Revista de Medicina Desportiva (English) May 2018 | Page 28

blood vessels. 2 There are several
classifications of these injuries,
but the most widely used is that of
Siffert. 3 It is based on the anatomical
location of the injury:
• The epiphysial or articular, such
as Legg-Perthes (at the head of the
femur), Kohler (in the navicular
tarsi bone) and Freiberg (at the
distal end of the 2 nd or 3 rd metatar-
sals) diseases
• The physeal, such as the Blount
disease or tibia vara (in the proxi-
mal physis of the tibia) and Scheu-
ermann disease (in the growth
plate of the vertebral body)
• The apophyseal or non-articular,
such as the Osgood-Schlatter
(on the anterior tuberosity of the
tibia), Sinding-Larsen-Johansson
(at the distal pole of the patella)
and Sever (on the calcaneal apo-
physis) diseases.
The diagnosis of osteochondro-
sis is done by a careful history and
clinical examination. The history
should lead to its cause and it usu-
ally includes insidious pain, that
worsens with physical activity and
improves with the rest, there is a
period of rapid growth, an increase
of the volume and intensity of the
training, and change of the technical
gesture, of the equipment or of the
floor during sports practice. On the
clinical examination (always com-
pared with the opposite side), there
is local pain on pressure or percus-
sion of the ossification nucleus and,
in certain cases, malalignments of
the limbs, myotendinous shorten-
ings or muscles masses very devel-
oped for that young age. Usually the
imaging study is not required, unless
a differential diagnosis is needed
(bone avulsions, fractures). What can
be done with osteochondrosis? The
treatment of the osteochondrosis
is almost always conservative. The
most important is to rest until the
pain disappears. If necessary, unload
the limb (rarely, short-term immo-
bilization), cryotherapy, analgesic
drugs and NSAIDs (these after the
age of 12) and other physical agents
that can be used at these ages. The
activities that do not cause pain are
allowed. Myotendinous stretches are
fundamental and must be taught
to be performed daily at home. The
program of maintenance and mus-
cle reinforcement will be carried out
26 may 2018 www.revdesportiva.pt
in the range of motion and with the
loads that do not cause pain. It will
rarely be necessary to have orthoses
for correction or support of static
of the feet. It is essential that the
athlete, the parents and the coaches
know and understand these patholo-
gies to comply with the measures for
treatment and to monitor the signs
of aggravation.
Bibliography
1. Pill SG et al. J Musculoskel Med (2003);
2. Varshney MK. Osteochondroses. Medscape
(2015);
3. Siffert RS. Clin Orthop Relat Res (1981).
Dr. Pedro Saraiva.
Medicina Física e
Reabilitação; Medicina
Desportiva, Coimbra.
The congenital anomalies. Clinical
approach.
The most frequent anomalies of the
foot and of the hindfoot are those
associated with changes of the
hindfoot in the frontal plane, valgus
and varus, and in the sagittal plane
with the abnormal verticalization or
horizontalization of the calcaneus.
The clinical analysis includes the
Foot Posture Index, podobarometry
and analysis of plantar printing
(Chipaux-Smirak index or Staheli
index). On the simple radiologi-
cal study includes the measure of
Djian-Annonier’s angle, the Meary’s
angle and the measurement of the
calcaneus angle. The rearfoot valgus
will probably causes inflammation
of the posterior tibial muscle tendon
and talofibular conflict, with associ-
ated chondral pathology, while the
varus promotes a greater functional
impact on the stability of the ankle,
with medial cartilage injury and
chronic inflammation of lateral
peroneal tendons. The treatment is
usually conservative with plantar
orthoses and/or ankle stabilizers
and introduction of a neuromuscu-
lar reprogramming program. The
ankle and foot ossifications have an
incidence of about 30% and develop
from 11-12 to 16 years of age. The
most frequent are the Os Peroneum,
the accessory navicular bone and
the Os Trigonum. The Os Peroneum is a
small sesamoid bone located within
the tendon of the muscle Peroneus
longus, at the level of the calcaneo-
cuboid joint. It can cause pain and
lead to the rupture of this tendon,
usually after an inversion sprain and
the treatment is usually surgical.
The accessory navicular bone, has
three types of clinical presentation,
is often associated with posterior
tibial tendon pathology on types II
and III, occurring with flat feet with
rigid valgus deformity. The treat-
ment is usually conservative with
plantar orthoses, but it will be surgi-
cal after several months of failure
of the conservative treatment. The
Os trigonum, located posteriorly to
the talus, appears between 8 and
11 years of age, it can be asymp-
tomatic, but can have symptoms
after repeated forced plantar flexion
movements. The conservative treat-
ment is effective, with rest and con-
trol of inflammation and, rarely, sur-
gery is needed. The most frequent
accessories muscles are the acces-
sory soleus, the peroneus quartus and
the accessory of the long flexors of
t