Nyeri tumit Posterior Posterior Heel Pain

Penyebab tersering penyebab nyeri tumit

Apa penyebab tersering nyeri tumit posterior ?
nyeri tumit posterior dapat berasal dari satu hingga beberapa penyebab. Ketika
dokter berbicara tentang nyeri tumit posterior, Posterior heel pain can come from one
of several causes. When a physician is talking about posterior heel pain, he or she is
referring to pain behind the heel, not below it. Pain underneath the heel, on the
bottom of the foot, has several causes including:

Tarsal Tunnel Syndrome

Plantar Fasciitis

Heel Spurs

Nyeri disekitar dari tumit posterior bagian belakang biasanya disebabkan oleh :

Achilles Tendonitis
Achilles tendonitis merupakan diagnosis umum dari inflamasi tendon pada
bagian belakang ankle. Most commonly pain is experienced directly over the
tendon, but it may also be at the point where the tendon attached to the heel
bone (the calcaneus). Degenerative changes such as small tears within the
tendon and calcium deposits within the tendon can contribute to this problem.

Retrocalcaneal Bursitis
There are several bursa behind the heel bone that protect this area of contact.

Often these bursa can become irritated leading to bursitis, inflammation and
posterior heel pain. Treatment of bursitis is covered in the article describing
bursitis.

Calcaneal (Heel Bone) Spur

A bone spur can form over a long period of time at the insertion of the Achilles
tendon in the back of the heel. This bony prominence can grow over time, and
is referred to as a "pump bump." This extra bone can irritate the surrounding
tissues and lead to bursitis (see above) of the surrounding bursa.

How is posterior heel pain diagnosed?

Diagnosis of the cause of posterior heel pain can be difficult as it is not uncommon
for these diagnoses to coexist. For example, a patient with a bony spur of the
calcaneus may have bursitis in that area as well. Because of this, all of these
diagnoses must be considered for effective treatment of posterior heel pain. Other
causes of posterior heel pain that should also be considered include plantar fasciitis,
stress fractures of the calcaneus, and os trigonum syndrome.
Common Heel Problems

Achilles Tendonitis

Plantar Fasciitis

Tarsal Tunnel Syndrome

Treatment of Heel Pain

Ice an Injury

Anti-Inflammatory Medications

Find A Doctor

Heel pain and calcaneal spurs

What is a calcaneal spur
If you
experience pain
in the heel, you
may be
overloading your
tendons.
A calcaneal spur is a small bony projection that is formed on the calcaneus or heel
bone, either at the back of the heel or under the sole of the heel.
It's caused by damage to the bone accumulating over a long period of time as a
result of chronic inflammation of the Achilles tendon in the calf or the tough sinewy
tissues called the plantar fascia, which is found on the soles of the feet.
What causes heel pain and calcaneal spurs?
Every time you take a step, one of your heels has to support the whole weight of
your body. As you move, the load is equal to 20 times your own body weight.
The load is softened by a pillow of fat under the heel and a large sinew or ligament
(the fibrous tissue that joins muscle and bone) under the sole of the foot.

This sinew is called the plantar fascia and it pulls the heel bone forward (in
opposition to the Achilles tendon, which pulls it backwards).
If an athlete does not warm up properly or a person with a sedentary job exercises
heavily during the weekends, they might overload the muscles of the calf or strain
the Achilles tendon, which joins these muscles to the heel bone.
When overloaded the tendon becomes tight and painfully inflamed, which places
extra strain on the plantar fascia and muscles in the soles of the foot.
The strained plantar fascia becomes inflamed and may even develop tiny cracks.
This is known as plantar fasciitis.
Every time you sit down, sleep or otherwise rest your legs, the muscles of the sole of
the foot will contract in an attempt to protect the damaged sinew.
The pain in the heel will then no longer be felt. But when you get up again and put
weight on the foot, the foot and ankle may feel stiff (because of the inflammation)
and the pain will return either at the back of the heel or on the soles of the feet.
When you start to move, the plantar fascia may crack even more causing a vicious
cycle of damage and pain.
Inflammation at the point where the Achilles tendon (at the back of the heel) or the
plantar fascia (under the heel) join the heel bone (a bone known as the Calcaneum)
stimulates cells that form bone to deposit bone in this area, eventually leading to the
build up of a bony prominence on the heel bone called a calcaneal spur.

But it's not the spur itself that causes the pain. The spur is a sign of chronic
inflammation in the connective tissues, which is the result of a prolonged overload.
It should also be pointed out that heel spurs can occur on their own, without plantar
fasciitis or pain, or may be linked to some types of arthritis (inflammation of the
joints). And plantar fasciitis or Achilles tendonitis don't necessarily lead to spur
formation.
What are the symptoms of an overloaded or inflamed sinew or of a calcaneal
spur?

A sharp, stabbing or dull but intense pain under or on the inside of the heel.

The pain is typically relieved during rest, but is worse after getting up again.

As a rule of thumb, it is most painful first thing in the morning.

The feet or calf muscles may feel very stiff in the morning, making walking
difficult.

The pain is made worse by walking on a hard surface or carrying something

heavy, such as a suitcase.

The pain can become so severe that it becomes difficult to continue your daily
work.

Calcaneal spurs may cause no symptoms at all.

Special risk groups

Most sufferers are people who are overweight and middle-aged. The excess
weight puts additional load on all the muscles, tendons and bones, while with
age, the shock-absorbing fat pillow under the foot shrinks and becomes less
effective.

Weekend athletes whose muscles aren't tuned up for sudden intense activity.

People who have feet that are pronated and not corrected. Pronated means
that the foot tends to roll inwards when a person walks or runs.

Foot care advice

Get advice from a physiotherapist about the right sort of exercises to help the
condition. Stretching exercises, which you can begin while still lying flat in bed
in the morning can help to loosen the feet and calves and get you going. They
should be done several times through the day too. Patients with plantar
fasciitis often have tightness of the Achilles tendon and stretching interrupts
the vicious cycle in which the two disorders aggravate each other.

Take time to warm up and stretch before taking part in sport or exercise and
cool down afterwards.

If you run or jog, it is better to run a short distance several times a week than
one long run once a week.

Do not overestimate your abilities. If necessary, seek advice about creating a

suitable running schedule that will give your body time to adapt.

If you experience pain in the heel, you may be overloading your tendons.

To help the healing process, follow the RICE principle, which stands for Rest,
Ice, Compression and Elevation.

If you have an acute flare up of pain, rest the foot and do not run until it has
settled again. Apply an ice pack, such as a packet of frozen peas that has first
been wrapped in a towel or cloth. An elasticated support bandage will
compress and support the foot. It should be firm, but not so tight that it affects
the circulation of blood. Elevate the foot by resting it on a chair or a pillow.
However regular low intensity exercise can help to ease the condition, so a
balance has to be found between too much and too little exercise. Simply
avoiding exercise completely may leave the legs and feet stiff and is not good
for your general health.

Invest in suitable shoes.

The heel can be supported with a small cushioned insole inside the shoe.

Arch supports that fit inside shoes will prevent feet from pronating.

If you are overweight, losing weight can help resolve foot problems and
prevent further trouble.

Talk to your doctor about anti-inflammatory painkillers for example ibuprofen

may help if taken regularly but can cause irritation of the stomach lining.

How does the doctor make the diagnosis?

Calcaneal spurs and plantar fasciitis are usually diagnosed by the symptoms
revealed during a clinical examination.

To eventually confirm the diagnosis and exclude other possible causes of heel pain
like arthritis, the doctor may order other investigations such as X-rays.
Prognosis
Plantar fasciitis is a chronic condition that often lasts 12 months or more before
eventually subsiding.
Once a calcaneal spur develops, it can be a difficult condition to treat.
However, many cases involve only minor ligament damage, which is relieved in a
matter of weeks or months.
Prevention by taking early corrective measures against any predisposing factors will
improve the long-term prognosis.
How is a painful heel or calcaneal spur treated?

In all stages of the condition it is important to use appropriate footwear and

adopt footcare habits.

Reduce activity during acute pain and rest the heel.

Physiotherapy can teach useful non-weight bearing exercises to stretch the

tissues and use techniques such as ultrasound to help healing.

Your doctor may prescribe anti-inflammatory medicines.

injections of steroids will sometimes reduce pain dramatically but the effects
will only be temporary.

A state-registered chiropodist or podiatrist, particularly one with an interest in

biomechanics will be able to offer advice on foot posture and the use of
corrective insoles or footwear.

Surgery is often no more than a last resort when pain is hard to deal with, and
it may be ineffective.

OSTEOCHONDRITIS DISSECANS - TALUS

ANATOMY & FUNCTION
The ankle is a joint which is formed by the tibia and fibula (bones above the ankle in
the foreleg) and the talus (below the ankle joint). The ankle joint allows for the
upwards (dorsiflexion) and downwards (plantarflexion) motion. The endof the shin
bone (tibia) forms the inner bony prominence of the ankle called the medial
malleolus. The outer bony prominence is called the lateral malleolus and is formed
by the small outer bone in the foreleg called the fibula.
Figure 1: Lateral (Side) View of RightFoot
Osteochondritis dissecans is an injury to the talus bone of the ankle joint. Because
the ankle joint is so small, the amount of force that goes across the joint, with each
step, has been estimated to be approximately 5-10 times a person's body weight.As
a result of this tremendous force that occurs in the ankle joint, relatively small injuries
to the articular surface of the talus often result in chronically painful injuries.
Osteochondritis dissecans is the result of the isolated loss of blood flow to a portion
of the talus bone. Usually this occurs in conjunction with a history of trauma. It is

sometimes also known as an osteochondral fracture of the talus, chip fractureof the
articular surface or a chondral fracture of the talus.
The development of osteochondritis may be very slow. Initially, a person may sustain
a twisting injury to the ankle. As the ankle is injured, the talus bone twists within the
space between the tibia and fibula. As this twisting occurs, the ligamentsaround the
ankle may be stretched (ANKLE SPRAINS). Unfortunately, in some people, as the
twisting injury occurs, not only are the ankle ligaments stretched, but the talus bone
strikes the tibia or fibula. When this occurs,some type of injury to the talus, tibia, or
fibula happens. Typically, the majority of the damage occurs to the talus at the
articular surface.
The articular surface (articular cartilage - WHAT IS A JOINT?) is normally nice and
smooth. It has no blood supply. Without a blood supply, the potential for healing
damage to the articular cartilage is minimal. Therefore,when this tissue is damaged,
it may slowly deteriorate with the passage of time. As the articular surface
deteriorates, the surface changes from a nice smooth frictionless surface to a rough
cobblestone like surface. This rough degenerative surface is aform of arthritis.
When the ankle is twisted, and the talus impacts the tibia or fibula, the talar articular
surface may be merely bruised, or a more serious injury may occur. If the twisting
injury results in a shearing force to the talus as it impacts the tibia orfibula, then a
chip fracture may occur. This "chip fracture" may either be complete, or incomplete,
and it may be detached (loose body), partially detached, or non-displaced.
To further confuse things, the bone injury may not become visible on x-ray for
several months.

When the chip becomes detached, then it floats freely inside the ankle joint. When
this occurs, patients may develop a definite catching sensation that is associated
with a loss of motion. In addition, the joint may become swollen and painful.
Later,when the chip slips out of the way, the symptoms may improve, swelling
decrease, and the may disappear - only to reappear at another time.
If the fragment is partially detached, then similar problems may occur.
However, if the fragment is not detached, then the only complaints may be pain and
discomfort.
The location of the injury is on the articular surface of the talus. It may be located on
either side of the talar dome. The talar dome is that semicircular portion of the talus
that sits beneath the tibia. On this dome, the osteochondritis dissecansmay occur on
either the medial or lateral sides of the talar dome (articular surface of the talus).
DIAGNOSIS
Initially, a physical exam should be done to try to determine the site of tenderness
and the cause of the patient's complaint. During this process, the stability of the
ligaments and tendons around the ankle is usually checked along with the range
ofmotion of the joint. Palpation is used to determine the areas of tenderness and to
check for signs of an effusion (collection of fluid within the joint).
Sometimes, it is necessary to aspirate (remove) the joint fluid collection to determine
the type of fluid present. IF the fluid is bloody with fat globules present
(lipohemarthrosis), then some type of injury to the bone may be the cause.
X-rays are taken to evaluate the talus, tibia, and fibula. With the x-rays, it is possible
to check for signs of arthritis, loose bodies, chip fractures, fractures, and other bone

abnormalities. Unfortunately, because the ankle bones overlap onx-rays, it is

necessary to take multiple views from different angles in order to try to completely
evaluate the bones. Even with multiple views, it is still possible for the overlapping
bone images to hide abnormalities. For that reason, if patientsfail to improve, it is
often necessary to obtain more sophisticated imaging studies such as MRIs, CT
scans, bone scans, or tomograms. Unfortunately, none of these studies are 100%
accurate.
With osteochondritis, sometimes, the initial imaging studies are normal. Only by
repeating the imaging studies is the abnormality ever found. This is related to the
fact the osteochondritis may take time to develop. Initially, the damage may be
greatenough to cause very mild intermittent symptoms, but too small to be visualized
on x-ray. With the passage of time, as the osteochondritis worsens, then changes
begin to appear on the imaging studies.
Osteoarthritis Overview
Osteoarthritis (OA) is not a single disease but rather the end result of a variety of
disorders leading to the structural or functional failure of one or more of your joints.
Osteoarthritis is the most common cause of chronic joint pain, affecting over 25
million Americans. Osteoarthritis involves the entire joint, including the nearby
muscles, underlying bone, ligaments, joint lining (synovium), and the joint cover
(capsule).
Osteoarthritis also involves progressive loss of cartilage. The cartilage tries to repair
itself, the bone remodels, the underlying (subchondral) bone hardens, and bone cyst
form. This process has several phases.

The stationary phase of disease progression in osteoarthritis involves the formation

of osteophytes and joint space narrowing.
Osteoarthritis progresses further with obliteration of the joint space.
The appearance of subchondral cysts (cysts in the bone underneath the cartilage)
indicates the erosive phase of disease progression in osteoarthritis.
The last phase in the disease progression involves bone repair and remodeling.
Definitions
Joint cartilage is a layer of tissue present at the joint surfaces that sustains joint
loading and allows motion. It is gel-like, porous, and elastic. Normal cartilage
provides a durable, low-friction, load-bearing surface for joints.
Articular surface is the area of the joint where the ends of the bones meet, or
articulate, and function like a ball bearing.
Bone remodeling is a process in which damaged bone attempts to repair itself. The
damage may occur from either an acute injury or as the result of chronic irritation
such as that found in osteoarthritis.
Collagen is the main supportive protein found in bone tendon, cartilage, skin, and
connective tissue.
Osteophytes are bony outgrowths or lumps, especially at the joint margins. They are
thought to develop in order to offload the pressure on the joint by increasing the
surface area on which your weight is distributed.
Synovium is a membrane surrounding the joints that secretes a fluid that lubricates
and provides nutrition to tissues.

Subchondral bone is the part of bone under the cartilage.

Osteoarthritis is also known as degenerative joint disease.
Related to its affect on joints, osteoarthritis is sometimes referred to as
osteoarthrosis.
Osteoarthritis facts
Osteoarthritis is a joint inflammation that results from cartilage degeneration.
Osteoarthritis can be caused by aging, heredity, and injury from trauma or disease.
The most common symptom of osteoarthritis is pain in the affected joint(s) after
repetitive use.
There is no blood test for the diagnosis of osteoarthritis.
The goal of treatment in osteoarthritis is to reduce joint pain and inflammation while
improving and maintaining joint function.
What is osteoarthritis?
Osteoarthritis is a form of arthritis that features the breakdown and eventual loss of
the cartilage of one or more joints. Cartilage is a protein substance that serves as a
"cushion" between the bones of the joints. Among the over 100 different types of
arthritis conditions, osteoarthritis is the most common, affecting over 25 million
people in the United States. Osteoarthritis occurs more frequently as we age. Before
age 45, osteoarthritis occurs more frequently in males. After 55 years of age, it
occurs more frequently in females. In the United States, all races appear equally
affected. A higher incidence of osteoarthritis exists in the Japanese population, while
South-African blacks, East Indians, and Southern Chinese have lower rates.

Osteoarthritis is abbreviated as OA or referred to as degenerative arthritis or

degenerative joint disease (DJD).
Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing
joints, such as the hips and knees. Osteoarthritis usually has no known cause and is
referred to as primary osteoarthritis. When the cause of the osteoarthritis is known,
the condition is referred to as secondary osteoarthritis.
What causes osteoarthritis?
Primary osteoarthritis, osteoarthritis not resulting from injury or disease, is mostly a
result of natural aging of the joint. With aging, the water content of the cartilage
increases, and the protein makeup of cartilage degenerates. Eventually, cartilage
begins to degenerate by flaking or forming tiny crevasses. In advanced osteoarthritis,
there is a total loss of the cartilage cushion between the bones of the joints.
Repetitive use of the worn joints over the years can irritate and inflame the cartilage,
causing joint pain and swelling. Loss of the cartilage cushion causes friction between
the bones, leading to pain and limitation of joint mobility. Inflammation of the cartilage
can also stimulate new bone outgrowths (spurs, also referred to as osteophytes) to
form around the joints. Osteoarthritis occasionally can develop in multiple members
of the same family, implying a hereditary (genetic) basis for this condition.
Secondary osteoarthritis is a form of osteoarthritis that is caused by another disease
or condition. Conditions that can lead to secondary osteoarthritis include obesity,
repeated trauma or surgery to the joint structures, abnormal joints at birth (congenital
abnormalities), gout, diabetes, and other hormone disorders.

Obesity causes osteoarthritis by increasing the mechanical stress on the joint and
therefore on the cartilage. In fact, next to aging, obesity is the most significant risk
factor for osteoarthritis of the knees. The early development of osteoarthritis of the
knees among weight lifters is believed to be in part due to their high body weight.
Repeated trauma to joint tissues (ligaments, bones, and cartilage) is believed to lead
to early osteoarthritis of the knees in soccer players and army military personnel.
Interestingly, studies have not found an increased risk of osteoarthritis in longdistance runners.
Crystal deposits in the cartilage can cause cartilage degeneration and osteoarthritis.
Uric acid crystals cause arthritis in gout, while calcium pyrophosphate crystals cause
arthritis in pseudogout.
Some people are born with abnormally formed joints (congenital abnormalities) that
are vulnerable to mechanical wear, causing early degeneration and loss of joint
cartilage. Osteoarthritis of the hip joints is commonly related to structural
abnormalities of these joints that had been present since birth.
Hormone disturbances, such as diabetes and growth hormone disorders, are also
associated with early cartilage wear and secondary osteoarthritis.
IMAGING STUDIES
The classification of osteochondritis dessicans is important because the prognosis
(expected outcome) and treatment options are often linked to the severity of the
osteochondritis dessicans. Typically, the injury classification is from stage 1through
stage 4. As the severity of the injury progresses, the stage increases with stage 4
osteochondritis dissecans being the worst. Although the classification is often based

upon the x-ray appearance, the abnormalities noted on x-ray may not alwaysbe
completely accurate.
In the following series of drawings, the ankle has undergone a twisting injury the
results in the progressive stretching of the medial ankle ligament (deltoid ligament).
By stage 2, the ligament has torn. As the twisting force is applied to thetalus, the
articular surface of the talus hits the tibia. A this occurs with progrssively greater
force, the talus bone sustains progressively greater damage as indicated by the
development of a bigger fracture line and eventrually a loose body (bonechip,
osteochondral fragment),
Stage 1: This is the most minor abnormality. Typically, there has been an injury to the
articular surface of the talus. Although an injury has occurred to the articular surface,
no significant disruption of the bone has taken place.
Stage 2: As the injury increase, a hairline crack begins to appear in the talus, just
beneath the articular surface. The crack (or fracture line) is incomplete. This means
that it does not completely extend from one side of the injury to the otherside
Stage 3: The incomplete fracture line has now progressed to completely separate
the fragment. However, the fragment remains in its place on the surface of the talus.
Stage 4: Now the fragment has broken loose and changed position so that it is no
longer in the defect on the talus.
TREATMENT
The treatment depends on the age of the patient, the circumstances of the injury,
and the type of bone damage. A simple bone contusion (bruise) would be treated
differently then a detached bone fragment. The treatment options may vary from

simply being on crutches to being casted to having surgery. The surgical procedures
used to treat osteochondritis dissecans may involve removing the fragment,
attempting to reattach thefragment, drilling the underlying bone to promote blood
flow, or some combination of these procedures. Obviously, the exact treatment and
procedure needs to be individualized to the patient, the type of bone injury,and the
location of the bone injury.