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Musculoskeletal problems and injuries - part 3

như tình trạng viêm, microtear, hoặc sự nhổ lên periosteal. Sharp đau gót chân là có kinh nghiệm với đi lại vào buổi sáng sớm và có xu hướng giảm bớt hoạt động, mặc dù một cảm giác nóng rát hoặc đau âm ỉ có thể xảy ra với các hoạt động. Kiểm tra cho thấy một khu vực cụ thể của đau nằm phía calcaneus chân trung gian là trầm trọng hơn bằng cách đứng trên các tiptoes hoặc dorsiflexing mắt cá chân. . | Table 3.4. Continued . Common Causes of forefoot pain Corns calluses Onychocryptosis Synovitis MTP joints First MTP sprain Subungual hematoma Hallux valgus Hallux rigidus Morton s neuroma Sesamoiditis Metatarsal stress fracture Jones fracture 5th MT base MTP metatarsophalangeal. Uncommon Not to be missed Freiberg s osteochondritis Joplin s neuritis Stress fracture sesamoids Toe clawing Plantar wart Subungual exostosis Hammer toe RSD Lisfranc fracture dislocation 80 Kenneth M. Bielak and Bradley E. Kocian 3. Disorders of the Lower Extremity 81 as an inflammation microtear or periosteal avulsion. Sharp heel pain is experienced with early morning ambulation and tends to lessen with activity though a burning sensation or dull ache can occur with activity. Examination shows a specific area of tenderness overlying the medial plantar calcaneus that is aggravated by standing on the tiptoes or dorsiflexing the ankle. Tight heel cords contribute to the chronic nature of this disorder. Lateral radiographs may show heel spurs but they are rarely the cause of the pain. Treatment options include activity modification NSAIDs physical therapy heel pads orthotic devices night splints and walking casts. Injectable corticosteroids are often used but long-term efficacy is negligible. Most patients if not all find some lessening of symptoms during the first week. Pain relief may last as long as six to seven weeks but more than half of these patients experience a return to preinjection discomfort.48 Haglund s Deformity Haglund s deformity or prominence of the posterosuperior os calcis presents with pain and swelling of the heel made worse by activity. Examination by palpation reveals tenderness thickening of the overlying skin and signs of local inflammation. There may also be a varus deformity of the heel and a mild degree of cavus of the foot reflected by a high medial arch making the tuberosity appear more prominent. Conservative treatment includes PRICE and only those not benefiting