Schinz's disease (osteochondropathy of the apophysis of the calcaneal bone, osteochondropathy of the calcaneal tuberosity, osteochondropathy of the heel bone, Haglund-Schinz disease)

Medial apophysitis is sometimes considered a variant of medial epicondylitis, but in fact it is caused by excessive traction and inflammation of the apophysis of the medial epicondyle and is therefore a separate term.

The elbow is the most common site of injury in the immature skeleton of baseball players aged 9–12 years. Inflammation of the apophysis of the medial epicondyle usually occurs as a result of repeated throwing or throwing of a ball with force.

Most patients consult a doctor with vague complaints of pain in the medial aspect of the elbow. They may also complain of decreased throwing speed and control.

The elbow joint consists of the bones of the upper arm (humerus) and one of the bones of the forearm (ulna). The bony projections at the end of the humerus are called epicondyles. The projection that is closer to the body is called the medial epicondyle, and the projection on the outside of the elbow is called the lateral epicondyle.

The muscles that allow wrist flexion attach to the medial epicondyle, and the muscles responsible for wrist extension attach to the lateral epicondyle. Excessive flexion causes irritation of the muscles that attach to the medial epicondyle.

In a child, bones grow from areas called growth plates. The growth zone of the medial epicondyle is called the medial apophysis. With medial apophysitis, irritation or inflammation occurs in this area.

Causes of the disease

Schintz disease most often affects children: boys aged 9–11 years, girls aged 7–8 years.
Adults who are actively involved in sports and dancing are also susceptible to pathology. Refers to diseases of adolescence and childhood; it is very rare in adults. The pathological process can involve either both or one limb. Unilateral lesions are diagnosed much more often than bilateral ones. The calcaneus is the largest bone of the foot; in its structure it belongs to the spongy bones. It bears a significant part of the load on the foot when running, walking and jumping, participates in the formation of several joints, and is the site of attachment of ligaments and tendons. On the back surface of the bone there is a protruding area - the calcaneal tubercle, which is affected in Schinz's disease. In the middle part, the Achilles tendon is attached to this tubercle, and in the lower part - the long plantar ligament.

Doctors have not yet identified the final cause that leads to the appearance of this pathology. But there are several factors that can contribute to the development of the disease:

• repeated heel injuries, sometimes minor;
• constant stress on muscles;
• diseases of the endocrine system associated with hormonal imbalance;
• diseases of the cardiovascular system;
• practicing certain sports, during which overstrain of the tendons of the muscles of the sole of the foot occurs;
• disruption of the body's absorption of calcium;
• vascular diseases;
• neurotrophic disorders;
• genetic predisposition;
• microtraumas in the area of ​​the heel tubercle due to insufficient blood supply.

Due to excessive loads, vascular tone is disrupted, the bone area ceases to receive sufficient nutrients, and aseptic necrosis develops (bone destruction without inflammation and the participation of infectious agents).

In children and adults, the development of this pathology is provoked by the same factors.

There are five stages of Schinz's disease:

1. Aseptic necrosis. The nutrition of the bone area is disrupted, and an area of ​​necrosis occurs.
2. Impression (depressed) fracture. The dead area cannot withstand normal loads and is “squeezed through.” Some areas of the bone are wedged into others.
3. Fragmentation. The affected part of the bone is divided into separate fragments.
4. Resorption of necrotic tissue.
5. Repair. At the site of necrosis, connective tissue is formed, which is subsequently replaced by new bone.

Osteochondrosis of the foot and lower limb

The faster a child develops, the more vulnerable growth points become. This is especially noticeable in boys aged 4, 7-8 and 12 years. That is, at the age when the next growth spurt occurs and children begin to actively engage in sports. And parents worry about their sports success.

What to pay attention to, how not to miss the onset of the disease or its complications was discussed with Olga Chizhevskaya, executive director of the League for the Promotion of Podiatry.

Signs of susceptibility to osteochondrosis

Bone develops from hyaline cartilage, in which the processes of ossification and calcification gradually occur. And by the time of birth, the only areas where hyaline cartilage remains are the articular surface and the growth plate area. Moreover, in the latter we observe the presence of cartilage even during the period of skeletal maturation. That is, this area remains vulnerable even in adulthood.

There are three main factors that influence the development of osteochondrosis: the intensity of growth, the weight of the child and his activity.

The child's weight is associated with the vertical load on the foot and lower limb. When the optimal body weight is exceeded, the foot experiences additional stress, which can lead to both the development of flat feet and more serious problems, including osteochondrosis.

“Growth spurts often coincide with the start of a particular sport. If swimming or cycling unload the foot, then running or football with increased vertical loads, on the contrary, contribute to the development of degenerative changes.

In this case, it is useful to alternate between different sports. This will help not only reduce the risk of developing osteochondrosis, but also harmoniously develop the musculoskeletal complex and even allow the child to achieve more significant sports results,” says Vladimir Nechaev, orthopedic traumatologist, chiropractor, sports doctor, osteopath.

Diagnosis of osteochondrosis

The first thing a doctor should pay attention to when diagnosing osteochondrosis of the lower extremities is the patient’s age. Due to the physiology of the development of the skeletal system, different parts and bones are most vulnerable at different periods of life.

The second is clinical signs. Most often this is pain without signs of inflammation. If a local increase in temperature, redness of the skin and swelling is observed in the affected area, more serious inflammatory diseases may develop.

The third diagnostic criterion is the results of x-ray examination. But they can only be valid if there is a clinical picture.

Kohler's disease – osteochondrosis of the scaphoid bone

This is an uncommon variant of osteochondrosis, occurring in boys aged 2 years and older. At this age, the child begins to walk, the foot begins to experience weight bearing, and secondary foci of ossification appear in the scaphoid bone.

With this disease, the child simply refuses to put any weight on the affected leg and refuses to walk. Attempts to examine and palpate also cause severe pain and crying. In this situation, only careful superficial palpation is possible, during which pain can be detected specifically in the area of ​​the scaphoid bone.

The main danger of this condition is that aseptic necrosis may develop. It is also always worth remembering the risk of complications, including infectious ones. Therefore, if the examination reveals not only pain, but also signs of inflammation, it is worth taking a particularly careful approach to diagnosis.

The simplest treatment method is to apply a plaster immobilizing bandage for 4-6 weeks. Also, depending on the individual foot condition, orthoses may be used to relieve weight on the affected limb. When selecting treatment, you should always pay attention to the severity of the pain syndrome and the rate of restoration of function of the lower limb when the weight load is reduced.

Sever's disease – apophysitis of the calcaneus

The most common type of osteochondrosis of the foot. The disease develops in children aged 7-14 years. It is at this age that a secondary ossification center appears in the calcaneus. These children will complain of heel pain after playing sports and occasional limping. If the heel is squeezed during examination, the child will feel pain.

Clinically, the doctor must confirm that it is the apophysis that is affected, and not the heel bone or ankle joint itself. If there are signs of inflammation or the child complains of pain not only after playing sports, but also during other periods, then it is worth taking a more careful approach to the diagnosis to exclude complications, including idiopathic juvenile arthritis.

During treatment, it can be recommended to stretch the calf muscle group and use shoes with high heel pads to relieve the necessary parts of the foot and growth plate. With the correct selection of shoes, the child can return to sports and continue training.

Perthe disease – osteochondrosis of the hip joint

This disease develops from age 4 and affects children under 10 years of age. Boys get sick 4 times more often than girls. As a rule, the joint is affected only on one side, although bilateral disease is possible.

Clinically manifested by lameness. Upon examination, the child has a reduced range of motion in the affected hip joint compared to the healthy one. The radiograph shows fragmentation of the articular surface.

Also, this type of osteochondrosis can manifest itself as pain in the knee. Therefore, if, with characteristic complaints during examination, there are no structural changes specifically in the knee area, it is worth paying attention to the hip joint.

Management of such a patient involves mainly rest and unloading of the affected limb. But it is difficult for a child at this age to give up activity. In this case, you can replace running with swimming to relieve the load on the hip joint.

Osgood-Schlatter disease – osteochondrosis of the tibial tuberosity

Just as the heel is the most affected bone of the foot, the knee is the most common osteochondrosis of the lower limb.

This condition develops in children as young as 8 years old, with an average age range of 8-15 years. This disease is called a self-limiting condition, that is, it is believed that by the age of 15-18 it goes away on its own. But recent research suggests that not everything is so simple.

Approximately 40% of children still have signs of the disease 2 years after the onset of the disease. That is, the child is still limited in his physical activity. In 25% of children they persist even 8-10 years after manifestation.

Clinically, the child experiences pain when running, playing sports, and any physical activity that requires sudden extension movements of the knee. Upon examination, the area of ​​the tibial tuberosity is sharply painful on palpation. The patella can stand quite high.

It is recommended to ensure rest during the first month. It is also worth changing the type of activity from running or other sports with a high load on the knee to swimming. Good results are achieved by training aimed at strengthening the quadriceps femoris muscle.

When making differential diagnoses, it should be remembered that similar signs can also result from more serious diseases. The most dangerous of them is osteogenic sarcoma. In this case, a characteristic symptom will be pain at night.

When diagnosing osteochondrosis of the lower extremities, it is worth paying attention not only to the clinical picture, but also to the age of manifestation, which is characteristic of certain diseases. It is also important to watch for developing complications such as idiopathic juvenile arthritis, infectious complications, trauma, osteosarcoma, or avascular necrosis.

As Olga Chizhevskaya, executive director of the League for the Promotion of Podiatry, emphasizes, when treating osteochondrosis in children, it is necessary to provide rest to the affected joint by limiting physical activity or applying a splint. You can also relieve the joint with orthopedic shoes or orthoses, change the type of physical activity and alternate between different sports.

Symptoms and course of the disease

Osteochondropathy of the calcaneus, or Haglund-Schinz disease, is associated with excessive stress on the leg muscles and tendon injuries. Typically, the disease develops at puberty, although an earlier onset is possible - cases of Schinz's disease have been described in patients 7-8 years old. It starts gradually.

Among the main symptoms of Schinz's disease are:

• pain in a vertical position when resting on the heel. Pain syndrome occurs mainly after exercise (running, long walking, jumping);
• "bouncing gait";
• absence of pain at night and at rest;
• swelling, swelling of soft tissues, skin atrophy, but there are no signs of inflammation (hyperemia, characteristic pressure, burning or distension);
• atrophy of the lower leg muscles;
• skin hyperesthesia and increased tactile sensitivity of the affected area;
• pain in the foot when flexing and extending;
• lameness of the affected leg while walking;
• Palpation of the heel tubercle area is painful.

The severity of the disease may vary. In some patients, the pain remains moderate, and support on the leg is slightly impaired. In the other part, the pain progresses and becomes so unbearable that support on the heel is completely excluded. Patients are forced to walk, relying only on the middle and forefoot, and they need to use a cane or crutches.

In children, sometimes symptoms may disappear after the foot stops growing.

There is no need to be afraid of the disease, since its correct treatment most often leads to a positive result without complications.

Diagnostics

The physician should take into account previous or recurrent elbow injuries, dominant arm, playing positions, and changes in throwing speed and power. It is also necessary to take into account the presence of paresthesia, numbness, and decreased range of motion. There may be mild swelling along the elbow joint. The patient also often complains of pain on palpation of the medial (and to a lesser extent lateral) epicondyle. Patients may also complain of tenderness along the medial-proximal forearm or distal arm. Elbow pain in patients with medial apophysitis may occur when throwing a ball.

Radiography allows one to visualize the presence of fractures or separation of the growth plate. An MRI scan can provide more reliable information.

Treatment of the disease

The choice of treatment method for the disease largely depends on the patient’s condition and the degree of complexity of the pathology.

Conservative treatment

Conservative treatment is carried out in an emergency room or outpatient orthopedic appointment. During the period of exacerbation, rest (ensuring complete immobility with the help of a plaster splint), physiotherapy aimed at improving local blood circulation, and wearing orthopedic shoes with an extended heel are necessary. In case of severe pain, short-term fixation with a plaster splint is possible. The patient is referred for ozokerite, electrophoresis of novocaine with analgin, ultrasound and microwave therapy. To reduce pain, use ice and prescribe drugs from the NSAID group. Taking vasodilators and vitamins B6 and B12 is also indicated.

Surgery

In some cases, with unbearable pain and lack of effect from conservative therapy, surgical intervention is performed. In case of severe deformation of the posterior part of the calcaneus, surgical intervention is performed.

Surgical intervention, depending on the degree of deformation, consists of:

• in the resection of osteochondral growths of the calcaneal tuber;
• shortening the calcaneus using osteotomy;
• neurotomy of the saphenous and tibial nerves and their branches. This operation consists of complete transverse cutting of the nerve trunk. It should be borne in mind that this operation not only completely relieves the patient of pain, but also leads to loss of skin sensitivity in the heel area.

Definition

Calcaneal apophysitis is an inflammatory disease that occurs before the age of 14 years. In a child, all bones have cartilaginous layers called growth plates, including in the heel area. In adults, cartilage is replaced by bone tissue, the bone becomes solid.

During the active growth of a child, the bones lengthen, and the muscles that cannot keep up with it become tense, resulting in tension in the Achilles tendon. If the child is also subject to increased physical activity, inflammation and pain occur in the heel area.

Most often, the disease occurs in child athletes, and its exacerbation occurs in the autumn, when the child returns after the summer holidays and begins to actively train. In general, calcaneal apophysitis does not cause serious complications, but it can cause very severe pain, so the pathology requires attention.

Diagnosis of the disease

Diagnosis of Schinz's disease is based on radiological results (fragmentation and hardening of the apophysis, roughness of the tubercle of the calcaneus) and clinical data: the child's complaints and medical history (when did the symptoms appear, were there any foot injuries, etc.). In severe forms of the disease, radiographic signs such as separation of fragments of the marginal bone and an increase in the distance between the calcaneus and the apophysis are clearly visible. In doubtful cases, comparative radiography of both calcaneal bones is performed or patients are referred to a CT scan of the calcaneus or MRI of the calcaneus.

It is imperative to carry out a differentiated diagnosis with diseases such as osteomyelitis, periostitis, bursitis, tuberculosis of the calcaneus. If the disease is observed in older people, it is necessary to exclude the so-called “heel spur”. X-ray, MRI and CT help to definitively differentiate Schinz's disease from other diseases. In doubtful cases, consultation with an oncologist or TB specialist may be required.

Treatment

Apophysitis of the calcaneus is treated only with conservative methods. First of all, the patient is advised to remain calm and active training is prohibited during the recovery period. Massage and special physical therapy are also prescribed, this will help relieve pain and speed up recovery.

It is worth understanding that physical therapy is prescribed individually, taking into account the child’s condition, and a specialist monitors the exercises. Loads should be minimal, and you can start training only after prescribing exercise therapy; until then there should be no amateur activity. An equally important part in the treatment of calcaneal apophysitis is shoes; they must be properly selected. Special orthopedic insoles can be useful here, they will relieve the heel and relieve pain when moving. It is forbidden to wear shoes with flat soles, since in this case the pressure on the heel is maximum.

If the child is experiencing severe pain, then drug treatment is indicated. As a rule, non-steroidal anti-inflammatory drugs, for example Nurofen (Ibuprofen), are prescribed to relieve pain and inflammation. The child is also prescribed vitamin complexes to quickly restore the affected area.

For heel apophysitis, the intake of ascorbic acid, calcium, and vitamin D is indicated. The child is also recommended to have a proper and balanced diet, but preference should be given to dairy products, fish, vegetables and fruits, and the consumption of sweets, salty and junk foods should be greatly limited. During the treatment period, physical therapy is also prescribed; it will help get rid of inflammation faster and relieve pain. Calcaneal apophysitis is often treated with balneotherapy, that is, therapeutic salt baths. In this case, baths according to folk recipes, with herbal decoctions, also help well.

Folk

Folk remedies are often used for calcaneal apophysitis; they help to quickly relieve pain and inflammation and alleviate the condition. But it is impossible to cure the disease with folk recipes; therapy must be comprehensive and under the supervision of a specialist.

Before using the product, you need to make sure that the child does not have an allergic reaction to it, and you should not apply external ointments and decoctions to damaged skin. The following remedies will help relieve pain from calcaneal apophysitis.

Contrasting baths have a wonderful effect. To do this, hot and cold water is poured into 2 basins, but it should not be icy or too hot. Then the child puts his feet in hot water for 5 minutes, transfers them to cold water for 10 seconds, and again to hot water for 1 minute, then again to cold water for 10 seconds, and again to hot water for a minute. In general, the duration of the procedure is no more than 15 minutes. A warm salt bath helps with heel pain; to prepare it you need to use natural sea salt. The duration of the procedure is 10-15 minutes.

Another effective remedy is a warm compress of potatoes and lugol. It is necessary to boil the potatoes and mash them into a thick puree, then add lugol to it and mix quickly. Place the warm puree in a bowl and place your heels in it for 5-7 minutes, and after the procedure, put warm woolen socks on your feet.

Horseradish root is very effective for heel pain. It is crushed in a blender or on a grater, and the resulting pulp is applied to the heel for 2 hours, the product must be secured on top with cling film and socks must be put on. A compress with radish also helps with heel pain. To prepare them, take black radish, wash it well and grate it, apply the pulp to the heel and wrap it with cling film, put warm socks on top and leave for 3-4 hours.

You can remove the inflammatory process with a compress of salt, honey, and iodine. For one bottle of iodine take 1 tbsp. honey and 1 tsp. salt. The product is mixed well and applied to a napkin, then applied to the sore spot for several hours, secure the product with cling film on top and put on socks.

If, while using a folk remedy, a child complains of a strong burning sensation, the skin should be rinsed with running water and the recipe should not be used again. If rashes and itching appear after using the product, you should definitely consult a doctor for advice and abandon traditional medicine recipes.

Prices

Prevention

It is quite possible to prevent the occurrence of the disease; to do this, you must follow the following recommendations:

• Choose the right shoes for your child, not too tight, preferably made from natural materials and not with flat soles, but with small heels.
• If a child plays sports, training should not be too intense; exercise should be done taking into account the child’s age.
• Sports children should definitely massage their feet in the evening after training to normalize blood circulation in the feet and prevent tissue destruction.
• Swimming is a good prevention of bone diseases, so it is recommended to send children to the pool.
• A child's diet should be healthy and balanced; overeating and weight gain should not be allowed. If a child is obese, you need to contact a nutritionist as soon as possible and begin treatment according to his recommendations. Putting your child on a diet on a whim is not recommended; it can be dangerous.

In general, disease prevention is a healthy lifestyle and moderation in everything, that is, in food, in sports.
Parents need to understand that there must be a golden mean in everything, and the child will achieve success even with less intense training, and there will be no harm to health. Share:

Diagnosis of osteochondrosis

The first thing a doctor should pay attention to when diagnosing osteochondrosis of the lower extremities is the patient’s age. Due to the physiology of the development of the skeletal system, different parts and bones are most vulnerable at different periods of life.

The second is clinical signs. Most often this is pain without signs of inflammation. If a local increase in temperature, redness of the skin and swelling is observed in the affected area, more serious inflammatory diseases may develop.

The third diagnostic criterion is the results of x-ray examination. But they can only be valid if there is a clinical picture.

Signs of susceptibility to osteochondrosis

Bone develops from hyaline cartilage, in which the processes of ossification and calcification gradually occur. And by the time of birth, the only areas where hyaline cartilage remains are the articular surface and the growth plate area. Moreover, in the latter we observe the presence of cartilage even during the period of skeletal maturation. That is, this area remains vulnerable even in adulthood.

There are three main factors that influence the development of osteochondrosis: the intensity of growth, the weight of the child and his activity.

The child's weight is associated with the vertical load on the foot and lower limb. When the optimal body weight is exceeded, the foot experiences additional stress, which can lead to both the development of flat feet and more serious problems, including osteochondrosis.

“Growth spurts often coincide with the start of a particular sport. If swimming or cycling unload the foot, then running or football with increased vertical loads, on the contrary, contribute to the development of degenerative changes.

In this case, it is useful to alternate between different sports. This will help not only reduce the risk of developing osteochondrosis, but also harmoniously develop the musculoskeletal complex and even allow the child to achieve more significant sports results,” says Vladimir Nechaev, orthopedic traumatologist, chiropractor, sports doctor, osteopath.

Stages of development of medial apophysitis

Doctors distinguish the following stages of disease progression: the initial stage is characterized by minor damage to muscle and bone tissue, accompanied by microtears. Implies the absence of restrictions on motor function, edema; the second stage involves tissue damage with an area of ​​up to 50%, accompanied by swelling, hemorrhage, and sharp painful sensations when moving the joint; the final stage is characterized by complete separation or significant stretching of the muscle fibers, more than 50%, implying large swelling, increased local temperature, and instability of the joint tissue.