Exostoses are osteochondral growths on the surface of the bone. They are classified as benign tumors, which are also called osteochondromas. They rarely affect the bones of the foot, which include the metatarsals, phalanges, calcaneus, talus and others. At the same time, many people have heard and know about the so-called heel spur. It is often also classified as exostosis, although its nature, as well as the causes of its occurrence, differ from osteochondroma.
Exostoses of the feet and their features
True exostoses or osteochondromas are benign tumors growing on a thin stalk or wide base, but always covered on the outside with cartilage of varying thickness. The exact reasons for their formation are unknown.
Since neoplasms of this kind most often occur in children and are osteochondral growths, it is believed that they are a consequence of displacement of part of the epiphyseal plate. It is a hyaline cartilage, the cells of which in children are constantly dividing, which ensures the growth of bones in length. Gradually, old cartilage cells move away from the epiphyseal plate due to the appearance of new ones and are replaced by osteoblasts, i.e., bone tissue cells. After the end of skeletal growth, the growth plates close and turn into thin epiphyseal lines.
Exostoses can form on any bone of the foot and have different shapes and sizes. They are usually diagnosed between 8 and 15 years of age, as they begin to actively grow along with the child’s skeleton. In adults, such formations are more often discovered by chance.
Exostoses of the feet can be single or solitary, but this is rare. More often they are only one of the manifestations of multiple exostosis disease. In this case, similar osteochondral growths will be found in other bones of the skeleton (usually the femur, tibia, humerus). This disease is transmitted hereditarily and is considered more dangerous than single osteochondromas, since with it the tendency of neoplasms to malignancy is 10 times higher than with solitary ones. Therefore, the detection of exostoses of the bones of the feet always becomes a reason for a comprehensive examination of the body.
Getting rid of osteochondropathy using traditional methods and prevention
At home, the patient applies warm compresses to the foot and heel. Use Dimexide (purchased at the pharmacy without a prescription): dilute in a 1:1 ratio with water and apply lotions to the sore spots using gauze or a cloth. To create a compress, place a bag on top, wrap it with a bandage and put on a wool sock. Keep the product for 50 minutes - 1 hour.
Warm salt baths have an analgesic effect: 100 g of salt, preferably sea salt, is dissolved in hot water poured into a basin and the heel is immersed there for half an hour. Afterwards, the foot is doused with warm running water, dried and a sock is put on.
Therapeutic physiotherapeutic procedures with paraffin and ozokerite can also be carried out at home. Dissolve both products in equal parts in a water bath, pour the mixture into a mold and let cool slightly. Next, the base for the application is made: you need to put a blanket on the floor, on top - oilcloth and polyethylene, on which to lay out the product. Place the heel on the prepared paraffin and wrap it in stages in polyethylene, oilcloth and a blanket. Keep your leg like this for up to half an hour.
Physical therapy is also indicated. Exercises for the feet that will strengthen the muscles, promote blood flow and relieve pain.
Exercise #1:
- lie on the floor on your side so that your sore leg is below;
- place your arm bent at the elbow under your head;
- move the leg that is at the top back;
- lift the sore foot and rotate it in different directions;
- Duration of the exercise: 1-1.5 minutes.
Exercise No. 2. Standing on the floor, lift your toes and try to spread them as far as possible, like a fan. In this case, the foot and heel should remain motionless. Stay like this for 15 seconds. Rest a little and repeat the exercise 3 more times.
Exercise No. 3. Sitting on a chair, place your heels on the floor and place your knees straight. Raise your toes alternately, bringing them to their starting position. Of course, the heel should not move during this. Let your feet rest for a few seconds and continue training your toes for another 5 minutes.
Exercise No. 4. Sit on a chair and close your soles for a while, relax. Repeat 15 times with breaks.
Exercise No. 5. Sit on the floor, keeping your legs extended. Place the sore foot on the knee of the healthy leg and, straining, make rotational movements.
After the symptoms of the disease have ceased to bother you, it is necessary to constantly take preventive measures so that osteochondropathy does not begin to develop again.
Wear loose, flat shoes.
Continue with physical therapy. Don't overcool your feet or put too much strain on them.
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Haglund's exostosis
Sometimes calcaneal exostosis is called Haglund's exostosis or heel spur. This is not entirely true, since such growths on the surface of the heel bone are an osteophyte, not an exostosis. The difference between them is that exostosis has walls and medullary space that are united with the mother bone (in this case, the heel). Osteophyte is formed on the surface of the bone and is a consequence of the activation of the body’s defense mechanisms. For patients, these differences are not of particular importance, and therefore the name “exostosis of the calcaneus” has become firmly established.
Haglund's exostosis got its name in honor of the Swedish surgeon Haglund, who first described it back in 1928.
Heel spurs are a consequence of constantly wearing shoes that place stress on the heel bone. Therefore, it most often occurs in women who prefer shoes with curved heels that rest against the back of the heel bone, as well as in skiers, figure skaters, and hockey players, since such boots also put strong pressure on the bone structures. As a result, such neoplasms are often present on both feet simultaneously, which is not typical for osteochondromas. Varus and valgus foot deformities also increase the likelihood of Haglund's exostosis.
As a result of prolonged, constant friction and pressure on the Achilles tendon and heel bone, inflammation develops. The protective mechanism initiates the formation of a pathological growth on the posterior calcaneal tuber, designed to strengthen the area of constant irritation. It grows slowly but often has sharp edges. Therefore, his education does not save the situation, but only aggravates it and closes the vicious circle.
The neoplasm injures the tendons and soft tissues, which causes the clinical picture of achilles bursitis and bursitis. This significantly complicates diagnosis, since patients experience symptoms characteristic of ordinary inflammation of the Achilles tendon. As a result, they are often prescribed treatment aimed at suppressing the inflammatory process. But it does not take into account the reasons for its development, so relapses are regularly observed until targeted treatment of calcaneal exostosis is carried out.
Symptoms
Osteochondromas may not appear for years until they begin to actively increase in size. This usually coincides with physiological periods of intensive growth of the child. As a result, dense knots or lumps may form in the area of the heel, metatarsus, and toes, including under the nails. Initially, they are painless, and upon palpation, the density characteristic of the bone is determined.
As you grow, pain may occur when walking, physical activity, or standing, especially if exostoses form on bones that are loaded during walking. In the future, the osteochondral growth can mechanically compress the blood vessels and nerves passing near it, which provokes the appearance of characteristic symptoms:
swelling of soft tissues;
numbness in a certain area of the foot, a feeling of goosebumps;
impaired mobility of the foot, unsteadiness of gait.
Haglund's exostosis manifests itself:
- the formation of a noticeable, gradually increasing bump on the back of the heel;
- pain that tends to intensify after prolonged walking, standing, or physical activity;
- swelling of soft tissues;
- the appearance of calluses.
Diagnostics
The appearance of signs of the formation of osteochondroma of the bones of the foot or calcaneal exostosis is a reason to contact an orthopedic traumatologist. Initially, the doctor examines the feet, determines the presence of deformities, palpates neoplasms and determines the nature of the complaints. The second stage of the examination is an x-ray of the feet. The resulting images usually make it possible to immediately diagnose heel spurs, exostoses of the metatarsal bones, phalanges, etc.
Haglund's exostosis is visualized on x-ray as an overgrowth of bone tissue at the superior posterior protuberance of the heel bone. Osteochondroma usually has a “cauliflower” appearance with signs of thinning of the cortical bone.
Based on the results obtained, the orthopedist determines the optimal treatment tactics. Sometimes it is necessary to perform a CT scan, MRI, or x-ray of other skeletal bones. This is especially important when diagnosing osteochondromas. Additional x-rays make it possible to detect neoplasms of other skeletal bones, and MRI makes it possible to assess the structure and thickness of the cartilaginous cap. This is important, since x-rays do not provide such an opportunity, especially in children, and the resulting parameters make it possible to objectively assess the risk of malignancy.
Signs that are dangerous from the point of view of malignancy of exostosis of the foot are blurred boundaries of the formation and a thickness of the cartilaginous cap of more than 1.5-2 cm.
Osteochondropathies
Ruben Garnikovich Minasyan
Osteochondropathies are a group of cyclical, long-term diseases, which are based on malnutrition of bone tissue with its subsequent aseptic necrosis.
Clinical manifestations of osteochondropathy are associated with resorption and replacement of damaged areas of bone. Diagnosis of osteochondropathy is based on ultrasound, x-ray and tomographic data. Treatment includes immobilization, physiotherapy, vitamin therapy, exercise therapy. According to indications, surgical treatment can also be performed. Osteochondropathies develop in patients of childhood and adolescence, more often affecting the bones of the lower extremities, and are characterized by a benign chronic course and a relatively favorable outcome.
COURSE OF OSTEOCHONDROPATHY.
First stage. Necrosis of bone tissue. Lasts up to several months. The patient experiences mild or moderate pain in the affected area, accompanied by impaired limb function. Palpation is painful. Regional lymph nodes are usually not enlarged. X-ray changes during this period may be absent.
Second stage . "Compression fracture." Lasts from 2-3 to 6 or more months. The bone “sags”, damaged bone beams wedge into each other. Radiographs reveal homogeneous darkening of the affected parts of the bone and the disappearance of its structural pattern. When the epiphysis is damaged, its height decreases and an expansion of the joint space is detected.
Third stage . Fragmentation. Lasts from 6 months to 2-3 years. At this stage, the dead areas of bone are reabsorbed and replaced by granulation tissue and osteoclasts. Accompanied by a decrease in bone height. Radiographs reveal a decrease in bone height, fragmentation of the affected parts of the bone with a chaotic alternation of dark and light areas.
The fourth stage of osteochondropathy . Recovery. Lasts from several months to 2 years. The shape and, somewhat later, the bone structure are restored.
The full cycle of osteochondropathy takes 2-4 years. Without treatment, the bone is restored with more or less pronounced residual deformation, which subsequently leads to the development of deforming arthrosis.
Osteochondropathy of the hip joint. (Legg-Calvé-Perthes disease). Affects the head of the hip bone. It most often develops in boys aged 4-9 years. The occurrence of osteochondropathy may be preceded by injury to the hip joint. It begins with a slight lameness, which is later joined by pain in the area of the injury, often radiating to the knee joint. Gradually, movements in the joint become limited. Upon examination, mild atrophy of the muscles of the thigh and lower leg, limitation of internal rotation and abduction of the hip are revealed. Painful reaction when loading the greater trochanter. Often the affected limb is shortened by 1-2 cm, caused by upward subluxation of the hip. Osteochondropathy lasts 4-4.5 years and ends with restoration of the structure of the femoral head. But without treatment, the head takes on a mushroom shape. The shape of the head does not correspond to the shape of the acetabulum, and deforming arthrosis develops over time. For diagnostic purposes, ultrasound and MRI of the hip joint are performed. To ensure restoration of the shape of the head, it is necessary to completely unload the affected joint. Treatment of osteochondropathy is carried out in a hospital with bed rest for 2-3 years. Skeletal traction may be applied. The patient is prescribed physiotherapy, vitamin therapy and climate therapy. Constant exercise therapy is of great importance to maintain the range of motion in the joint. If the shape of the femoral head is abnormal, osteoplastic operations are performed.
Osteochondropathy of the heads of the II and III metatarsal bones . (Keller's disease). It most often affects girls and develops at the age of 10-15 years. Keller's disease begins gradually. Periodic pain occurs in the affected area, lameness develops, which goes away when the pain disappears. Upon examination, slight swelling is revealed, sometimes - hyperemia of the skin on the dorsum of the foot. Subsequently, shortening of the second and third fingers develops, accompanied by a sharp limitation of movements. Palpation and axial load are sharply painful. This osteochondropathy does not pose a significant threat to subsequent dysfunction of the limb and the development of disability. Outpatient treatment with maximum load on the affected part of the foot is indicated. Patients are given a special plaster boot, vitamins and physical therapy are prescribed.
Osteochondropathy of the navicular bone of the foot. (Keller's disease). Rarely develops. It most often affects boys aged 3-7 years. Initially, pain in the foot appears for no apparent reason, and lameness develops. Then the skin on the back of the foot turns red and swells. Treatment is outpatient. The patient is limited in the load on the limb, in case of severe pain, a special plaster boot is applied, and physical therapy is prescribed. After recovery, it is recommended to wear shoes with arch supports.
Osteochondropathy of the tibial tuberosity . (Osgood-Schlatter disease). The disease develops at the age of 12-15 years, boys are more often affected. Swelling gradually appears in the affected area. Patients complain of pain that worsens when kneeling and walking up stairs. The function of the joint is not impaired or only slightly impaired. Treatment is conservative and carried out on an outpatient basis. Limitation of the load on the limb is prescribed; in case of severe pain, a plaster splint is applied for 6-8 weeks, physiotherapy (electrophoresis with phosphorus and calcium, paraffin baths), and vitamin therapy. The disease progresses favorably and ends with recovery within 1-1.5 years.
Osteochondropathy of the calcaneal tuberosity. Schintz disease develops very rarely, usually affecting children aged 7-14 years. Accompanied by the appearance of pain and swelling. Treatment is outpatient, load limitation, calcium electrophoresis and thermal procedures.
Partial osteochondropathy of articular surfaces. Typically develop between the ages of 10 and 25 in men. Usually in the knee joint area. An area of necrosis appears on the convex articular surface. Subsequently, the damaged area can separate from the articular surface and turn into an “articular mouse” (a loose intra-articular body). Diagnosis is carried out by ultrasound or MRI of the knee joint. In the first stages, conservative treatment is carried out: rest, physiotherapy.
Osteochondropathy of the vertebral apophyses. Common pathology. Scheuermann-Mau disease occurs in adolescence, most often in boys. Accompanied by kyphosis of the middle and lower thoracic spine (round back). The pain may be mild or completely absent. Sometimes the only reason to visit an orthopedist is a cosmetic defect. Diagnosis of this type of osteochondropathy is carried out using radiography and CT scan of the spine. Additionally, to examine the condition of the spinal cord and ligamentous apparatus of the spinal column, an MRI of the spine is performed. Osteochondropathy affects several vertebrae and is accompanied by severe deformation that remains for life. To maintain the normal shape of the vertebrae, the patient must be provided with rest. For most of the day, the patient should remain in bed in a supine position (in case of severe pain, immobilization is performed using a posterior plaster bed). Patients are prescribed back and abdominal muscle massage and therapeutic exercises. With timely and correct treatment, the prognosis is favorable.
Osteochondropathy of the vertebral body. Calve's disease develops at the age of 4-7 years. The child, for no apparent reason, begins to complain of pain and a feeling of fatigue in the back. Upon examination, local pain and protrusion of the spinous process of the affected vertebra are revealed. Radiographs reveal a significant (up to 1/4 of normal) decrease in vertebral height. Usually one vertebra in the thoracic region is affected. Treatment is only inpatient. Rest, therapeutic exercises, and physiotherapy are indicated. The structure and shape of the vertebra is restored within 2-3 years.
With wishes of health,
Yours Ruben Minasyan
Treatment
Exostosis of the foot does not require treatment until it causes discomfort. If discomfort occurs, conservative therapy is prescribed, selected on an individual basis. It usually includes:
- drug therapy, which consists of the use of painkillers and anti-inflammatory drugs from the NSAID group, drug blockades indicated for severe pain;
- physiotherapy, which involves courses of magnetic therapy, UHF;
- selection of comfortable orthopedic shoes with offset edges, individual insoles.
If bony exostosis of the calcaneus is diagnosed, shock wave therapy is indicated. The method involves exposing the bone growth to infrasonic acoustic waves, creating a cavitation effect. Since the acoustic resistance of soft tissue is less than that of bone, the waves pass through it and affect bone formation. As a result, it is sometimes possible to reduce its size and also activate blood circulation in the area of influence.
Characteristic signs and development of the disease
Heel pain does not appear when the foot is at rest, but when moving or if you press your fingers on the area of the foot that is bothering you.
With other diseases, such as bursitis, tumor, bone tuberculosis, periostitis, completely different symptoms are observed. The pain lasts constantly, the heel suffering from osteochondropathy does not turn red, but only swells. An equally important sign is that the image shows tissue in those areas of the bone that are affected by the disease. They are shifted to the side, the contour of the bone is uneven and very pronounced, quite different from the healthy state.
The disease develops quite slowly. Manifestations of pathology and the rate of progression of the disease depend on the patient’s age and physical condition. Sometimes it takes several months or even years before the main stage. It all starts with decreased muscle tone and rapid fatigue of the patient. The condition improves after sleep, but returns with intense exercise. There is also increased sensitivity of the skin in the area of the tubercle of the heel bone.
See your doctor as soon as possible. At the initial stage, even simple pain relief can significantly improve the picture.