Epidemiology And Diagnosis

There are very few epidemiological data relating to soft-tissue disorders of the lower limb. Risk factors for the development of these disorders include trauma, unaccustomed exercise, obesity, poor footwear, and prolonged standing.167

In the hip, the most common soft-tissue disorders are due to problems associated with the numerous bursae that are found in this region. Trochanteric bursitis is the most prevalent condition and is often associated with other disorders, including osteoarthritis of the same hip, lumbar spondylosis, and RA.168 Since no findings are pathogno-monic of trochanteric bursitis, the diagnosis is generally based on the clinical picture, which includes pain along the lateral side of the upper thigh that is aggravated by activity or lying on the affected side. Physical examination reveals tenderness over the greater trochanter. Less frequent soft-tissue disorders in this area include iliopsoas bursitis, iliogluteal bursitis ("weaver's bottom''), and adductor tendinitis, which tends to occur as a sporting injury, particularly in gymnasts and horseback riders.169

Chronic knee pain is common at all ages: OA is the major determinant in the elderly, whereas anterior knee pain syndrome (chondromalacia patellae) is more important in adolescents and children. There are also a large number of soft-tissue structures within the knee giving rise to symptoms including ligamentous injuries, meniscal tears, bursitis, popliteal cysts, iliotibial band syndrome, and synovial plicae.170 Prepatellar bursitis is among the most common of these and is usually related to repetitive trauma. Diagnosis is usually obvious, with a fluctuant swelling over the front of the patella. Anserine bursitis is also common, although in practice the term tends to be used loosely to describe any pain over the medial aspect of the upper tibia in the region of the bursa and so may include lesions of the medial ligament or pes

anserus insertion.171

Soft-tissue disorders of the ankle include Achilles tendinitis, which is generally associated with repetitive trauma due to excessive use of the calf muscles during sporting activities. There may be an associated Achilles bursitis, which can also arise spontaneously or in association with a systemic arthropathy such as RA. One of the most common causes of pain around the heel is plantar fasciitis, which generally also results from repetitive microtrauma with risk factors being obesity, athletics, and poor footwear.172 The disorder may coexist with subcalcaneal bursitis.

Arthritis Relief and Prevention

Arthritis Relief and Prevention

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