Llanol: Calcaneal Fractures

Llanol: Calcaneal Fractures

Fractures of the calcaneus (heel bone) is the most common tarsal bone fracture. Most calcaneal fractures occur as the result of a fall from a height greater than 14 feet. Calcaneal fractures are common among roofers and rock climbers. The second most common contributing cause to these types of traumatic fractures are automobile accidents. Calcaneal fractures are most commonly found in males age 30-50 y/o.

Treatment of Calcaneal Fractures

As previously mentioned, calcaneal fractures can be very difficult to manage. Closed reduction is a term used when doctors will manipulate the fracture under anesthesia without surgery. Closed reduction can be successful in treating calcaneal fractures in many cases based upon the stage of fracture. Open reduction (surgical reduction of the fracture) is not guaranteed to produce more successful outcomes. Calcaneal fractures can range from simple to explosive. Follow-up following reduction (whether close or open) varies but will include a period of non-weight bearing, splinting or throwing to allow for fracture healing.

Three phase technitium bone scan can help differentiate the location and degree of inflammation in the calcaneus thereby helping to diagnose a calcaneal stress fracture. Bone scans are a test the place where a radioactive nucleotide is injected into the patient and a scan is taken of the injured area three times over the course of three hours. Each of the scans show a different degree of inflammation based upon the increased blood flow to the painful area. In the case of a calcaneal fracture, a bone scan can help in many ways.

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  • First, the scan will locate the area of the fracture based upon the inflammation seen in fracture healing.
  • Second, the bone scan will help to differentiate between a number of other potential issues with the heel such as plantar fasciitis.
  • Not only that, a scan can help to determine the acuteness of an injury.
  • For instance, we may see a questionable area on an x-ray but we shall not be able to tell whether the diagnosed injury is old or new.
  • The bone scan will help us in that a new injury will 'light up' on the scan due to its' current inflammation.
  • An old injury on the other hand will not lighting up' on the scan due to its' not enough current inflammation.
  • Gout can be treated with medications that are used to relieve the symptoms that patients can experience.
  • This treatment will depend on whether or not the patient s suffering from acute attacks or working to prevent attacks that may occur in the future.
  • Technitium - a radioactive substance that is attracted to area of inflamation.
  • Used as the active substance in bone scans.
  • Anatomy: The calcaneus is very firm on its' outer surface but soft as well as spongy on the inside, much like an egg.
  • It is really an unusually shaped bone with numerous surfaces making up the support for the subtalar joint and the calcaneal cuboid joint.

The most common symptom of a calcaneal stress fracture, and the one symptom that can help to differentiate tension fractures from fasciitis, is the nature of the pain. Stress fracture pain is constant. It hurts when a person's body weight is first applied and continues to hurt. Pain due to plantar fasciitis is sharp in the beginning of weight bearing but soon subsides, to a diploma, above 5-10 minutes.

The Disease is Caused by Increased Levels of Uric Acid in the Blood

Uric acid is a natural byproduct made by the body after eating particular foods. Most of what is produced is eliminated through the urine waste products. The situation occurs when there are high levels of uric acid products in blood.

  • Severe cases of joint depression fractures (Rowe type 4 and additional surgery may be required to fuse the subtalar joint.
  • If the subtalar joint is significantly damaged in the injury, blend of the stj is the only solution.
  • Most doctors will stage these methods, performing a subtalar fusion long after the immediate trauma of the injury.

Type 5 - Body fracture with stj depression and comminution The Essex-Lopresti Classification Of Calcaneal Fractures

  • One or more medications during the first sign of a gout attack which can include;
  • Colchicine, Adrenal cortical steroids, and Nonsteroidal anti-inflammatory drugs.
  • For a home remedy, aim at maintaining a low body weight since being overweight increases uric acid levels.
  • Research has also shown that a cup of cherries for gout taken daily lowers risk of attacks.
  • Both rapid weight loss as well as overeating can contribute to an attack so taking frequent but small amounts of food can markedly cause relief.
  • Using the many Treatments With regard to Gout will help us to treat it quickly and efficiently.
  • Learn how to recognize Causes Of Gout so that we can get it early.
  • Doctors will first try rapid prevention and treatment that will help to relieve the pain and to prevent problems in the future.
  • If not treated properly gout can cause kidney damage and can destroy the joints.
  • They will often provide medications and ways that you can treat attacks while at home.

Type 1c - Fracture of the anterior process of the calcaneus Type 2A - Beak fracture of the posterior calcaneus Type 2b - Avulsion fracture involving the insertion from the tendo-Achillles

The Location of Pain is Also Important

Stress fracture pain will typically (and not always) be in the body of the calcaneus. Pressure to the medial and lateral walls of the calcaneus result in pain. Plantar fascial pain is specific to the bottom of the heel and is reasonable with direct pressure, but sever with weight bearing.

The Biggest Factor of Course, is to Stay Away from Foods Which are High in Purine

Foods like red meats, fish and shell fish, mushrooms, cauliflower, broth, roasted nut products, sardines, fried foods, sweets and rich foods like brownies, coffee, beans, oatmeal, and asparagus. These are extremely high acid producing foods as well as they need to be strictly avoided. One big thing to be able to stay away from is alcohol. Booze is one of the most robust gout aggravators. Even small doses of aspirin may be tricky enough.

Broccoli is Rich in Fiber and Vitamin C, and is a Great Source of Folic Acid and Potassium

Potassium, along with the magnesium and calcium also found in broccoli, is also good for lowering blood pressure. A great thing about broccoli, with its high levels of dietary fiber, is that it makes you feel full. A nutritious diet is great for keeps gout flares away. Broccoli is a deliciously versatile vegetable; it can be eaten raw, steamed, or boiled. You can often see it on party trays with dip or even in a delicious broccoli salad. For some delicious broccoli recipes please click here.

Type A - Tongue type Type B - Joint depression type Stress fractures of the calcaneus Stress fractures of the calcaneus are typically the result of a sudden abrupt injury but may appear without a history of trauma. The most common injury seen our practice is a fall from a height of more than 6 feet. A stress fracture of the calcaneus is a condition that is often overlooked as a differential diagnosis of heel pain. Plantar fasciitis (also called heel spur syndrome) is so common that most health care providers will defer to plantar fasciitis as a primary diagnosis when checking heel pain. A good patient history, and particularly one that notes the onset and character of the pain, is very important when differentiating between plantar fasciitis and calcaneal stress fractures.

Biomechanics: The biomechanics of calcaneal stress fractures has not been defined. Due to the fact that most calcaneal stress fractures happen due to a random traumatic incident, no defined pathway for that fractures has been established. Symptoms: The diagnosis of a calcaneal stress fracture is usually considering pain that continues following an incident of trauma. Sometimes a calcaneal stress crack will have a great insidious onset, but many with have an acute onset. Edema (swelling) and erythema redness) may or may not be present.

  • Treatment of calcaneal stress fractures varies with the severity of the fracture and the degree of pain.
  • Numerous cases of calcaneal stress fractures are simply treated with rest and a decrease of activity.
  • Others may necessitate a walking cast or period of non-weight bearing.
  • Surgical intervention is rarely indicated.
  • Healing of calcaneal stress cracks can be prolonged and may require a period of several months to heal.

Type 3 - Oblique fracture not involving the subtalar joint Type 4 - Body break involving the subtalar joint

Order to reduce the pain, redness, and the swelling caused by gout during an attack doctors will prescribe: Plenty of rest for the joints that are affected

But what have you heard about broccoli? Broccoli, a leafy relative of cabbage, is high in many of the vitamins proven to help lower uric acid levels, and as a bonus, it's very low in purine. Broccoli only contains 50-100mg of purine per 100g of the vegetable. When eaten regularly, broccoli is an all natural detoxifier, helping to flush out uric acid and free radicals.

This is a Form of Arthritis that is Marked by a Sudden Sharp Joint Pain

The condition could involve any joint though mostly it begins with the big toes or around the feet. The important joints that are involved become swollen and painful, the skin around turns shiny and red. An attack can last 10 days if not treated. In addition to joint pain, there could be an ulcer or lump creation under the skin. Kidneys can also be damaged if involved. An understanding of this disease is important for keeping gout out or even in finding gout cures.

  • Tarsal Tunnel Syndrome - also known as posterior tibial nerve neuralgia.
  • Tarsal Canal Syn. characteristically has pain that does not decrease with rest.
  • Also has numbness or 'tingling' of the toes
  • There are other methods of gout treatments that have been created from scientific studies - but have not yet been fully proven to work.
  • However, some people still try these therapies in the hopes that it will relieve their pain.

Nomenclature: Calcaneus - The bone of the heel Subtalar Joint - (STJ) the joint between the two major bones of the rearfoot, the talus and calcaneus. The actual STJ is a common site of residual arthritis following calcaneal fractures.

Calcaneal fractures have a track record of being difficult to treat and have frustrated doctors for years. The issue in treating calcaneal fractures is in trying to rebuild the fracture in order that healing may take place. The calcaneus is actually much like an egg; an outer firm shell and soft on the inside. As a result, the calcaneus usually shatters when broken. Calcaneal repair not only calls for re-apposition of multiple break patterns, but also requires restoration of the subtalar joint. The subtalar joint is the interface between the calcaneus and also talus and is a main load bearing joint of the foot. In some cases, additional joint surfaces may be affected (the calcaneal cuboid joint) but are of lesser importance due to their limited weight bearing roles.

Plain x-rays may be able to see a calcaneal fracture, but quite often, due to the lack of disruption of the bone, plain films lack the ability to 'see' the fracture. As fractures heal, many times the healing process can be seen on plain x-ray films. The healing process will increase the amount of calcium encircling the fracture. This process of calcification typically takes about 4-6 weeks to see on plain x-ray, as a result, periodic follow-up x-rays may aid in diagnosing a stress fracture of the heel.

  • Before trying any of these methods you should consult with your doctor and ask them whether or not they think it would help.
  • They may encourage you to take minerals or vitamins instead to help reduce assaults.

Differential Diagnosis: Baxter's nerve entrapment - an entrapment of the recurrent branch of the posterior tibial nerve Gout - deposition of monosodium urate crystals (hyperuricemia)

  • There are no true gout remedies available, the current medications only reduce pain and symptoms.
  • Three main types of drugs are used to treat attacks.
  • The non-steroidal anti-inflammatory drugs, the adrenal cortical steroids group and colchicine.
  • Adhering to these measures may not guarantee gout cures but will keep any attacks of gout out of your system.

Two Classifications are Used for the Classification of Calcaneal Fractures

The Rowe classification and the Essex-Lopresti category both describe calcaneal fractures. The Essex-Lopresti classification describes subtalar joint depression fractures (very severe fractures) in much more detail than the more commonly used Rowe classification. Plain xrays and CT scans are often used to determine the extent and classification of calcaneal fractures.

  • Gout is a rheumatologic disorder characterized by pain and inflammation in the joints.
  • An attack is brought on by increased uric acid in the body which is a byproduct of purine breakdown.
  • It is a form of arthritis and can cause severe, sudden attacks.

The Diagnosis of Calcaneal Stress Fractures can be Difficult At Times

Stress fractures, regardless of where they occur in the body, are different than what we would tend to think of when we discuss fractures. The appearance of a stress fracture on x-ray are not always evident.. Quite often, the only x-ray findings that we'll see are the ones that show up towards the end of the healing process, sometimes as long as several months after the injury. We don't actually visualize the crack, but rather we see the calcification that occurs in the late phases of the healing process. Should the symptoms of heel pain not respond to treatment for plantar fasciitis, or initial clinical findings seem suggestive of a stress fracture, there are several tools that can be used to help differentiate between calcaneal stress fractures and each of the other common conditions considered in treating heel pain.

  • Drinking plenty of water and avoiding drinks high in sugar which can increase weight are good for relief.
  • There are also two major drugs that can help reduce attacks.
  • These include Allopurinol as well as probenecid, they directly lower uric acid levels in blood.
  • You are looking for a way to get gout out of your body, you should follow this link for more information.
  • You can link to gout relief or visit gout remedies now.

Retrocalcaneal bursitis (Albert's Disease) - this is the formation and irritation of a bursa at the back of the heel between the heel bone and Achilles tendon

Now, as gout sufferers, I am sure you have heard tons about what you should be eating and drinking to fend off painful attacks. Not only is this diet full of purine, that cause excess uric acid production, but the diet also causes stored body fat to be consumed thereby releasing more uric acid. This is a double dose of uric acid to the gout sufferer causing an overload on the system and perhaps making some of the worst gout attacks and buildup of in ligament a person has ever experienced.

References: Rowe CR, Sakellarides HT, Freeman PA, et al. Fractures of the os calcis: long term follow-up study of 146 patients. JAMA.

Heel Spur Syndrome

See plantar fasciitis Plantar fasciitis - a common condition of the heel that results in pulling by the plantar fascia and a tearing pain at the attachment of the fascia on the bottom of the heel. Pain is serious with the first few steps out of bed in the morning or after a brief period of rest.

Combining cherries and special herbs is called the devil's claw and is a folk remedy that is used as an anti inflammatory medicine for gout treatment. More research is being done on this in order to see how successful it is as a treatment.

About the Author:Jeffrey a

Oster, DPM, C.Ped is a board certified foot and ankle surgeon. Dr. Oster is also board certified in pedorthics. Dr. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.

When the Levels are Raised, They Crystallize

The crystals are shaped like needles and are usually sharp. They are therefore able to result in the pain and swelling characteristic of the attacks. The crystals damage the cartilage that usually make the joint smooth. When deposited under the skin, the deposits form gouty lumps and sometimes ulcers. In the kidney they cause kidney damage or kidney stones.

  • Another remedy is eicosapentaenoic acid and it is also used to reduce inflammation caused by chronic gout.
  • This has yet to be studied.
  • MRI's are also helpful in differentiating calcaneal fractures from plantar fasciitis.
  • MRI's can identify small areas of bone edema suggestive of a fracture.
  • Those who suffer from chronic gout attacks have a hard time dealing with the pain that is associated with it.
  • For some people the slightest touch from the lightest feather can cause them immense pain.
  • There are treatments that doctors will use to help relieve this pain.

Broccoli Was First Used Over 2000 Years Ago

Ever since the Romans started using it in their cooking, broccoli has been turning up in many Italian dishes. It was Italian immigrants who first brought broccoli in order to North america, but it didn't start gaining popularity until the 1920's.

As We Get Older We Tend to Wear Down Like Cars

But normally we can't switch out parts like cars. So it is very important that we take care of our selves. One thing that can wear out if not taken care out properly is the joints. As we get older without proper care you could develop arthritis. The most painful form of arthritis is gout.

The Disease Has Several Causes

There is one form linked to genetics where one could inherit it from parents who may have suffered the disease. Kidney conditions are also causes of gout in that the kidneys will not be able to eliminate the uric acids. Steak is also implicated in precipitating the condition due to the high levels of protein in it. Excessive consumption of alcoholic drinks and some drugs such as the diuretics can also result in this condition.

A well-balanced diet (including broccoli!), abstaining from alcohol and exercising regularly are helping to control your gout flares, talk to your doctor. They may prescribe you colchicine, a drug verified to lessen the severity of gout attacks, or if taken everyday, may prevent them all together. Colchicine can be bought at a discount from a licensed Canadian pharmacy such as Big Mountain Drugs, where you will be taken care of quickly and securely.

  • Hermann OJ. conservative therapy for fractures of the os calcis.
  • J Bone Combined Surg 1963:45-A:865-867

The Rowe Classification Of Calcaneal Fractures Type 1a - Tuberosity fracture medial or lateral Type 1b - Fracture of the sustentaculum tali

Parker JC. Injuries of the hindfoot. Clin Orthop 1977; Palmer I. The mechanism and treatment of fractures of the calcaneus: open reduction with the use of cancellous grafts. J Bone Joint surg 1948;30-A(1):2-8

Rheumatoid Arthritis

Rheumatic Fever Septic Arthritis Sero-negative arthropathies such as Reiter's Syndrome Sever's Disease - and inflammatory condition typically found in youthful over weight boys age 10 to 15 years old.

  • Julia Mulline is a medical writer based out of Vancouver, Bc, Canada.
  • She recommends Big Mountain Drugs, a licensed Canadian on the internet pharmacy, to buy Colcrys and other anti-inflammatory medications.

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