HAGLUNDA — SHYNTSA the DISEASE (P. S. E. Haglund, the Swedish orthopedist, 1870 — 1937; H. R. Schinz; a synonym an apophysitis of a calcaneus) — option of an osteochondropathy of apophyses with localization of pathological process in a hillock of a calcaneus.
Shintsem as an apophysitis of a calcaneus is for the first time described in 1907 by Haglun-dom under the name «change of epiphyseal kernels of a calcaneus», and in 1922. Meets seldom. Develops more often at the age of 7 — 15 years. Defeat in the basic unilateral.
The etiology is finally not found out. Most of researchers consider that an osteochondropathy (see) hillock of a calcaneus is a consequence of many pathogenic factors: microtraumas, the raised loading (run, jumps), a tension of sinews of the muscles which are attached to a calcaneal hillock (sural, bottom), endocrine disturbances, vascular and neurotrophical frustration. Apparently, is the main reason hron. or an acute injury in combination with local disturbance of blood circulation. At the heart of a pathogeny of X. — Highway. the osteodystrophy lies (see) hillock of a calcaneus.
Beginning of a disease usually gradual, but maybe acute. Complaints to pains on a back surface of a heel during the walking are noted, with a pressure by a back of footwear; sometimes — on a swelling or puffiness of this area. Load of a heel is limited, the support is transferred to a front or anteroexternal part of foot, lameness is expressed. During the pressing on a hillock of a calcaneus pain, pressure from sides of a calcaneus is behind noted and from a sole without serious consequences. Bending and extension of foot can be complicated because of morbidity in the field of a hillock of a calcaneus.
Radiological diagnosis is based on the following data. Normal in a hillock of a calcaneus is available several (3 — 4) kernels of ossification of irregular shape with uneven contours separated from each other by light layers of a cartilage. At the same time contours of a hillock of a calcaneus can be uneven, jagged, asymmetry of their ossification is often observed.
At X. — Highway. homogeneity of a shadow of a hillock of a calcaneus is lost, its spottiness (a sekvestropodobny picture) because of emergence of the small roundish centers of a resorption with thin walls and the islands consisting of deposits of mineral salts is noted. Department of regional fragments is possible, to-rye can be displaced aside. The distance between a calcaneus and an apophysis increases because of growth of a cartilage (fig). Contours of bone surfaces uneven. The intensive homogeneous mineralization of a hillock of a calcaneus is quite often observed. Education on its place of two-three fragments not identical on form and content of mineral salts is possible.
Differential diagnosis carry out with tubercular defeat of a calcaneus, a bursitis, a periostitis, osteomyelitis, tumoral Amy's process.
Treatment conservative. In the period of an aggravation appoint rest (an immobilization a plaster splint), the physiotherapeutic procedures directed to improvement of local blood circulation. Out of the periods of an aggravation recommend the mode excluding excessive load of a hillock of a calcaneus (run, jumps), wearing orthopedic footwear with an expanded back and deepening under a heel (see Footwear, orthopedic footwear).
Fig. The roentgenogram of calcaneal area (a side projection) at a disease of Haglun - yes — Shintsa: the distance between a calcaneus and an apophysis (it is specified by an arrow) is increased; contours of an apophysis uneven, in its upper part the separated regional fragment is visible.
At sharp deformation of back department of a calcaneus perhaps operational treatment: removal of speakers of osteoarticular growths or a wedge-shaped resection of a calcaneus in the field of a hillock.
HADDLSONA REACTION 475
At timely begun and correct treatment occurs a complete recovery of structure and a form of a calcaneus. At late and irrational treatment the hillock of a calcaneus sometimes remains increased and deformed that does not exert special impact on function, but complicates wearing usual footwear. In such cases appoint orthopedic footwear.
Bibliography: Bogoyavlensky I. F.
Pathological functional reorganization of bones of a skeleton, page 274, JI., 1976; M. V wolves. Diseases of bones at children, page 525, M., 1974; Layber B. and
About l r and x. Clinical syndromes, the lane with it., page 182, M., 1974; P e y N - e r S. A. Radiodiagnosis of diseases of bones and joints, book 2, page 291, M., 1964; Selivanov V. P. Diagnosis and treatment of osteochondropathies and aseptic necroses, with - 51, Kemerovo, 1965; Haglund P. t)ber Fractur des Epiphysenkerns des Calcaneus nebst allge-meinen Bemerkungen tiber einige ahnliche juvenile Knochenkernverletzungen, Langen-becks Arch. klin. C.hir., Bd 82, S. 922, 1907; Obrerski Z. Nadmierny pozrost guza kosci pietowej jednostka chorobowa (hypertrophia tuberi calcanei), Chir. Nar-z^d. Ruchu, t. 27, s. 149, 1962 P a v 1 a n-sky R. u. Dvorak J. Differential-diagnostik der Schmerzen der Achillesseh-nengegend, Beitr. Orthop. Traum., Bd 17, S. 229,1970; Schinz H. R. Die Ossi-fikationsstorung des Calcaneus als eigenes Krankheitsbild, Zbl. Chir., Bd 49, S. 1786, 1922. I. S. Istomina.