Foot swelling and tenderness
Introduction
Introduction The heel of the calcaneus fracture can be extremely swollen, the posterior sulcus becomes shallow, and the entire hind foot is swollen and tender. Can be seen in a variety of diseases, benign, but also malignant, so pay attention to the cause of swelling, timely treatment, diagnosis, so as not to be mistaken. Calcaneal fractures are the most common type of humeral fractures, accounting for approximately 60% of all tibiofibular fractures. Most fall from the height, the foot touches the ground, and the heel suffers from vertical impact. Sudden contraction of the gastrocnemius muscle can cause the Achilles tendon to avulsion the calcaneus tuberosity. If the foot varus stress is too strong, it will cause avulsion of the anterior calcaneal tuberosity; and the valgus stress will cause the longitudinal fracture of the carrier or the calcaneal tuberosity. But the latter is rare.
Cause
Cause
(1) Causes of the disease
Calcaneal fractures are the most common type of humeral fractures, accounting for approximately 60% of all tibiofibular fractures. Most fall from the height, the foot touches the ground, and the heel suffers from vertical impact.
(1) When the longitudinal fracture of the calcaneus nodule is mostly high, the bottom of the heel valgus nodule is grounded, and the medial ridge of the nodule is caused by shearing external force. It is rarely shifted and generally does not need to be processed.
(2) The level of calcaneus nodule (bird's beak) is a kind of avulsion fracture of Achilles tendon. If the avulsed bone is small, it will not affect the Achilles tendon function. If the fracture piece exceeds 1/3 of the nodule, and there is rotation and severe inclination, or if the upward traction is severe, the operation can be reset and the screw is fixed.
(3) When the calcaneus fracture is a varus, the carrier is caused by the impact of the talus in the lower part of the talus. It is rare. Generally, there is not much displacement. If there is displacement, the thumb can be used to push it back to the original position, and the short leg plaster is fixed for 4 to 6 weeks.
(4) The fracture of the anterior calcaneus is less common. The injury mechanism is a strong adduction of the forefoot plus a plantar flexion. The X-ray oblique slice should be taken to exclude the anterior humeral fracture of the calcaneus, and the short leg cast can be fixed for 4-6 weeks.
(5) The fracture close to the joint is a fracture of the calcaneus. The injury mechanism is also caused by the high point falling down with the bone, or the heel being affected by the counter-impact force from below. The fracture line is oblique. When the X-ray film is viewed from the front, the fracture line is inclined from the inside to the outside, but not through the joint surface. Because the calcaneus is cancellous, the axial position is widened on both sides of the humerus; the lateral image, the posterior half of the calcaneus and the calcaneal nodule are displaced backwards, causing the calcaneus to protrude to the center of the foot. It is rocking chair.
(two) pathogenesis
1. About 80% of cases with vertical pressure are caused by falling or sliding from height. Depending on the position of the foot when it falls, the direction of its force is also inconsistent, and it shows different types of fracture, but it is mainly based on compression fracture. In addition, depending on the strength and duration of the force, the degree of compression changes inconsistency.
2. Direct impact is a fracture of the posterior calcaneus, which is caused by multiple external forces.
3. Muscle pull force The sudden contraction of the gastrocnemius muscle can cause the Achilles tendon to avulsion the calcaneus tuberosity. If the foot varus stress is too strong, it will cause the anterior tuberosity of the calcaneus. The valgus stress will cause the load fracture or the calcaneus knot. The longitudinal fracture of the section, but the latter is rare.
Examine
an examination
Related inspection
General radiography examination calcaneus sniper test husband Ouchi test hallux valgus detection
The patients with this disease mainly have the following performance:
1. After trauma, heel pain, unfavorable standing and walking.
2. Local swelling, tenderness, deformity, or bone rubbing.
According to the typical history of trauma, heel pain and tenderness, heel congestion, wide and flat deformity, and the outward slanting of the calcaneus, the normal sag below the lateral iliac crest, etc., it is not difficult to make a fracture judgment. The X-ray film is mainly the standard lateral position and the axial position piece. When the axial position piece is taken, the X-ray tube should be projected at an angle of 40° with the longitudinal axis of the foot. The lateral position piece draws a line from the anterior facet of the calcaneus to the posterior articular surface. Then, draw a line from the posterior articular surface to the calcaneus nodule. The two-line intersection angle is called the calcaneus nodule. The two-line intersection angle is called the calcaneus nodule angle (Böhler angle), and the normal is 20°~40°.
Diagnosis
Differential diagnosis
Swelling of the back of the foot: lymphedema in the early stage is characterized by depressed edema, swelling of the back of the foot is more obvious.
Plantar and foot edema: Postural flat feet can present symptoms of plantar and dorsal edema.
Radiation pain of the foot: Because lumbar disc herniation occurs mostly in the lumbar and lumbar intervertebral space, and the sciatic nerve is from the lumbar and sacral nerve roots, patients with lumbar disc herniation often have sciatica or begin with the buttocks and gradually radiate to the thigh. Lateral, lateral calf, instep and lateral plantar and toes. Central type of protrusion often causes bilateral sciatica. When the intra-abdominal pressure such as coughing, sneezing, and urination is increased, the radiation pain of the lower extremities is aggravated. Leg pain is more important than low back pain is one of the main signs of disc herniation.
Foot pain: common symptoms of ankylosing spondylitis include heel pain, foot pain, intercostal muscle pain. Young men with lumbar stiffness, low back pain can not be relieved after rest, should be suspected of this disease, need to take timely high-quality pelvic orthotopic X-ray film. Many scholars believe that there is low back pain plus bilateral arthritis (X-ray findings), which can be diagnosed as this disease.
