Calcaneus osteochondropathy in children

Preventive measures are associated with that part of the body that has been exposed to the pathological process.

So, to prevent pathology it is necessary:

  • Always wear comfortable and spacious shoes – for pain in the heel.
  • Engage in physical therapy and strengthen your back muscles in case of problems with the spine and at the same time do not bother yourself with excessive loads.
  • If your knees hurt during training, athletes are advised to sew foam pads into the mold.
  • Massage and swimming are indicated for the prevention of hip disease.

Shinz’s disease in children – what is it, and is it possible to get r >

Often, young athletes in adolescence are faced with a pathology such as Schinz disease. The disease is associated with the gradual destruction of the calcaneus, which is accompanied by pain. Lack of therapy can lead to lameness.

Sinz disease in children – what is it?

Haglund-Schinz disease in medicine is often referred to as calcaneus osteochondropathy. Physiologists have found that in humans, the complete formation of the musculoskeletal system ends by 17-18 years. If you expose the body to significant physical exertion before this age, there is a risk of developing Schinz disease. This explains the widespread pathology mainly in children involved in sports.

As a result of constant and frequent jumps and jumps, there is a violation of blood circulation in the calcaneal region. This gradually leads to necrosis, the death of the spongy tissue of the bone. Ossification occurs incorrectly, as a result of which a protrusion, a lump is formed in the calcaneal region. According to statistical observations, adolescent girls are more likely to suffer from pathology.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Sinz disease – causes

Haglund-Sinz calcaneus disease occurs due to non-infectious necrosis. This formation may occur as a result of:

  • genetic predisposition;
  • neurotrophic disorders;
  • metabolic failure;
  • transferred injuries of the calcaneus.

The main triggering factor that provokes Shinz’s disease in children (photo below) is the constant excessive mechanical load on the calcaneal tubercle, foot tendons. In the presence of a genetic predisposition in patients, a decrease in the number of blood vessels in this area or a narrowing of their lumen is observed. As a result of unfinished blood supply, the foot site begins to receive less nutrients, which leads to tissue necrosis and bone destruction. Contribute to the development of pathology:

  • overweight;
  • frequent injuries of the ankle joint;
  • diabetic angiopathy;
  • flat feet, clubfoot;
  • wrong shoes;
  • violation of blood circulation.

Haglund Schinz disease in children in most cases proceeds without complications. In addition to pain and tuber on the heel, which prevents the normal wearing of shoes, nothing bothers them. However, this does not mean that the disease does not require therapy. Lack of proper treatment can lead to lameness. Due to painful sensations, the child involuntarily, when supporting, transfers the load to the middle part of the foot and fingers.

Sinz disease – symptoms

Disease of the heel, Schinz, is characterized by the defeat of mainly one leg. Pathology begins with a sudden manifestation of pain in the heel. Lameness gradually appears, which attracts the attention of parents. Children often complain of aching pain after physical exertion, long walking, so parents often do not attach importance to this, attributing it to fatigue.

When examining the foot on the back of the heel, you can find a slight swelling. At the moment of touching, pressing it, the patient feels pain. As a result of such changes, the child loses the ability to lean on the heel, which forces many to walk on toes. Only the middle and forefoot are involved. Some patients may need to use crutches or canes (in rare cases).

Sinz disease – stages

Osteochondropathy of the calcaneal tuber develops gradually. Experts who studied Shinz disease identified 5 stages during the pathology:

  1. Aseptic necrosis of the calcaneal tuber is a violation of the nutrition of the bone tissue of the calcaneus, resulting in a focus of dead tissue.
  2. Impression (depressed) fracture – the necrosized portion of the heel becomes unable to withstand even normal physical exertion and is pressed through. As a result, some parts of the bone are wedged into others.
  3. Fragmentation – the affected area of ​​the bone is divided into separate fragments.
  4. Resorption of dead tissue.
  5. Repair – the site of the former necrosis is gradually filled with connective tissue, which over time is replaced by new bone tissue.

Schinz disease – radiological signs

If Schinz disease is suspected, an X-ray is one of the first examinations to be prescribed to a patient. Radiography of the calcaneal tuber at the first stage of pathology indicates compaction. Due to this, an expansion of the gap is observed between the calcaneus and the calcaneal tuber. In the picture, doctors fix the uneven structure of the ossification core, obvious areas of bone loosening with cortical substance.

In the later stages of the pathology, individual fragments of the tuber are fixed. In addition, the emerging signs of the formation of a new spongy substance are also noteworthy. In doubtful cases, when it is difficult to make a diagnosis, a comparative diagnosis of both calcaneus bones is performed. To make an accurate diagnosis, the patient is referred for CT or MRI.

Sinz disease – treatment

Before treating Sinz disease in children, doctors conduct a comprehensive diagnosis to determine the cause of the violation. In most cases, it is associated with excessive physical activity on the leg. Given this, doctors recommend strictly restricting sports. To correct the violation, the wearing of special heel pads or orthopedic insoles is prescribed. If the pain is frequent and severe, fixation of the ankle joint with a longet is indicated. As part of complex therapy, physiotherapy is used:

Schinz Disease – Clinical Recommendations

To completely exclude Haglund Schinz disease, treatment is selected individually.

Experts recommend sticking to the following recommendations:

  1. Avoid physical exertion.
  2. Wear shoes with special orthopedic insoles.
  3. To fix the foot, wear high-heeled shoes with laces.

Massage for Schinz’s disease in children

Massage for Schinz disease is prescribed in order to normalize blood circulation in the lower leg and foot. During the procedure, the specialist must act on the calcaneus. The intensity of the massage should be medium. If necessary, a special warming ointment can be used to enhance blood flow. The procedure is carried out daily for a course of 10 days. If necessary, the course may be repeated 1–1,5 months after the preliminary course.

Methods for electrophoresis in Schinz disease

Electrophoresis in osteochondropathy of the calcaneal tuber is prescribed to reduce pain. During the procedure, small currents are used on the surface of the ankle joint and heel. To reduce pain, a napkin moistened with Novocaine solution is placed under the electrode plates. The session lasts 3-5 minutes. The duration of the course of treatment is set individually, but does not exceed 10 sessions. Patients notice a decrease in pain after 2-3 procedures.

Slippers for Sinz disease

So that osteochondropathy of the calcaneal tuber in children does not progress, doctors recommend wearing heels. These simple devices perform several functions simultaneously:

  • unload the heel;
  • reduce shock when walking, protecting knee joints, hips and spinal column;
  • reduce the load on the Achilles tendon.

Heels are selected individually, according to the size of the shoe. They should fit snugly against the backs. At the same time, shoes should have high heels. An excellent option is to make an individual pair of orthopedic shoes or sandals. As the foot grows, the shoes change. Its use allows the child to walk normally, without experiencing the painful sensations that accompany Sinz disease.

Schinz disease and sports

Once diagnosed with Sinz disease in children, sports are prohibited. Such children are exempted from attending physical education lessons and training. To reduce symptoms, recovery of the foot should be subjected to minimal physical exertion. At the same time, the intensity of training is adjusted downward. Disease of Shinz, calcaneus in a child in some cases can cause a refusal of a sports career.

What to do with osteochondropathy of the calcaneal tuber?

In adults, cases of calcaneus osteochondropathy are an exception to the rule, affecting mainly elderly people. In children under 10 years old, this disease also practically does not occur, since the cartilage and bones are still soft. It is relevant for adolescents experiencing puberty, more often girls from 13 to 16 years. In addition, heel pain is characteristic of physically active young people, especially those who are passionate about sports.

Causes of

The greatest loads when walking, running, jumping fall on the largest and most fragile calcaneal bones of the feet. 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 most often suffers from injuries. In addition, behind this bone there is a bulge – the protrusion of the calcaneal tuber. He is also vulnerable to the disease, which is called the names of the doctors Haglund and Schinz, who studied this pathology.

What is the reason for osteochondropathy of apophyses – bone processes near their rounded ends of tubular tissue that form the articular joint? The specific causes of the 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 load on the muscles of the legs;
  • multiple tendon microtrauma;
  • impaired blood flow in the calcaneus;
  • pathologies of the heart and blood vessels;
  • endocrine diseases.

Calcaneal tuberosus osteochondropathy – Haglund-Schinz disease – most often results from:

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

The trigger mechanism of the disease is based on excessive physical exertion on the tubercles of the calcaneus, the Achilles tendon and the cords of the foot. Since blood vessels are affected, normal blood supply to the bone tissue is disrupted. They do not receive the necessary amount of nutrients, and the calcaneus bones become dead, and in the absence of a pathogenic infection and inflammatory process. Their destruction is especially rapid if the blood vessels are few or their gaps are narrow from birth, due to the genetic characteristics of the body.

Stages of the disease

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

  1. Aseptic necrosis. In this case, a focus of necrosis appears.
  2. Impression (intra-articular) fracture – “punching” of the dead part of the bone, which does not withstand previous loads.
  3. Fragmentation of a bone – crushing it into separate fragments.
  4. Resorption of dead tissue.
  5. Reparation – replacement of the necrotic area with first connective tissue, and then with the newly formed bone.

Symptomatic manifestations

Characteristic symptoms of osteochondropathy of Haglund-Schinz:

  • pain in a standing position with support on the heels, as well as with flexion and extension of the feet;
  • easy bouncing of the patient when walking;
  • swelling in the heel or the entire foot;
  • increased tactile sensitivity in the affected area;
  • dystrophy of the muscles of the leg;
  • lameness.

The course of the disease at an early stage can be either gradual, invisible, or sudden, with unbearable pain at the slightest load on the calcaneal tubercle. Edema appears above it, but there is neither redness nor burning. However, palpation of the foot soon becomes painful, especially with flexion and extension. Over time, a person begins to limp, as he is forced to move the center of gravity of the body to his toes when walking. At rest, there is no pain.

In a child, heel pain can persist for a long time, sometimes until the end of puberty. Although it happens that as you grow older the ailment goes away on its own. The orthopedist makes a diagnosis of the pathology of the calcaneus, taking into account the anamnesis, the course of the disease and the results of the examination.

Diagnostics

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

A photo. Redness and tubercle in Schinz disease

In the later stages of the disease, the spongy substance of the new bone tissue is clearly visible in the picture. Comparative X-ray of a sick and healthy foot helps to understand difficult cases. It is important to carry out differential diagnostics in order to exclude:

  • any acute inflammatory processes;
  • bursitis, heel periostitis;
  • 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 suffer elderly people. Increased fatigue, irritability, characteristic of tuberculosis of bones and cancerous tumors, do not occur in Haglund-Schinz disease.

A computer or magnetic resonance tomogram of the calcaneus helps to finally dispel doubts to the doctor. In difficult cases, the orthopedist consults with a TB specialist, an oncologist.

Disease treatment methods

Treatment is carried out on an outpatient basis under periodic medical supervision. Parents should not panic if the child has a Haglund-Schinz pathology, since most often a full recovery occurs without any dangerous complications. Treatment in children is aimed at minimizing pain and maximally quickly restoring the functions of a sore leg. The possibilities of conservative therapy are used if the pathology is not started.

Operative intervention

Surgical intervention is practiced only in the most extreme cases. If measures of conservative therapy do not bring the expected results and the pains remain acute, they perform an operation – a neurotomy (excision) of nerves in the foot area.

However, you need to know: after this, not only the pain disappears forever, but the tactile sensitivity of the heel is completely lost.

Conservative treatment

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

To this end, it is rigidly fixed with a splint. In acute pain, a plaster cast is applied for a short time.

Analgesics, anti-inflammatory drugs, injections of Milgamma, heating pads with ice help relieve a teenager from pain.

To improve blood circulation, vasodilator drugs are used. Muscle cramps relieve No-spear, nicotinic acid.

Physiotherapy

An excellent therapeutic effect is achieved thanks to complex physiotherapy. Procedures are prescribed after relief of acute pain. It:

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

Recovery period

After the completion of the main course of therapy, further treatment consists in a significant reduction in physical activity on the heels.

To do this, choose shoes with a stable wide heel and orthopedic insoles-arch supports or gel heel pads. It must be worn constantly. Shoes with solid soles are not suitable, because of her recovery is delayed.

When the pains are significantly weakened, the load on the legs can be increased. The prognosis for osteochondropathy of Haglund-Schinz is favorable. All painful symptoms usually disappear after 1,5–2 years.

What is calcaneus osteochondropathy and how to treat it?

Calcaneus osteochondropathy is a disease that is a degenerative necrotic change in the pineal gland (end section of the tubular bone) and apophysis (an additional ossification point at the site of attachment of large muscles), spongy bones. Most often, osteochondropathies of the knee joint, femoral head, and metatarsal bones are found. Calcaneus osteochondropathy is more common in children and adolescents than in older patients.

Haglund syndrome is the main cause of impaired motor activity and soreness in the back of the calcaneal joint.

Historical information

In 1983, pains arising in the back of the calcaneal joint were first described. The surgeon Edward Albert, who is considered the founder of the term “achillodynia”, described the ailment. But in his work he did not put forward a theory about the causes and mechanism of the development of the disease.

Patrick Haglund in 1928 first set forth his vision that pain in the distal Achilles joint can be triggered by several factors. According to his theory, the concept of “achillodynia” is too generalized and does not highlight the true cause of the pain syndrome. He suggested that pathology provokes:

  • Achillotendinitis (inflammatory process in the area of ​​the Achilles tendon),
  • Achillobursitis (inflammation of the synovial sac surrounding the tendon),
  • Pathology of the pineal gland area, responsible for the growth of the calcaneus in children.

P. Haglunda suggested that the factor provoking the development of superficial bursitis was wearing uncomfortable or small shoes, and deep – one-time or chronic trauma. He suggested treating deep bursitis operatively.

In the works of 1990-1991, the terminological confusion remained: in addition to the Haglund syndrome, the terms “achillodynia” and “achillobursitis” were used.

In Russian literature, the terms Haglund’s disease (an abnormal bone located between the scaphoid tarsus and the talus head) or Haglund-Sinz disease (calcaneal apophysis) were used to describe the pathology in the calcaneus.

International classification

ICD-10 calcaneus osteochondropathy: a class of disease of the musculoskeletal system and connective tissue (M00-M99). Chondropathy (M91-M94). Other juvenile osteochondrosis (M92). Disease code juvenile osteochondrosis of the tarsus (M92.6).

Etiology

The causes of osteochondropathy of the calcaneal tuberosum are not well understood. It is believed that this is the result of the action of many pathogenic factors:

  • Strong mechanical load
  • Injuries
  • Neuro trophic disorders,
  • Disorders of local blood circulation during mechanical damage to blood vessels, thrombosis or prolonged spasm.

symptomatology

Symptoms of calcaneus chondropathy depend on the stage of the disease. The acute period of the disease in some cases can be asymptomatic, and the first manifestations appear several years after the onset of the disease. They are caused by secondary changes in the joints and periarticular tissues.

Osteochondropathy of the heel develops in most cases slowly and proceeds chronically. The main symptoms are:

  • Pain on the back of the heel when walking, with shoe pressure, sometimes swelling in this area,
  • Limiting support on the heel, transferring the load to the forefoot, as a result of which deformation of the fingers, lameness,
  • Muscle atrophy is moderate, pain at rest disappears,
  • Sometimes the body temperature rises.

Osteochondropathy stages

The division of the disease at the stage according to the clinical manifestations is rather arbitrary. At the same time, changes can be observed corresponding to two or three phases of the course of the disease.

The first is the stage of aseptic necrosis of bone spongy substance as a result of vascular disorders.

The second is the stage of false sclerosis, caused by squeezing of necrotic bone beams (crossbeams), under the influence of dynamic and static loads.

The third is the fragmentation stage, characterized by the introduction of cartilaginous growths into the spongy bone tissue. The largest number of calls occurs at this time.

The fourth – reparations, is characterized by intensive regenerative processes of spongy bone substance.

The fifth is the recovery stage with residual deformation phenomena.

Diagnostics

Crucial in the diagnosis of chondropathy belongs to radiography:

  • At the first stage, there are no pronounced changes in the picture,
  • The second stage is characterized by the appearance in the photo at the site of the lesion of homogeneous structureless blackouts, the surface loses its smoothness,
  • The third stage is a sequestration-like picture, the bone structure does not give a clear homogeneous appearance. The affected area consists of bone residues and is flattened even more,
  • The fourth stage – sequestration-like areas are not visible, there is no correct structural pattern. In some cases, rounded cystic enlightenments are determined,
  • Fifth – residual effects of deformation.

Computed tomography is an effective method for the early diagnosis of calcaneal tuber osteochondropathy. Using this study, the anatomical forms of the calcaneus can be clarified.

Ultrasound examination reveals an enlarged calcaneal mucous bag.

An electrophysiological study of muscles, a biomechanical examination of the patient reveals a decrease in bioelectrical activity of muscle tissue (by 1,5 times) in the affected leg, a decrease in static supportability and walking rhythm coefficient.

Osteochondropathy Treatment

Conservative treatment of calcaneus osteochondropathy in children is aimed at eliminating the possible causes of the disease and preventing or inhibiting the progression of bone deformation. Small patients are prescribed:

  • Restorative treatment,
  • Vitamin therapy (B vitamins, calcium),
  • Nutrition,
  • Physiotherapeutic procedures
  • Unloading the affected area by wearing orthopedic shoes,
  • Orthosis of the foot – the manufacture and continuous wearing of individual insoles-arch supports, which allow you to bring all parts of the foot in the correct position,
  • Load limitation, exemption from professional sports,
  • Nonsteroidal anti-inflammatory drugs.

The total duration of conservative treatment is 6 months.

In the absence of a positive result of such treatment, surgery is indicated. Surgical intervention consists in an edge resection of the Haglund tuberosity and excision of the retrocalcaneal sac.

Even adequate resection does not always lead to successful results. One year after surgery, pain may persist. A long rehabilitation period is also noted. It usually takes from six months to two years before all symptoms disappear.

Treatment of calcaneus osteochondropathy with folk remedies is ineffective and can be used as adjunctive therapy in the form of contrasting baths and applications from herbs.

Physiotherapy

Physiotherapeutic methods of treating osteochondropathy are used for:

  • Improvement of blood supply to the limbs,
  • Decrease in a pain syndrome (UV-therapy, medium-wave ultraviolet irradiation, in erythemal doses), diadynamic therapy (application of pulse currents),
  • Acceleration of regeneration in the area of ​​damage – ultrasound therapy (phonophoresis of drugs), mud therapy,
  • Reducing the severity of bone tissue dystrophy (heliotherapy, thalassotherapy, therapeutic massage, air baths,
  • Restoration of impaired functions (electrophoresis, radon and sodium chlor >

Physiotherapy exercises for osteochondropathy

General gymnastics to strengthen the muscles of the abdomen, back, upper limbs is carried out at all stages of the disease. In the first two stages, the load consists in the contraction of the muscles of the thigh, buttocks and active movements in the ankle joint.

If within 6 months, according to the results of an X-ray examination, the bone structure remains unchanged, the full load on the affected limb is allowed.

Prevention of osteochondropathy includes the prevention of diseases that reduce the resistance of the musculoskeletal system to external influences – rickets, dystrophy, anemia, the proper organization of sports and wearing the right shoes.

Morozov Georgiy

Georgy Morozov, rheumatologist. For more than 20 years, he has been involved in the diagnosis, treatment and prevention of joint diseases.

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