整形２７

【臨床症状】50代　歩行時の踵付近の痛み

【問題】画像所見と診断名は？

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※ 脂肪抑制、プロトン強調、T2*の矢状断、脂肪抑制の冠状断の順に表示

➡ 造影後MRI画像
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※ 造影後の矢状断、冠状断の順に表示

    ▶答えはこちら
    • 脂肪抑制画像で足底腱膜が踵骨付着部にて高信号を認め、浮腫性変化が疑われる
    • また造影後ではエンハンスされ、炎症が起きている状態と考えられる
    • 臨床症状も加味し、足底腱膜炎と診断された

    【足底腱膜炎】

    ・足底腱（筋）膜は踵骨後下部から、扇状に広がり中足骨頭～近位趾骨に付着している

    ・足部のアーチ構造を支持するクッション機能と、歩行時の蹴り出しのスムーズにする役割（ウィンドラス機構）がある

    ・足底腱膜炎は踵の痛みの代表的な原因の一つ

    ・中長期的な機械的損傷、変性、リウマチなどの炎症性疾患が原因と考えられている

    ・男性よりも女性に多い

    ・踵骨と足底腱膜の付着部に骨棘が見られる事があるが、健常例でも見られる事があるので注意が必要

    ・治療法はインソールの使用や理学的療法などの保存的治療の他に、外科的や衝撃波治療を実施するケースもある

    骨軟部疾患の画像診断 第2より引用改変