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26.10.2015
Osteochondral lesion of the talus, also known as OLT, is a disorder, which consists of a section of damaged cartilage. This condition usually is asymptomatic and is diagnosed only on MRI which may be done for a different medical condition altogether. Exercises such as cycling and swimming which are gentle to the joint are useful in retaining fitness and mobility of the ankle. If grade I and II injuries do not heal within three months, then surgery becomes essential. For Grade III and IV injuries, arthroscopic surgery of the ankle is necessary for removal of the fragments which become separated.. Patient needs to undergo a rehab program with emphasis on stretching and strengthening to regain mobility, flexibility, balance and range of motion of the ankle. Approximately 40 percent of adults in the United States experience foot problems.1 Plain radiography is an important diagnostic tool in the initial evaluation of patients with chronic foot pain. Osteoarthritis (OA) also known as degenerativearthritis or degenerative joint disease or osteoarthrosis, is a group of mechanical abnormalities involving degradation of joints,including articular cartilage and subchondral bone. Treatment generally involves a combination of exercise, lifestyle modification, and analgesics. IN Modern Medicine at present there Is no treatment which can stop the progression of OA and finally all patients have to go for joint replacement. This article deals with only pathological point of view of sujok treatment in Osteoarthritis of knee joint. Considering the fundamentals of triorigin we can conclude that skeletal system of our body carries basic nature of energy of Homo at triorigin level and Humidity at six ki level. All peripheral joints are controlled by Ah Wind in which knee joints are controlled by subbranch of dryness energy. In triorigin we have many formulas but I choose to influence skeletal system via triorigin. We need to strenghten Ho in bones of whole body as well as in bony parts of knee as both erosion and Osteophytes are strongly HE in nature. After improvement patient should start SMILE TAICHI and SMILE YOGA to prevent relapse of disease. Dr Paawan Wadhawan hold an MBBS Degree from the prestigious Maulana Azad Medical College, New Delhi and MD Degree from SriDevaraj Medical College, Kolar.
Despite careful and detailed clinical history and physical examination, providing an accurate diagnosis is often difficult because chronic foot pain has a broad spectrum of potential causes.
It is thought to be a chronic traction type injury, and it may occur in isolation or as a manifestation of a systemic disease such as seronegative spondyloarthropathies, rheumatoid arthritis, gout, or systemic lupus erythematosus.
A fatigue fracture is caused by the prolonged cyclical application of abnormal mechanical stresses to a bone that has normal elastic resistance.
The term CRPS describes abnormally intense and prolonged pain that is not related to tissue damage and that is sometimes a sequela of injury.18 CRPS is a clinical entity that includes pain combined with autonomic dysfunction, atrophy, and functional impairment. The disease is usually detected in adolescents and is more common in adolescent females than males by a ratio of three or four to one.
Three types of coalition exist: fibrous (syndesmosis), cartilaginous (synchondrosis), and osseous (synostosis) fusion.
Careful analysis of imaging findings and correlating them with the patient's history and physical examination, as well as considering the anatomic location of the injury, can help physicians prescribe the appropriate treatment.
Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion.
If pain becomes debilitating, joint replacement surgery may be used to improve the quality of life. Radiography using the oblique view shows articulation of the calcaneus, talus, navicular, and cuboid bones, and it can be helpful in patients with foot pain who have no obvious diagnosis.Although not routinely indicated, magnetic resonance imaging (MRI) can play a significant role in making a precise diagnosis, guiding treatment decisions, and determining response to therapy. The initial plain radiographs showed subtle lucency with cortical interruption over the distal shaft of the second metatarsal, which was initially interpreted as a stress fracture (Figure 2A).
Radiographic findings include joint space narrowing, osteophyte formation, subchondral sclerosis, and cyst formation.


These neuromas occur more often in women and typically involve the three-four (or less commonly, the two-three) inter-metatarsal space.10 They are best detected on MRI using T1-weighted inversion recovery or T1-weighted, fatsuppressed images with gadolinium enhancement and T2-weighted images in the coronal plane.
In athletes, plantar fasciitis typically produces foot pain and is attributed to mechanical stresses, presumably caused by repetitive trauma that creates microtearing of the plantar fascia at its origin, as well as fascial and perifascial inflammation.
In most cases, the posterior tibial nerve divides into terminal branches (the medial and lateral plantar nerves) within the tarsal tunnel.Tarsal tunnel syndrome is a compressive entrapment neuropathy of the posterior tibial nerve or one of its branches. The true incidence of tarsal coalition in the general population is unknown, but it is less than 1 percent.26 The coalition is bilateral in about one half of patients. Plain radiography is the most cost-effective modality and is the standard initial imaging technique for many conditions of chronic foot pain such as arthritis, Freiberg's disease, or RSD. A variety of causes—hereditary, developmental, metabolic, and mechanical deficits—may initiate processes leading to loss of cartilage. OA is the most common form of arthritis,and the leading cause of chronic disability in the world.
This condition is commonly seen with traumatic injuries like acute ankle sprain; although ankle joint misalignment due to chronic overuse also can lead to this condition.
Initial assessment is typically done by plain radiography; however, magnetic resonance imaging has superior soft-tissue contrast resolution and multiplanar capability, which makes it important in the early diagnosis of ambiguous or clinically equivocal cases when initial radiographic findings are inconclusive. Bone scanning, ultrasonography, and computed tomography (CT) also are useful tools in the diagnosis of specific conditions. Insufficiency fractures occur with normal or physiologic stresses on a weakened skeleton that is deficient in mineral or elastic resistance. Three-phase radionuclide scans have been used to diagnose RSD.19,20 In the three-phase bone scan, the first phase (the blood-flow phase) imaging is performed by acquiring dynamic two- to five-second images over the area of clinical concern for 60 seconds after the bolus intravenous injection. Patients typically complain of poorly localized, burning pain and paresthesias along the plantar surface of the foot and toes. A traumatic insult in the form of acute or repetitive injury and vascular compromise are the most popular theories.25 Bone scanning shows photopenia, decreased uptake in early stages, and increased uptake as the metatarsal head is reconstituted. Calcaneonavicular coalition is the most common, with a relative incidence of about 53 percent.
For other conditions, such as Morton's neuroma, painful accessory bones, or tarsal tunnel syndrome, MRI and ultrasonography could be useful.
When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. A sprain can also lead to osteochondral fractures but such fractures generally are not able to be detected. Computed tomography displays bony detail in stress fractures, as well as in arthritides and tarsal coalition. The multidetector row CT, one of the newest modalities, significantly improves scan speed and utilization of the available radiographic power. As the tophi enlarge, they erode the para-articular bone, producing sharp, punched-out erosions with well-defined cortical margins. The diagnosis is usually made on clinical grounds.Typically, plain radiography is not helpful, but it is always done to rule out other conditions. In the second phase (the blood-pool or soft-tissue phase), imaging is acquired within five minutes after injection. Causes of tarsal tunnel syndrome include varicosities, trauma, fibrosis, accessory muscles, ganglion cysts, lipoma, and nerve sheath tumors. Approximately 37 percent of patients with tarsal coalition have talocalcaneal (subtalar) coalition, which most commonly involves the middle facet at the level of the sustentaculum tali.Calcaneonavicular coalition may be detected on oblique anteroposterior radiography of the foot (Figure 5). As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax.
After the sprain is treated, there is improvement to some degree but is still continues to be bothersome with development of pain and swelling after activity. Bone scanning and ultra-sonography also are useful tools for diagnosing specific conditions that produce chronic foot pain.
Calcium pyrophosphate deposition disease is the most common form of crystal-induced arthropathy.


Radiography may reveal a plantar calcaneal spur, but because this type of spur is commonly observed in asymptomatic adults, it is not a sign of any one specific condition. Only one cortex may be involved; a hint of periosteal reaction with some endosteal new bone may develop. In the final phase (the delayed-skeletal phase), the images should be acquired approximately two to four hours after injection to maximize clearance of the radiopharmaceutical from the overlying soft tissues. Talocalcaneal coalition is often associated with severe valgus deformity of the hindfoot, rigid painful flatfoot, and restricted subtalar motion. With this disease, the talonavicular joint can sometimes be involved.Rheumatoid arthritis also typically involves the foot.
Bone scanning and MRI have been shown to be helpful in determining a diagnosis11; however, MRI is rated 9 on the ACR Appropriateness Criteria Scale, whereas bone scanning is rated 2 because MRI could show more detailed findings.
It can take three to four weeks for changes to occur in the metaphyseal area of bone, and four to six weeks for them to occur in the diaphysis.
It is often overlooked on plain radiographs because of overlapping structures; however, secondary signs on the lateral view could be suggestive of talocalcaneal coalition (Figure 6).
Apart from this, MRI scans, isotopic bone scans, and CT are also useful in detecting very small lesions. Radiographic findings include periarticular soft-tissue swelling, marginal erosion (where the bone is not protected by overlying cartilage), periarticular osteopenia, and uniform joint space narrowing. MRI findings include thickening of the proximal plantar fascia (7 to 8 mm; normal is 3 to 4 mm), inflammation in the plantar aponeurosis, adjacent soft-tissue edema, reactive calcaneal marrow edema and fluid-filled fascia, and rupture at mid or proximal segments (Figure 4).
During the healing phase, new periosteal and endosteal bone are incorporated in the cortex, resulting in a fusiform expansion of the cortex (Figure 2B). These signs include talar beaking,27 flattening and broadening of the lateral talar process, positive C sign,28–30 absent middle facet sign,31 and narrowing of the posterior talocalcaneal joint.
There is evidence that gadolinium-enhanced MRI can be helpful in detecting early rheumatoid arthritis.6 Radiography in seronegative arthritis is more likely to show new bone formation and fusion. In the tarsal navicular, stress fractures are oriented in the sagittal plane and occur in the central third of the bone. Neuropathic arthropathy in patients with diabetes involves the forefoot (metatarsophalangeal and interphalangeal joints), tarsometatarsal joint (Lisfranc's joint), and hindfoot (subtalar and ankle joints).7,8 Fracture-dislocation of Lisfranc's joint is one of the most common features of neuropathic arthropathy in patients with diabetes. They start as partial fractures involving only the dorsal portion of the tarsal navicular.Although plain radiography is not listed in the original ACR Appropriateness Criteria Scale for stress fracture, it is typically ordered first. Note also the pes planus.Although CT and MRI are not the imaging studies of choice for tarsal coalition, CT of the subtalar joint is usually diagnostic,32 and MRI has been shown to be effective in depicting all types of coalition. MRI reveals myositis, bone edema, and foot ulcers associated with diabetes before revealing other features of neuropathic osteoarthropathy. Most importantly, MRI can diagnose superimposed infection by identifying ulcers, cellulitis, sinus tracts, and soft-tissue abscesses. Abnormal marrow in osteomyelitis and neuropathic reactive bone edema also can be assessed on MRI.Tendinopathy of the foot, ranging from tendinosis or tendon degeneration to a complete tear, can result in significant pain and disability.
Bone scanning demonstrates abnormal findings early in the continuum of the stress response by detecting the increased bone metabolism and osteoblastic activity associated with osseous remodeling. Bone scanning shows abnormalities early in the course of a stress fracture, which is often days to two weeks before the radiographic changes become obvious.Ultrasonography can be used to evaluate superficial bone cortices such as feet and distal tibia. T1-weighted images provide good anatomic detail, whereas T2-weighted images are useful for evaluating the abnormal increased signal intensity that occurs in most pathologic conditions.
In persons with tenosynovitis, MRI will reveal fluid accumulation within the tendon sheath.



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