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 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