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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Painful enlargement of the entire posterior aspect of the calcaneus can be difficult to effectively treat and must be differentiated from a classical Haglund's deformity. Clinical, radiographic, and surgical treatments of this deformity will be discussed. An illustrative case presentation is also included.
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PMID:Enlargement of the entire posterior aspect of the calcaneus: treatment with the Keck and Kelly calcaneal osteotomy. 143 Aug 20

An excessive prominence of the bursal projection in the posterosuperior aspect of the calcaneous constitutes Haglund's deformity. Swelling in this area constitutes Haglund's disease and is associated with retrocalcaneal bursitis. Rigid and prominent heel counters with high heels impinge on the soft tissues overlying the prominence and give rise to symptoms of pain and swelling. Cavo varus deformities exacerbate this problem. The bursal projection can be demonstrated radiologically by a superior calcaneal angle of more than 75 degrees, a combination of calcaneal inclination and a posterior calcaneal angle of more than 90 degrees, and excessive bone above the upper parallel pitch line. Conservative treatment should always be implemented, and only those that have not benefited from such therapy should be considered for surgery. The results of surgery are satisfactory, provided adequate bone has been resected and no damage to local peripheral nerves or the Achilles tendon has been sustained. After a period of immobilization, an appropriate rehabilitation program must complement the treatment to ensure the early return of function to the tendons and surrounding joints.
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PMID:Haglund's deformity and retrocalcaneal bursitis. 829 Feb 30

As with deformities of the forefoot, deformities of the rearfoot often respond well to conservative therapy. Rest and nonsteroidal anti-inflammatory medications are often used. Patients with plantar fasciitis may benefit from corticosteroid injections. Surgery may be helpful in refractory cases. Haglund's deformity is associated with pain in the area of the osseous ridge on the posterosuperior aspect of the calcaneus. The retrocalcaneal bursa may be inflamed. This disorder is diagnosed by palpation of the painful area. Conservative treatment consists of minimizing pressure over the osseous ridge. Corticosteroid injection is not advised since it may weaken the Achilles tendon. Surgical intervention consists of resection or reduction of the osseous ridge. Posterior calcaneal spur is another cause of heel pain. The spur can be visualized radiographically in the tendon insertion. Treatment is conservative, with footgear modification and nonsteroidal anti-inflammatory drug therapy. Surgery to remove the spur may be indicated if conservative measures fall to relieve the pain. Tarsal tunnel syndrome is characterized by pain and numbness from the medial malleolus to the sole of the foot. Conservative treatment includes reducing abnormal pronation with an orthosis.
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PMID:The painful foot, Part II: Common rearfoot deformities. 914 47

Haglund's deformity, or "pump bump" is a common cause of posterior heel pain, characterized clinically by a painful soft tissue swelling at the level of the Achilles tendon insertion. We reviewed 30 heels in 19 patients with failure of conservative treatment. Surgical management consisted of excision of the posterior calcaneal tuberosity and bursectomy through a medial longitudinal incision. The average follow-up period was 6 years (range, 3-10 years). Only 3 heels (10%) in 2 patients had persistent pain. Twenty-seven heels (90%) were cured after operation. However, 25 heels (83%) had residual pain for a half to two years after operation and became free of symptoms thereafter. We conclude surgical treatment of Haglund's deformity produces a predictably good result (90%) but requires a long time about a half to two years for full recovery.
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PMID:Surgical treatment for Haglund's deformity. 1171 41

Achilles tendinosis is a degenerative overuse tendinopathy involving the primary ankle plantarflexors, namely the soleus and gastrocnemius muscles forming the tendo Achilles. The Orthopaedic Research Institute-Ankle Strength Testing System (ORI-ASTS) was designed to record objective measurements of force generated with a resisted ankle plantarflexion test. Testing normal subjects (n=6) was used to establish the reliability of the ORI-ASTS for measuring ankle plantarflexion force. Testing patients with Achilles tendonitis (n=5) over time and comparing Achilles tendon analogue pain scores to ankle plantarflexion force measurements was used to assess the validity of the ORI-ASTS for monitoring progression of Achilles tendinopathy. Inter-rater reliability of the ORI-ASTS with normal subjects was excellent, with single measure intraclass correlation coefficients (ICC) for right mean peak force of 0.92, left mean peak force of 0.96, right mean total force of 0.89, left mean total force of 0.91. The ORI-ASTS also had excellent intra-rater reliability for normal subjects with the following single measure ICC scores: right mean force 0.96, left mean force 0.92, right mean total force 0.97, left mean total force 0.92. The relative technical errors of measurement were calculated from these results, and ranged from 1.0% to 2.7%. Testing patients with Achilles tendinosis (n=5), and comparing analogue activity pain scores to ORI-ASTS testing demonstrated a strong negative relationship between the two parameters (Spearman Rho -0.87 to -1.0, Kendall tau b -0.82 to -1.0). The relationship was statistically significant at the p=0.01 level for two of the five patients. The ORI-ASTS shows excellent reliability for testing ankle plantarflexor force, and appears valid for objectively assessing and monitoring patients with Achilles tendinosis.
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PMID:The Orthopaedic Research Institute-Ankle Strength Testing System: inter-rater and intra-rater reliability testing. 1185 30

This article, the final in this series, describes taping techniques for common lower limb problems. Taping can be used to correct abnormal biomechanics (e.g. patellofemoral pain), prevent recurrent injury (e.g. ankle taping for instability), offload the injured tissue (e.g. acute ankle sprain) or provide proprioception awareness (e.g. Achilles tendonitis).
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PMID:Lower limb taping. 1204 50

We are reporting two cases of calcaneal fractures with posterior heel pain due to a prominent superior calcaneal tuberosity impinging on the Achilles tendon after a tongue type fracture. Malunion of the tongue fracture fragment resulted in the symptomatic bony prominence, which we defined as the secondary Haglund's deformity. Both cases were treated with resection of the superior calcaneal tuberosity when symptoms continued after non-surgical treatment. Clinical results after operations were both satisfactory with complete pain relief.
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PMID:Late sequelae of secondary Haglund's deformity after malunion of tongue type calcaneal fracture: report of two cases. 1244 6

The authors report a retrospective study involving 25 feet in 21 patients who underwent percutaneous drilling for chronic heel pain. Patients with increased activity of the heel were considered for surgical treatment if there was increased uptake on the delayed bone scans. The average follow-up was 21 months (range, 6 to 30 months). All patients were treated in day surgery with local anesthesia. Three small holes were bored in the medial cortex of the calcaneus. Clinical evaluation of the parameters of pain, walking distance, fascial tenderness, paresthesias, and ankle and subtalar joint motion were evaluated preoperatively and at final follow-up. In 7 patients, repeat bone scans were performed and 6 patients had resolution of the abnormal uptake. In 81% of feet treated, there was a favorable outcome based on a subjective scoring scale. Using a visual analog pain scale, the preoperative pain level was 8.8 (range, 4 to 10), and at latest follow-up, it was 2.4 (range, 0 to 10). These results are comparable to other available surgical methods for the treatment of recalcitrant heel pain. Less predictable results were seen in patients with rheumatic and systemic pathologies and in those diagnosed with Haglund deformity. This technique appears to be effective in the relief of intraosseous congestion and bone-marrow edema.
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PMID:Percutaneous drilling for chronic heel pain. 1456 22

Heel pain is a common condition in adults that may cause significant discomfort and disability. A variety of soft tissue, osseous, and systemic disorders can cause heel pain. Narrowing the differential diagnosis begins with a history and physical examination of the lower extremity to pinpoint the anatomic origin of the heel pain. The most common cause of heel pain in adults is plantar fasciitis. Patients with plantar fasciitis report increased heel pain with their first steps in the morning or when they stand up after prolonged sitting. Tenderness at the calcaneal tuberosity usually is apparent on examination and is increased with passive dorsiflexion of the toes. Tendonitis also may cause heel pain. Achilles tendonitis is associated with posterior heel pain. Bursae adjacent to the Achilles tendon insertion may become inflamed and cause pain. Calcaneal stress fractures are more likely to occur in athletes who participate in sports that require running and jumping. Patients with plantar heel pain accompanied by tingling, burning, or numbness may have tarsal tunnel syndrome. Heel pad atrophy may present with diffuse plantar heel pain, especially in patients who are older and obese. Less common causes of heel pain, which should be considered when symptoms are prolonged or unexplained, include osteomyelitis, bony abnormalities (such as calcaneal stress fracture), or tumor. Heel pain rarely is a presenting symptom in patients with systemic illnesses, but the latter may be a factor in persons with bilateral heel pain, pain in other joints, or known inflammatory arthritis conditions.
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PMID:Diagnosing heel pain in adults. 1529 Oct 91

Up to now diagnosis of Haglund's disease is based on patient's history and clinical findings. There is no valid diagnostic tool described to functionally detect retrocalcaneal bursitis. Retrocalcaneal bursa pressure may be increased in these patients. We hypothesized that retrocalcaneal bursa pressure can directly be measured. In this pilot investigation we tested the feasibility of a system which is already in clinical use for arterial blood pressure monitoring to quantitatively assess retrocalcaneal bursa pressure in a human and a swine cadaver specimen and in vivo. Using the presented system retrocalcaneal bursa pressure measurement is demonstrated to be feasible. Moreover, intrabursal pressure is reproducibly and validly quantified. In an uninjured subject increasing ankle dorsiflexion was not associated with increasing pressure in the retrocalcaneal bursa. Experimental liquid injection in the retrocalcaneal bursa was associated with increased intrabursal pressure and increasing pain. Feasibility of the tested setup could be proven. The question, if retrocalcaneal bursitis can be distinguished from further heel pathologies by different pressures in the retrocalcaneal bursa has to be addressed in a subsequent in vivo study.
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PMID:Minimally invasive retrocalcaneal bursa pressure measurement: development and pilot application. 2116 64


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