Kim Tae-Hwan, Lee Jin Kyu, Sung Hyo-Kyung, Kim Bo-Hyun, Song Young-Sik, Sung Il-Hoon
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Department of Orthopedic Surgery, School of Medicine, Hanyang University, Seoul, Korea.
Int J Rheum Dis. 2019 Feb;22(2):222-227. doi: 10.1111/1756-185X.13379. Epub 2018 Sep 5.
Most heel pain occurs at the posterior or plantar aspect, where main entheses of the heel are located. However, simple radiographs as basic work-up tools, their features based on their association with local symptoms in the heel in ankylosing spondylitis (AS) patients, have rarely been described.
Forty patients with AS and unilateral heel pain were enrolled to evaluate radiographic differences between symptomatic and asymptomatic heels. The two groups were assessed according to symptom location: posterior (group PS) or plantar (group PL). Typical abnormalities in bone and/or soft tissue on the heel due to inflammation were compared.
In group PS (20 cases), 19 (95%) symptomatic feet and 7 (35%) asymptomatic feet showed abnormal findings on the posterior heel and symptomatic feet showed 6 (30%) plantar abnormalities. Erosion of the posterior calcaneal tuberosity, obliteration of the retrocalcaneal recess (RR), and swelling shadows with increased thickness on posterior soft tissue were observed more frequently and significantly in symptomatic feet in group PS (P < 0.05). In group PL (20 cases), 11 (55%) symptomatic feet and 8 (40%) asymptomatic feet showed abnormalities on the plantar heel and symptomatic feet showed 14 (70%) posterior abnormalities, and none showed significant differences between symptomatic and asymptomatic feet.
Among simple radiographic alterations on heels with AS, such changes around the enthesis of the Achilles as bony erosion and RR obliteration with swollen posterior soft tissue are strongly related to current painful posterior heels. Assessment of enthesitis of the Achilles tendon in AS using plain radiography seems to be valid.
大多数足跟痛发生在足跟的后部或足底，此处是足跟主要附着点所在位置。然而，作为基本检查工具的普通X线片，其在强直性脊柱炎（AS）患者中与足跟局部症状相关的特征却鲜有描述。
纳入40例患有AS且单侧足跟痛的患者，以评估有症状足跟与无症状足跟的影像学差异。根据症状部位将两组进行评估：后部（PS组）或足底（PL组）。比较足跟处因炎症导致的骨和/或软组织的典型异常情况。
在PS组（20例）中，19例（95%）有症状的足部和7例（35%）无症状的足部在后足跟处显示出异常表现，有症状的足部有6例（30%）存在足底异常。在PS组有症状的足部中，跟骨后结节侵蚀、跟骨后隐窝（RR）闭塞以及后软组织厚度增加的肿胀阴影更为频繁且显著地被观察到（P<0.05）。在PL组（20例）中，11例（55%）有症状的足部和8例（40%）无症状的足部在足底足跟处显示出异常，有症状的足部有14例（70%）存在后部异常，且有症状与无症状足部之间均未显示出显著差异。
在AS患者足跟的普通X线改变中，跟腱附着点周围诸如骨质侵蚀、RR闭塞以及后软组织肿胀等变化与当前疼痛的后足跟密切相关。利用普通X线片评估AS患者的跟腱附着点炎似乎是有效的。
