#16
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Öèòàòà:
Åñòü ïîíÿòèå øïîðà, à åñòü ïîäîøâåííûé ôàñöèèò. Ðÿä àâòîðîâ ðàññìàòðèâàþò èõ êàê ñëåäñòâèå è ïðè÷èíó. Ñêàæó, ÷òî ñêëîíÿþñü ê ýòîìó äèàãíîçó, òî åñòü ïðîöåññ â íàñòîÿùåå âðåìÿ ëîêàëèçóåòñÿ â ìÿãêèõ òêàíÿõ. Íèêàêèõ ïðèçíàêîâ ñòðåññîâîãî ïåðåëîìà íà ðåíòåíîâñêèõ ñíèìêàõ íå íàáëþäàþ, äàæå ó÷èòûâàÿ âðåìåííîé àíàìíåç çàáîëåâàíèÿ. Åñëè âíèìàòåëüíî ïîñìîòðåòü íà ñíèìîê ïÿòî÷íîé êîñòè ïðàâîé ñòîïû - òî â ïðîåêöèè çîíû ïðèêðåïëåíèÿ ïîäîøâåííîé ôàñöèè ê êîñòè ìîæíî ðàçëè÷èòü ëîêàëüíóþ ñìàçàííîñòü êîíòóðà êîñòíîé òêàíè íà ïðîòÿæåíèè áóêâàëüíî 4 - 5ìì (êà÷åñòâî ñíèìêà ïîçâîëÿåò ñäåëàòü ýòî) - ýòó îáëàñòü âîçìîæíî ðàññìàòðèâàòü êàê ëîêàöèþ ïðîöåññà è ïîòåíöèàëüíóþ â ïëàíå îáðàçîâàíèÿ â áóäóùåì çäåñü øïîðû â å¸ îáû÷íîì ïîíèìàíèè. ×òî êàñàåòñÿ ëå÷åíèÿ - íå èñïîëüçîâàí íàèáîëåå ýôôåêòèâíûé ìåòîä ëå÷åíèÿ ýòîãî çàáîëåâàíèÿ - îäíîêðàòíàÿ ëîêàëüíàÿ èíúåêöèÿ ñ ÃÊÑ â çîíó íàèáîëüøåé áîëåçíåííîñòè. Âñåâîçìîæíûå îðòîïåäè÷åñêèå ñòåëüêè, ò.í. ïîäïÿòî÷íèêè, ïðîêëàäêè è ò.ï. èìåþò â äàííîì ñëó÷àå íàèìåíüøèé ýôôåêò (åñëè îí åñòü), ýòî ïî îïûòó. |
#17
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Ñïàñèáî áîëüøîå çà ïîäðîáíûé îòâåò.
Ïî ïîâîäó èíúåêöèè, ìíå åå êàê ðàç òî è íå ñäåëàëè, ÷òî îòâåðãëè äàííûé äèàãíîç ïîñëå ïðîõîæäåíèÿ òîìîãðàôà. È ñêàçàëè, ÷òî ýòî ïåðåëîì. Æàëü, ÷òî íå ìîãó âûëîæèòü âòîðîé òîìîãðàô, ò.ê. íà íåì âðà÷ óâèäåë îáëàñòü ãîðàçäî áîëåå øèðîêóþ, ÷åì ïîëãîäà íàçàä. È êàê îí ìíå îáúÿñíèë, ïåðåëîì ýòî òîëüêî íàçâàíèå, à íà ñàìîì äåëå ïåðåëîìà êàê òàêîâîãî íåò, ïîýòîìó íà ïðîñòûõ ñíèìêàõ íå âèäíî íè ÷åãî. ×òî ýòî íà óðîâíå ôóíêöèîíèðîâàíèÿ êîñòíîé òêàíè âñå, ÷òî êîñòü êàê áû íå âîâðåìÿ âîññòàíàâëèâàåòñÿ èëè ñëèøêîì áûñòðî íàîáîðîò. (èçâèíèòå çà ñìóòíîñòü ìîæåò ìîèõ ïîÿñíåíèé, íî ÿ íå ìåäèê è òåì áîëåå ñëîæíî íàéòè ïîäõîäÿùèå ýêâèâàëåíòû, ÷òî âðà÷ òî íå ïî ðóññêè ãîâîðèë) È åùå âîïðîñ. Âû ãîâîðèòå, ÷òî â ìîåì ñëó÷àå åñòü âåðîÿòíîñòü èìåòü âñå òàêè øïîðó ïîïîçæå. Åñòü ëè ñïîñîáû ïðåäîòâðàòèòü ýòî? |
#18
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 êà÷åñòâå äèôåðåíöèàëüíîé äèàãíîñòèêè, ïðåäëîæèë áû åù¸ èñêëþ÷èòü ñòåíîç êàíàëà Ðèøå. Òî ÷òî Âû îïèñûâàåòå, ÷àñòè÷íî óêëàäûâàåòñÿ â êëèíè÷åñêóþ êàðòèíó ýòîé ïàòîëîãèè. Ïðîèñõîäèò óùåìëåíèå áîëüøåáåðöîâîãî íåðâà â òàðçàëüíîì êàíàëå, ýòî êàê ðàç íèæå è ÷óòü êçàäè âíóòðåííåé ëîäûæêè. Äëÿ ïîäòâåðæäåíèÿ (èëè îïðîâåðæåíèÿ) äèàãíîçà íóæíî ñäåëàòü íåñêîëüêî òåñòîâ. Ïóñòü ïîñìîòðèò íåâðîëîã.
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#19
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Tarsal Tunnel Syndrome
Plantar fasciotomy without calcaneal exostectomy is effective surgical treatment of plantar fasciitis. Tarsal tunnel syndrome is caused by compression of the posterior tibial nerve as it courses from the posterior aspect of the medial malleolus toward the anteromedial aspect of the calcaneus. The tarsal canal is a fibro-osseous structure bounded by the flexor retinaculum medially, the posterior aspect of the talus and calcaneus laterally, and the medial malleolus anteriorly. The tendons of the posterior tibialis, the flexor digitorum longus and the flexor hallucis longus muscles, as well as the posterior tibial nerve, artery and vein, course within this space. Compression of the posterior tibial nerve here may cause a burning sensation. Specific conditions that may cause compression of the posterior tibial nerve include a soft tissue mass, callus from a previous fracture of the medial malleolus, inflammation of one of the tendons coursing through the tarsal canal and excessive pronation that increases tension on the posterior tibial tendon and the corresponding nerve. Patients may describe heel pain with a tingling sensation around the plantar and medial aspect of the heel. Symptoms are often exacerbated by weight-bearing and ambulation but may persist at rest. The posterior tibial nerve is responsible for a large area of sensory innervation, and patients often experience difficulty in pinpointing their discomfort to a specific location in the heel. Unlike patients with heel pain from plantar fasciitis, those with tarsal tunnel syndrome typically describe their pain as being most intense on standing and walking after long periods of rest. They usually do not experience pinpoint tenderness at the origin of the medial band of the plantar fascia. Physical examination should include palpation of the course of the posterior tibial nerve from the proximal aspect of the medial malleolus distally toward the anterior aspect of the calcaneus. Patients may experience an uncomfortable burning pain that radiates proximally toward the calf (Valleix sign) or distally toward the toes (Tinel's sign). Pain with medial to lateral compression of the calcaneus is present in patients with stress fractures but rare in patients with plantar fasciitis. Finally, the clinician should inspect the patient's hindfoot for any structural conditions that may alter the patient's biomechanics. An abnormal gait can create greater tension on the contents of the posterior tarsal tunnel, resulting in an irritation of the posterior tibial nerve. Nerve conduction velocity studies and electromyographic tests can confirm the diagnosis of tarsal tunnel syndrome. Conservative therapy should address excessive pronation, which can cause compression of the posterior tibial nerve. Reduction of ambulation, NSAIDs, physical therapy and orthotic devices may alleviate these symptoms. Patients who do not respond sufficiently to conservative therapy may require surgical decompression of the tarsal canal. Entrapment of the Lateral Plantar Nerve Entrapment of the first branch of the lateral plantar nerve, which provides innervation to the abductor digiti quinti muscle, has been said to cause plantar medial heel pain. The entrapment usually occurs between the abductor hallucis muscle and the quadratus plantae muscle, giving patients a burning sensation on the plantar aspect of the heel that is aggravated by daily activities and may even persist at rest. Palpation of this area may prove painful, with a tingling sensation. The same conservative modalities that are used to treat plantar fasciitis are effective in treating this condition. |
#20
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should include palpation of the course of the posterior tibial nerve from the proximal aspect of the medial malleolus distally toward the anterior aspect of the calcaneus.
posterior tarsal tunnel between the abductor hallucis muscle and the quadratus plantae muscle, Ýòî ãäå? ß íå äîêòîð, ê ñîæàëåíèþ. Ñåãîäíÿ áûëà ó âðà÷à, êîòîðûé ìíå ïîäòâåðäèë äèàãíîç ñòðåññîâîãî ïåðåëîìà. À âû íå âèäèòå åãî íà òîìîãðàôå?  ÷åòâåðã èäó ê î÷åðåäíîìó ðåâìàòîëîãó. |
#21
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Ìíå ñåãîäíÿ ñêàçàëè, ÷òî ýòî ó ìåíÿ àëãîäèñòðîôèÿ.
×òî çà çâåðü òî òàêîé? Ïî âàøåìó. |
#22
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Ñêàæèòå ïîæàëóéñòà, à Âû íå âûåçæàëè â ñòðàíû Àôðèêè (Ñóäàí, Ñîìàëè, Ñåíåãàë è ïð) Èíäèþ, Ìåêñèêó?
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#23
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Íåò.
ß ðàáîòàëà â Àçèè (Ìàëàéçèÿ, Òàéëàíä, Ëàîñ) |
#24
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À çà âðåìÿ ðàáîòû â òðîïèêàõ íå áûëî ëè òðàâìû ñòîïû, îáëàñòè ãîëåíîñòîïíîãî ñóñòàâà? Èìåþòñÿ ââèäó äàæå ìèíèìàëüíûå óêîëû, ïîðåçû, ññàäèíû?
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#25
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Êàê áóä òî íåò. Áîëåëè êîëåíè. Íî ÿ ýòî îòíåñëà ê áåãó ïî òâåðäîé ïîâåðõíîñòè è íàáîðó âåñà. Ïîòîì ïðîøëî.
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#26
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 òàêîì ñëó÷àå âåðîÿòíî ìîæíî èñêëþ÷èòü äîñòàòî÷íî ðåäêîå ãðèáêîâîå çàáîëåâàíèå ñòîï, âñòðå÷àþùååñÿ â òðîïèêàõ.
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#27
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Íàçíà÷èëè êàïåëüíèöû Àðåäèà. Ðàç â ìåñÿö ïî 60 ìã.
Òèïà òåïåðü ó ìåíÿ äåêàëüöèôèêàöèÿ ïÿòî÷íîé êîñòè. |