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علت درد پاشنه پا چیست و چگونه درمان می شود ؟پاها یکی از مهم ترین عضو در بدن هستند که هر گونه درد در این ناحیه، زندگی فرد را با اختلال مواجه می کند، این درد خصوصا ناحیه پاشنه پا را بیشتر درگیر می کند، خیلی از مراجعین به کلینیک فیزیوتراپی همای سلامت از درد پاشنه پا شکایت می کنند، اما راه حل قطعی برای درمان درد پاشنه پا چیست ؟
علل بروز درد پاشنه پا به سادگی، با توجه به محل بروز آن دسته بندی می شود .
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بیماری های کالکانئوس چیست ؟
استخوان کالکانئوس به ندرت دچار عفونت می شود که شایع ترین نوع عفونت این استخوان، عفونت چرکی می باشد . این استخوان گاهی ممکن است، منشا تومور های خوش خیم یا بدخیم باشد .
همچنین سایر بیماری های استخوان مانند بیماری پاژه نیز ممکن است، در این استخوان روی دهند .
آرتریت مفاصل ساب تالار
شایع ترین التهاب مفصل ساب تالار، استئوآرتریت ثانویه به شکستگی کالکانئوس می باشد . این مفصل همچنین در سایر انواع آرتریت، مانند آرتریت چرکی، آرتریت روماتویید، آرتریت سلی یا نقرس ممکن است درگیر شود .
التهاب اطراف تاندون
تاندون آشیل با یک بافت همبند شل یا پاراتنون احاطه شده است، که سر خوردن این تاندون را امکان پذیر می سازد . به ندرت این عارضه به علت سایش بیش از حد تاندون روی می دهد . از آنجا که لایه سینوویال واقعی در اطراف این تاندون وجود ندارد، برای این وضعیت اصلاح Paratendintis راباید به جای تنوسینوویت به کاربرد .
این بیماران معمولا بالغین جوان ورزشکار هستند . درد در ناحیه تاندون کالکانئوس وجود دارد که با فعالیت هایی مانند دویدن یا رقصیدن تشدید می یابد . در معاینه بالینی در لمس عمقی تاندون بین انگشتان شست و اشاره، تندرس و ضخیم شدن خفیف موضعی وجود دارد . اندازه و قوام این تاندون طبیعی است.
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استفاده از فیزیوتراپی موضعی، به ویژه استفاده از اولتراسوند بر ناحیه مبتلا، یا انجام ورزش های نامتعارف برای عضلات ساق پا ممکن است، مفید باشد . در بسیاری از بیماران، تزریق هیدروکورتیزون به زیر تاندون باعث تخفیف علائم می شود . در موارد مقاوم به درمان ممکن است، به انجام جراحی نیاز باشد، طی این عمل جراحی، بافت همبند شل اطراف و زیر تاندون برداشته می شود .
التهاب بورس روی کالکانئوس
این عارضه، شایع ترین بروز درد پشت پا محسوب می شود و غالبا باعث ناتوانی ناراحت کننده در زنان جوان می شود . یک بورس اضافی بین برجستگی استخوان کالکانئوس و پوست، در پشت پا وجود دارد. سایش مکرر این ناحیه به کفش باعث التهاب مزمن و افزایش ضخامت دیواره بورس و تجمع مایع درون آن می شود . برجستگی استخوانی زیرین نیز التهاب بورس را تشدید می کند .
درمان التهاب بورس روی کالکانئوس
در موارد خفیف یا تازه ایجاد شده، با محافظت از پاشنه با استفاده از دو لایه چسب ارتجاعی و پوشیدن کفش های دارای پشت نرم می توان علائم بیمار را کنترل کرد . اگر این درمان ها موثر نباشد، باید بورس را برداشت، جهت جلوگیری از عود این ضایعه باید برجستگی فوقانی خلفی پشت کالکانئوس ، درست بالای محل اتصال تاندون آشیل برداشته شود .
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در این وضعیت که تصور می شود التهابی باشد، درد زیر قسمت قدامی کالکانئوس احساس می شود . این وضعیت ممکن است قسمتی از یک وضعیت التهابی گسترده تر مانند بیماری رایتر باشد .
این ضایعه در بافت نرم محل اتصال آپونوروز کف پا به سطح تحتانی برجستگی کالکانئوس ایجاد می شود .
در این حالت بیمار از درد زیر پاشنه پا، حین ایستادن یا راه رفتن شکایت دارد . این درد به سطح داخلی و به کف پا نیز گسترش می یابد . در مواردی که این ضایعه قسمتی از یک اختلال التهابی گسترده تر است، ممکن است پاشنه هر دو پا درگیر باشد . در معاینه بالینی، تندرس قابل توجه در محل اتصال فاسیای کف پا به کالکانئوس وجود دارد . محل این تندرنس نسبت به موارد تندرس بالشتک پاشنه پا جلوتر است .
درمان
درمان های محافظتی اگر با علاقه پیگیری شوند، معمولا برای تخفیف علائم کافی هستند. اگر چه بهبود علائم ممکن است به آهستگی روی دهد . یک دوره داروهای ضد التهاب غیر استروئیدی برای بیمار تجویز می شوند . پاشنه پا باید با استفاده از یک بالشتک ارتجاعی درون کفی کفش محافظت شود . اگر شما هم از درد پاشنه پا رنج می برید بهتر است بعد از تشخیص علل به دنبال راهکار درمان باشید .
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