MRI in patients with Haglund's deformity and its influence on therapy

INTRODUCTION

Heel pain is one of the common reasons why patients consult orthopaedic surgeons in an outpatient setting. The dorsal heel pain is often caused by a Haglund's deformity which is an exostosis of the posterior superior calcaneus. It often leads to Haglund's syndrome with calcaneal bursitis and Achilles tendinosis. This study aims to investigate the roll of MRI in diagnosis of Haglund's syndrome and its influence on therapy.

MATERIALS AND METHODS

We retrospectively analysed data of 45 patients which clinically and radiologically confirmed Haglund's deformity. Patients were divided into two groups that either did not receive MRI (MRI_0) or received MRI (MRI_1). To evaluate the significance, Fisher´s test was used. A statistical significance was assumed at p < 0.05.

RESULTS

The average age was 57.0 years. There was no significant difference in therapy comparing the groups MRI_0 and MRI_1. Haglund's syndrome was detected in 86.7% of all patients with Haglund's deformity.

CONCLUSION

MRI does not influence the therapy of patients with Haglund's deformity. Therefore, the resources of this cost-intensive and limited type of investigation should be used elsewhere. In cases of atypical heel pain, the MRI might be useful.

Plantar heel pain

Plantar heel pain is a common complaint encountered by orthopedic surgeons, internists, and family practitioners. Although it is most often caused by plantar fasciitis, this is a diagnosis of exclusion. Other mechanical, rheumatologic, and neurologic causes must be considered first. The history and physical examination are typically all that is needed to make the proper diagnosis, but diagnostic adjuncts are available to assist the clinician. When plantar fasciitis is diagnosed, conservative modalities must be tried first. Corticosteroid injections and extracorporeal shock-wave therapy may also be used. After 6 months of failed conservative treatments, surgical intervention should be considered.

CT findings of a unicameral calcaneal bone cyst containing a fluid-fluid level

Calcaneal unicameral bone cysts often contain fluid, but rarely contain fluid-fluid levels. We present a case focusing on the CT findings of a large calcaneal bone cyst with a fluid-fluid level and a review of the literature.

Low-dose radiotherapy for painful heel spur. Retrospective study of 117 patients

PURPOSE

Retrospective analysis of 117 patients treated between 1996 and 2000 with low-dose radiotherapy (RT) for painful heel spurs.

PATIENTS AND METHODS

71 women and 46 men were irradiated on 136 painful heel spurs in one (n = 104) or two radiation series (n = 13). The painful spurs were located either at the plantar (n = 94), dorsal (n = 5) or bilateral heel (n = 18). 82 patients had prior treatments, in 35 patients RT was the primary treatment. Low-dose RT was performed twice a week with one 6-MV photon field. Ten fractions of 0.5 Gy were applied to a total dose of 5 Gy. Evaluation was done on completion and during follow-up using the four-scale von Pannewitz score.

RESULTS

On completion of RT, 27 patients were free of pain, 40 were much improved, 31 reported slight improvement, and 19 experienced no change. After a mean follow-up of 20 months, 75 out of 100 patients were free of pain, twelve had marked and three some improvement. Ten patients reported no change of symptoms. Mean duration of pain before RT was 6 months. RT applied < or = 6 months after the onset of clinical symptoms resulted in improvement in 94%. By contrast, an interval of > 6 months until the initiation of RT resulted in only 73% of patients with clinical improvement.

CONCLUSION

Low-dose RT reveals a benefit in > 80% of the patients. RT should start during the first 6 months of symptoms. Prospective clinical studies with validated symptom scores should be conducted to assess optimal dose and fractionation scheme of RT.

[Evaluation of the effectiveness of the calcaneal spurs radiotherapy]

The radiotherapy results of 46 calcaneal spurs were analysed. Patients were irradiated using fraction dose of 1.0 Gy, 1.5 Gy or 2.0 Gy up to total dose of 2.0-22.5 Gy. All patients previously had chronic pain in the plantar region influencing possibility of walking and not reacting for conventional treatment. Whole group was periodically controlled after the treatment completion. The mean follow-up period was 12.5 months. The complete pain relief was observed in 9% cases one month after treatment and in 52% during the last control. The lack of analgetic effect was noted only in 3% cases as well one month after the treatment as during the last examination. Performed statistical analysis showed only inverse significant correlation between degree of pain relief six months after the treatment and duration of symptoms. Obtained results allow to form conclusion that radiotherapy of calcaneal spurs is easy, effective and safe way of analgetic treatment giving good results after low fraction and total delivered doses and that its efficacy depends on symptoms duration what is correlated to disease stage.

The influence of local steroid injections, body weight and the length of symptoms in the treatment of painful subcalcaneal spurs with extracorporeal shock wave therapy

OBJECTIVE

To evaluate the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of painful subcalcaneal spurs and evaluate whether local steroid injections, body weight and the length of symptoms can affect the clinical results.

DESIGN

Subjects were selected through clinical examination and heel radiograms according to diagnosis of painful subcalcaneal spurs.

SUBJECTS

Sixty-four subjects were divided into two groups of treatment depending on their past history of previous local steroid injections.

INTERVENTIONS

Each subject received a three-session ESWT (performed weekly). A rehabilitative programme was instituted, consisting of self-assisted plantar fascia and plantar flexors stretching exercises.

MAIN OUTCOME MEASURES

The Mayo Clinical Scoring System (MCSS) was utilized to evaluate each subject before the treatment and at two- and ten-month follow-ups. In addition, standard radiograms were done both before the treatment and at the ten-month follow-up.

RESULTS

Patients with no past treatment using steroids did not show any statistically significant improvement of the MCSS at the two-month follow-up. The statistical significance was obtained at the ten-month follow-up. Patients with past treatment using steroids did not show any statistically significant improvement of the MCSS at either follow-up. At the radiogram check, none of the subjects showed any modification of the heel spurs.

CONCLUSIONS

According to the results of the present study ESWT should be considered as an effective treatment for painful subcalcaneal spurs. Previous local steroid injections may negatively affect the result of ESWT.