia is loose, you can use a bandage containment foot, taking the heel cups and pads that can help to reduce noise at the heel.
is clear that once eased the pain, you must perform an examination posturographic and biomechanical assessment, orthotic device to achieve an ad hoc basis.
To cope with bursitis of the Achilles tendon can be used with NSAIDs, proceeding, whenever there is a payment inflammatory fluid intake.
In severe cases, and to prevent relapse may be considered appropriate to intervene with surgical excision dell'esostosi and / or bag.
bursitis back of the Achilles tendon can be diagnosed either by radiographic, which directly verifying the painful part that usually has a diffuse swelling and the formation of a thick callus on the back surface of the calcaneus. Possible therapies
course the treatment depends largely on the nature and extent of any damage talalgia of the heel bone. Remember that a mild disease heals within a few days. If pain persists beyond two weeks is necessary to use a specialist visit.
The main board, especially if the patient is involved in physical activity continues, is to immediately suspend, waiting to resume its normal function. The heel pain, in fact, should not be underestimated under any circumstances, but above all we must avoid the risk of possible deterioration that can occur if you do not suspend the motor activity, because of what are called compensatory paramorphism. People who suffer from heel strikes tend to limit the load on the sore foot, but by adopting a particular posture or incorrect change in an unnatural gait. Which, in the long run, it might cause problems, even serious, pelvis, spine and knees.
The first intervention during the acute phase of illness is, as always, the application of a bag of ice on the painful area. In cases of plantar fasciitis can be effective to undergo stretching exercises, in addition to the plantar fascia, involving the calf and the Achilles tendon. Then, we may resort to the use of orthotics, the so-called "discharge", guardians night, knee-highs that promote walking and, in cases where the pain is particularly intense, it may be advisable the use of crutches. Profits also physiotherapy, possibly also using crioultrasuoni , a recent therapy that has proven effective in many cases, and iontophoresis. It is clear that if the heel does not resolve within a period of two weeks, it is necessary to conduct further investigations and clinical examinations. In the case of heel spurs overt can proceed immediately to treatment with infiltrative local injections of a corticosteroid and an anesthetic on a weekly basis, with the utmost care to avoid injecting directly into the Achilles tendon, until the complete resolution of pain.
addition, to ensure that the tension on the plantar fascia is loose, you can use a bandage containment foot, taking the heel cups and pads that can help to reduce noise at the heel.
is clear that once eased the pain, you must perform an examination posturographic and biomechanical assessment, orthotic device to achieve an ad hoc basis.
To cope with bursitis of the Achilles tendon can be used with NSAIDs, proceeding, whenever there is a payment inflammatory fluid intake.
In severe cases, and to prevent relapse may be considered appropriate to intervene with surgical excision dell'esostosi and / or bag.
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