Haglund's Deformity

Haglund's deformity is a bony growth along the posterior lateral border of the calcaneus or the heel bone surrounded by a tender tissue. Haglund's deformity primarily springs from bone enlargement at the back of the heel bone in the area where Achilles tendon attaches to the bone. Hence it is also called pump bump. It is also called as 'retroocular bursitis and 'calcaneal exotosis'. Bursitis is an inflammation of the sacs (bursae) that contain small amounts of lubricating fluid to help the joints move smoothly. The syndrome is usually found to occur in females in their teens who often use high heels causing irritation of the rigid heel counter of the shoe rubbing up and down on the back of the heel bone. However, the deformity can also occur among runners and athletes. Common symptoms include red painful area in the back of the heel and swollen area at the back of the heel bone. There is irritation in the Achilles tendon. Repeated blistering on the back of the heel leads to callous formation.

Haglund's deformity is identified by physical examination and x rays. The doctor correlates the physical symptoms of redness and pain in the area with findings in x-ray studies, bone scans and MRI. Haglund's deformity can be present at birth or may be acquired by injury over the patient's lifetime. Shoe gear is the primary reason for Haglund deformity. Haglund's deformity can be caused by bursitis or pressure against the shoe.

The treatment for Haglund's deformity depends upon the severity and cause of the disease. During the initial stages when the disease is mild, applying ice followed by moist heat and compression will help ease discomfort from pump dump. Changing the type of shoes can stop the injury and consequent redness and swelling from developing. The pain can also be alleviated to some extent by placing a heel lift inside the shoe so as to lift the Haglund bump above the part of the heel counter of the shoe that rubs it. A doctor may also prescribe anti-inflammatory drugs to reduce pain. Soaking the foot may also soothe the area. In mild cases, a doctor may also recommend padding of the area. Normally corticosteroid injections are given to relieve the pain but for long term complication this injection cannot be recommended as it can weaken and cause rupture to the Achilles tendon. In severe cases of deformity, surgery may be necessary to remove or reduce the bony growth.

Knee Tendonitis

Tendonitis is one of the most common injuries that affect the knee. In simple terms it means inflammation and/ or rupture of the tendons of the knee. Knee tendonitis is also called 'Jumper's knee' as it was first described in the takeoff leg of high jumpers. It occurs in dancers, runners and players and anyone who runs and jumps regularly suffer from it. Typical symptoms of knee tendonitis:

• Knee tendonitis produces pain, tenderness and stiffness near/on the knee joints.
  
• Worst pain is experienced when ascending or descending stairs or when getting up from a seated position.
  
• Chronic pain is common due tendon and ligament weakness and cartilage deterioration.
  
• Inflammation of the tendons in the knee occurs. The inflamed tendons are painful when moved or touched.
  
• The tendon sheaths are visibly swollen. This may be due to accumulation of fluid and inflammation.
  

• A small tear or inflammation in the knee caused the pain in knee tendonitis.
  
• Inflammatory diseases such as rheumatoid arthritis can also cause knee tendonitis.
  
• Popliteus tendonitis is caused by excessive inward rolling of the feet. This is called 'pronation'. This occurs when excessive stress is put on the tendon, thereby causing a tear or inflammation in the tendon.
  
• Pes anserine tendonitis is characterized by inflammation of the medial knee. This often coexists with other knee disorders.
  
• Semi membranous tendonitis is characterized by posteromedical aspects of the knee and tenderness. Here resisted flexion and 'outward turned strain' occurs.
  

• Orthopedic surgeons recommend conservative treatment for knee tendonitis. Physical therapy and injections are commonly administered.
  
• Modern treatment regime includes rest, cryotherapy, non-steroidal anti-inflammatory drugs, physical therapy and massage.
  
• For the athlete who wants to improve his/her condition much faster, cortisone injections are given every one to two weeks.
  
• Surgery for knee tendonitis is rare. However if the person develops a tear in the tendon,surgery is the only answer.
  

• Prolotherapy: In knee tendonitis that occurs in sports persons, the athlete is encouraged to perform exercises during the healing process. This natural medical treatment helps to strengthen structural weaknesses in the.
  
• The MEAT treatment consists of tendon and strengthening of ligaments by movement, exercise, analgesics and treatment by herbal supplies. The approach here is to encourage the damaged tissues to heal as quickly as possible without decreasing the inflammation quickly with ice or anti inflammatory drugs.
  
• A heat pad could be applied on the pain area for 15 -20 minutes to relieve pain.
  
• Similarly cold therapy can also be resorted to.
  
• Bracing is considered by sports persons to provide stability to the knee and thereby relieve pain by stimulating the nerve fibers which makes the wearer feels that the joint is more stable and secure. Football players, racers and skiers particularly benefit from such bracing.
  
• Avoid activity that can cause pain.
  

Aspirin - Acetylsalicylic Acid

Developed by German chemist Felix Hoffmann in 1897, acetylsalicylic acid or Aspirin as it is popularly known is a safe and effective treatment for many an ailment ranging from moderate fever to swelling or even blood clotting. This over-the-counter medication is probably one of the widest selling drugs.

Aspirin is used to treat headache, migraine, muscular pain, neuralgia and sore throat. Aspirin or acetylsalicylic acid has anti-coagulant properties as well as analgesic and antipyretic properties. This drug is a NSAID - non steroidal anti inflammatory drug. Prostaglandins - a family of chemicals are produced within the body's cells by the enzyme cyclo oxygenase (COX). Further there are 2 kinds of COX enzymes - COX 1 and COX 2 which produce prostaglandins which in turn promote pain, inflammation and fever. Nonsteroidal anti inflammatory drugs - NSAIDS act by blocking the COX enzymes and reduce prostaglandins thereby reducing the pain, fever and inflammation. In this process of reducing the prostaglandins, NSAIDS promote bleeding and may contribute to stomach ulcers. Aspirin is an unique NSAID in the sense that it inhibits clotting of blood for prolonged period - up to 4 to 7 days. It is used to reduce temperature and is commonly recommended for pain relief as in the case of dental pain. Aspirin works as a pain reliever by working on the sensitivity of the nerves both at the site of the pain as well as the central nervous system. FDA has approved the use of aspirin in the following conditions:

Heart conditions : The FDA has approved the use of aspirin to reduce the risk of fatality in the event of a heart attack. Aspirin taken during a suspected heart attack can also lessen the damaging effects of the heart attack. Persons who have already suffered a heart attack or unstable angina are put on a course of aspirin to reduce the risk of another heart attack. Aspirin is also recommended for use in people who have suffered transient ischemic attack (TIA or mini-stroke). FDA has endorsed the use of low dose aspirin (75 and 325 mg) for lowering the risk of heart attack and strokes. Aspirin helps in improving blood flow through narrowed blood vessels.

Side Effects of Aspirin: Side effects from aspirin are relatively rare. If you are prone to heartburn or indigestion, ensure that you take aspirin after food. Some people experience rashes or vomiting or stomach pain. Rarely are side effects such as ringing in the ears, dizziness or mental confusion noticed. In such a case, consult a doctor immediately.

Contraindications: Aspirin must not be taken on an empty stomach. Persons suffering from peptic ulcer must consult the doctor for the recommended dosage. Aspirin must not be taken along with alcohol. Aspirin and other salicylates should not be taken during the last 3 months of pregnancy or while breast-feeding. It is essential to keep the doctor informed if you are allergic to aspirin If you are taking medications for high blood pressure, diabetes or any anticoagulants, you must inform your physician before he prescribes aspirin.

Bibliography / Reference

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