Abnormality of the calcaneus as a cause of painful heel - Its diagnosis and operative treatment
Abnormality of the calcaneus as a cause of painful heel - Its diagnosis and operative treatment
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DOI：
10.1002/bjs.18003212812
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发表时间：
1945-04-01
影响因子：
9.6
通讯作者：
Philip, JF
中科院分区：
文献类型：
--
作者：
Fowler, A;Philip, JF
在过去的几年里，我们经常在门诊外科诊所观察到紧邻跟腱附着点近端的脚跟后方出现疼痛的肿胀。据指出，这种情况在年轻女性中比男性更常见，而且由于鞋子后部的上边缘与肿胀的部位重合，因此原因被归因于压力。在寒冷的天气里，炎症的反复发作几乎是冻疮的性质，使步行成为一种试验，事实证明，这是患者相当恼火的来源。所有这些患者都可分为两种类型：(1)在第一组中，位于跟腱浅层的一个明确的法氏囊是可以切除的，此后这种情况没有复发；(2)在第二组中，没有实际的法氏囊是可以切除的，肌腱浅层增厚的组织似乎是由皮肤和皮下组织的慢性炎症反应组成的，并且综合征的复发是不变的。尽管几位作者讨论了跟骨后滑囊炎的情况，但我们认为作为这种情况的真正原因的潜在的结构性骨变异太少被关注。White(1913)对跟骨后滑囊炎的症状学进行了出色的研究，他的观点与Neilson(1921)的观点一致，因为他们将滑囊炎的原因归因于创伤，如短鞋、过度行走等。此外，两位作者都认为感染在其原因中起到了一定作用。尼尔森强调了这一点，并指出：“细菌感染主要是转移性的，这种疾病通常是双侧的。”然而，我们认为，双边情况与转移性起源相反。怀特说：“从生理上讲，可以说跟骨的不规则性起到了一定作用，尤其是那些脊椎后方较小的病例，但X光显示了许多骨骼轮廓的偏差，这几乎是可以忽略不计的因素。”因此，他建议切除法氏囊；然而，他接着说：“我们经常能发现，骨囊的后角很尖，几乎是棘状的，而且可以用骨刀把它整圆，尽管这根本不是必要的。”Gottlieb(1928)在写到脚后跟周围的疼痛性滑囊炎时指出，即使在X光片上没有显示出外生骨疣，但刺激的结果是
FREQUENTLY during the past few years we have observed at the Out-patient’s Surgical Clinic a painful swelling on the posterior aspect of the heel immediately proximal to the insertion of the tendo Achillis. It was noted that the condition occurred in young women more frequently than among men, and as the upper margin of the back part of the shoe coincided with the site of the swelling, the cause was attributed to pressure. During cold weather repeated attacks of inflammation almost in the nature of a chilblain made walking a trial and proved a source of considerable irritation to the patient. All such patients fell into one of two categories:(I) In the first group a definite bursa lying superficial to the tendo Achillis was excisable and thereafter no recurrence of the condition was seen;(2) In the second group no actual bursa was excisable, the thickened tissue superficial to the tendon appeared to consist of a chronic inflammatory reaction of the skin and subcutaneous tissues and a recrudescence of the syndrome was invariable.Although the condition of retrocalcanean bursitis has been discussed by several writers, we feel that too little attention has been paid to an underlying structural bone variation as the real cause of this condition. White (1913) gives an excellent survey of the symptomatology of retrocalcanean bursitis and his views agree with those of Neilson (1921) in that they attribute the cause of the bursitis to trauma, such as may be caused by short shoes, excessive walking, etc. Both writers, moreover, believe that infection plays a part in its causation. Neilson stresses this point and states,“Bacterial infection is chiefly metastatic, the disease being on this account very often bilateral.” We feel, however, that a bilateral condition is rather against a metastatic origin. White says,“Physiologically, it may be said that irregularities of the 0s calcis, more particularly those cases having a small spine posteriorly, have played a part, but the X-ray has demonstrated so many deviations in bone contours that this is almost a negligible factor.” He thus advises removal of the bursa; nevertheless, he goes on to state:“It is not uncommon to find the superior posterior angle of the 0s calcis quite sharp, almost spinous in type, and it may be rounded off with an osteotome, though this is not at all necessary”. Gottlieb (1928), writing on painful bursitis around the heel, points out that even though there is no exostosis shown on radiography, the results of irritation of