Falsetti P, Frediani B, Acciai C, Baldi F, Filippou G, Marcolongo R
Department of Clinical Medicine and Immunological Sciences, Section of Rheumatology, University of Siena, Italy.
Scand J Rheumatol. 2004;33(5):327-31. doi: 10.1080/03009740410005395.
Heel fat pad inflammation and degeneration have been frequently proved to cause talalgia. Painful heel fat pad is often confused with plantar fasciitis, and only magnetic resonance imaging (MRI) or ultrasonography (US) can differentiate these conditions. Scanty data are available about heel fat pad involvement in the course of chronic polyarthritis.
To investigate with US the heel fat pad involvement in patients with rheumatoid arthritis (RA) and spondyloarthropathies (SpA); to describe and compare the clinical and sonographic features of this lesion in the two groups.
The heels of 181 consecutive outpatients with RA and 160 with SpA were studied by US and radiography. A control group of 60 healthy subjects was examined by US.
Two different patterns of involvement of the heel fat pad were observed. The inflammatory-oedematous pattern was more frequent in patients with RA (6.6%) than in those with SpA (1.8%), and was associated with talalgia--even if it was not associated with plantar fasciitis or enthesophyte (bony spur). The degenerative-atrophic pattern was less frequent (1.1% in RA, 1.9% in SpA), and was associated with plantar fasciitis and subcalcaneal enthesophyte.
The inflammatory-oedematous lesion of the heel fat-pad is relatively frequent in RA and causes subcalcaneal pain. Degenerative-atrophic changes of the heel fat pad can be observed in RA and SpA, and seem to be associated with chronic abnormalities of the plantar fascia and of its enthesis.
足跟脂肪垫炎症和退变常被证实可导致足跟痛。疼痛性足跟脂肪垫常与足底筋膜炎相混淆，只有磁共振成像（MRI）或超声检查（US）才能区分这些情况。关于慢性多关节炎病程中足跟脂肪垫受累的数据较少。
用超声检查类风湿关节炎（RA）和脊柱关节病（SpA）患者的足跟脂肪垫受累情况；描述并比较两组患者该病变的临床和超声特征。
对181例连续门诊的RA患者和160例SpA患者的足跟进行超声和X线检查。对60名健康受试者组成的对照组进行超声检查。
观察到足跟脂肪垫受累的两种不同模式。炎症水肿型在RA患者中比在SpA患者中更常见（分别为6.6%和1.8%），且与足跟痛相关——即使它与足底筋膜炎或骨赘无关。退变萎缩型较少见（RA中为1.1%，SpA中为1.9%），且与足底筋膜炎和跟骨下骨赘有关。
足跟脂肪垫的炎症水肿性病变在RA中相对常见，可引起跟骨下疼痛。足跟脂肪垫的退变萎缩性改变在RA和SpA中均可观察到，且似乎与足底筋膜及其附着点的慢性异常有关。
