Saggini Raoul, Bellomo Rosa Grazia, Affaitati Giannapia, Lapenna Domenico, Giamberardino Maria Adele
Department of Medicine and Science of Aging, G D'Annunzio University of Chieti, Chieti, Italy.
J Pain. 2007 Mar;8(3):215-22. doi: 10.1016/j.jpain.2006.07.002. Epub 2006 Oct 2.
This study evaluated sensory and biomechanical assets in 2 heel pain conditions with similar symptoms, entrapment syndrome of the nerve to abductor digiti quinti and myofascial syndrome of abductor hallucis. Thirty-three patients with unilateral heel pain and 20 asymptomatic subjects underwent pressure pain threshold measurement in the painful area in site A (medial process of calcaneal tuberosity, trigger point site of abductor hallucis) and site B (1 cm posteriorly to site A, where the nerve to abductor digiti quinti becomes most superficial) and contralaterally; electroneurography of posterior tibial nerve; evaluation of ground-foot reaction on a dynamic platform. Eighteen patients had electric shock-type pain (entrapment syndrome, Group 1), 15 had cramp-like pain (myofascial syndrome, Group 2). Pain thresholds on the affected side versus contralaterally were significantly lower in site B in Group 1 and in site A in Group 2 (P < .001). Nerve conduction velocity was slightly reduced in Group 1 (P = .05). Ground-foot reaction was significantly altered on the affected side in all patients versus asymptomatic subjects; a significant difference between the 2 sides was found for peak of force (F1) in Group 1 and for all parameters except temporal phase of peak of force (TF3) (P = .05) for Group 2 (P < .0001). The different sensory and biomechanical patterns of the 2 examined syndromes help the differential diagnosis and consequent therapeutic approach.
This study shows different sensory and biomechanical patterns in 2 algogenic conditions of the heel with similar pain location. These distinct patterns reflect different pathophysiologic mechanisms in the 2 cases, which has a potential significant impact on treatment.
本研究评估了两种具有相似症状的足跟痛情况的感觉和生物力学特征，即小指展肌神经卡压综合征和拇展肌肌筋膜综合征。33例单侧足跟痛患者和20例无症状受试者在A部位（跟骨结节内侧突，拇展肌触发点部位）和B部位（A部位后方1厘米处，此处小指展肌神经最表浅）及其对侧的疼痛区域进行压痛阈值测量；对胫后神经进行神经电图检查；在动态平台上评估地面足部反应。18例患者有电击样疼痛（卡压综合征，第1组），15例有痉挛样疼痛（肌筋膜综合征，第2组）。第1组在B部位以及第2组在A部位，患侧与对侧的疼痛阈值显著降低（P <.001）。第1组神经传导速度略有降低（P =.05）。所有患者患侧与无症状受试者相比，地面足部反应有显著改变；第1组在力峰值（F1）方面两侧有显著差异，第2组在除力峰值时间相位（TF3）外的所有参数方面两侧有显著差异（P =.05）（P <.0001）。所检查的两种综合征不同的感觉和生物力学模式有助于鉴别诊断及后续治疗方法的选择。
本研究显示，在足跟部疼痛部位相似的两种致痛情况下，存在不同的感觉和生物力学模式。这些不同模式反映了这两种情况下不同的病理生理机制，对治疗可能有重大影响。
