- \n
- Aya\u011f\u0131n orta k\u0131sm\u0131nda a\u011fr\u0131 (midfoot)<\/li>\n
- Lateral: Peroneus brevis tendiniti, peroneus longus tendiniti<\/li>\n
- Medial: Fleksor digitorum longus, fleksor hallusis longus, tibialis posterior tendinitleri Arka topuk a\u011fr\u0131s\u0131<\/li>\n
- Asil tendiniti, retroa\u015fil bursiti, retrokalkeneal bursit<\/li>\n
- Topu\u011fun alt k\u0131sm\u0131nda a\u011fr\u0131<\/li>\n
- Plantar fasiit ve epin kalkanei, topuk ped atrofisi, tarsal t\u00fcnel sendromu (TTS), morton n\u00f6roma, kemik kistleri, osteomiyelit, frakt\u00fcr, t\u00fcm\u00f6r<\/li>\n<\/ul>\n
Hastan\u0131n ifadesi hastal\u0131\u011f\u0131n tabiat\u0131 hakk\u0131nda \u00f6nemli ipu\u00e7lar\u0131 verir. A\u011fr\u0131n\u0131n yeri, ba\u015flang\u0131c\u0131, g\u00fcn i\u00e7indeki de\u011fi\u015fmeleri, artt\u0131ran ve azaltan fakt\u00f6rler \u00f6nemli ipu\u00e7lar\u0131 sunarlar. Aktiviteyle artan a\u011fr\u0131, kas-iskelet sisteminde bir a\u015f\u0131r\u0131 kullan\u0131m (overuse) oldu\u011funu g\u00f6sterir.<\/p>\n
Yanma, kar\u0131ncalanma ve uyu\u015fma gibi semptomlar periferik sinir lezyonlar\u0131n\u0131 i\u015faret eder. \u015eeker hastal\u0131\u011f\u0131, romatizmal hastal\u0131klar, malignite topuk a\u011fr\u0131lar\u0131n\u0131n nadir g\u00f6r\u00fclen sistemik nedenleridir. Ayaktaki \u015fi\u015fmeler, kemik deformiteleri, deri b\u00fct\u00fcnl\u00fc\u011f\u00fcndeki bozukluklar, ekimoz (morarma), iyice incelenmelidir. Ayr\u0131ca ayaktaki arklar\u0131n dengesi, d\u00fczle\u015fmesi incelenmelidir.<\/p>\n
Plantar fasia lezyonlar\u0131:<\/h3>\n
Plantar fasia ayak taban\u0131n\u0131 kaplayan 3 par\u00e7al\u0131 bir apon\u00f6rozdur. Bu fasia ayaktaki \u00fc\u00e7 adet \u00f6nemli y\u00fck ta\u015f\u0131y\u0131c\u0131 b\u00f6lgeye yap\u0131\u015f\u0131r (kalkeneus, 1.ve 5.metatars ba\u015flar\u0131) ve aya\u011f\u0131n uzunlamas\u0131na ark\u0131n\u0131 olu\u015fturur. Y\u00fcr\u00fcmenin topuk vuru\u015fu, tam basma ve itme faz\u0131nda plantar fasiaya \u00e7ok fazla y\u00fck biner. D\u00fcz tabanl\u0131k, \u00e7ukur ayak, subtalar eklem sertli\u011fi, kal\u0131n a\u015fil tendonu plantar fasian\u0131n biyomekani\u011fini bozar.<\/p>\n
Plantar fasiitis (asl\u0131nda fasioz) topuk a\u011fr\u0131lar\u0131n\u0131n en s\u0131k rastlanan sebebidir. Tekrarlayan hareketler ve a\u011f\u0131r y\u00fcklenme (obezite gibi) en \u00f6nemli plantar fasiit nedenleirdir. Tipik g\u00f6r\u00fcn\u00fcm\u00fc topu\u011fun alt k\u0131sm\u0131nda sabah ilk hareketle ortaya \u00e7\u0131kan bir a\u011fr\u0131d\u0131r. Kalkaneal \u00e7\u0131k\u0131nt\u0131n\u0131n i\u00e7 yan\u0131nda hassasiyet vard\u0131r. Ba\u015fparma\u011f\u0131n pasif dorsifleksiyonu a\u011fr\u0131y\u0131 a\u00e7\u0131\u011fa \u00e7\u0131kar\u0131r. Travma ya da sportif aktivitelerden sonra ortaya \u00e7\u0131kan \u015fiddetli topuk a\u011fr\u0131s\u0131 plantar fasiada bir y\u0131rt\u0131k olabilece\u011fini i\u015faret eder.<\/p>\n
Bu durumda kalkaneal tuberositasta defekt ve ekimoz g\u00f6r\u00fcl\u00fcr. R\u00f6ntgende kalkeneal spur (topuk dikeni, epin kalkanei) g\u00f6r\u00fclebilir. Bu spurlar (topuk dikenleri) asemptomatik te olabilirler. Plant\u00f6r fasiitler stres k\u0131r\u0131klar\u0131, artrit ve iskelet bozuklu\u011fu ile kar\u0131\u015fabilir. Bazen siyatik n\u00f6ropati ayak ucuna kadar vuran a\u011fr\u0131lara yola\u00e7abilir.<\/p>\n
Tendon lezyonlar\u0131<\/h3>\n
Tendinitlerde, tendonun yap\u0131\u015fma yerinde a\u011fr\u0131, hassasiyet ve \u015fi\u015flik olabilir. Aya\u011f\u0131n dorsifleksiona zorlanmas\u0131 a\u015fil tendonun yap\u0131\u015fma yerindeki a\u011fr\u0131y\u0131 uyar\u0131r. Tendinitlerin en \u00f6nemli sebebi ani y\u00fcklenmeler yada tekrarlayan y\u00fcklenmelerdir. A\u015fil tendiniti topuk arkas\u0131nda a\u011fr\u0131 \u015feklinde kendini g\u00f6sterir. Aya\u011f\u0131n pasif dorsifleksionu a\u011fr\u0131l\u0131d\u0131r.<\/p>\n
Tendon \u00fczerinde hassasiyet vard\u0131r. Gastroknemius-soleus kas grubu zorland\u0131\u011f\u0131nda a\u011fr\u0131 olu\u015fur. Topuk \u00fczerinde y\u00fcr\u00fcme a\u011fr\u0131l\u0131d\u0131r. Posterior tibialis, fleksor digitorum longus, fleksor hallusis longus tendonlar\u0131 medial fleksor retinakulumdan ge\u00e7erek aya\u011f\u0131n i\u00e7 taraf\u0131na yap\u0131\u015f\u0131rlar. Peroneal tendonlar, aya\u011f\u0131n d\u0131\u015f orta b\u00f6l\u00fcm\u00fcne yap\u0131\u015f\u0131rlar. Aya\u011f\u0131n, i\u00e7 ve d\u0131\u015f kenar\u0131nda tendinit, a\u015fil tendinitine g\u00f6re \u00e7ok nadir g\u00f6r\u00fcl\u00fcr.<\/p>\n
Bursa lezyonlar\u0131<\/h3>\n
Bursalar normalde anatomik bo\u015flu\u011fu olmayan keseciklerdir. Retrokalkeneal bursa kalkeneusla a\u015fil tendonu aras\u0131nda, retro a\u015fil bursa ise a\u015fil tendonu ile deri aras\u0131nda bulunur. Bu iki bursada da enflamasyon s\u0131k g\u00f6r\u00fcl\u00fcr. Bursitler; k\u00f6t\u00fc ayakkab\u0131lar, dar ayakkab\u0131lar, a\u015fil tendinitleri, romatizmal hastal\u0131klar, Haglund hastal\u0131\u011f\u0131 (kalkeneusun arka \u00fcst y\u00fcz\u00fcnde spur) gibi durumlarda ortaya \u00e7\u0131kar. Osse\u00f6z (kemiksel) lezyonlar: Metatarslarda stres k\u0131r\u0131\u011f\u0131, kalkeneal stres k\u0131r\u0131\u011f\u0131, sporcularda osteopeni ile birlikte olursa s\u0131k g\u00f6r\u00fcl\u00fcr. Bazen d\u00fcz filmlerde g\u00f6zden ka\u00e7abilir. Bu durumda MR ve sintigrafi \u00e7ektirilmelidir. Nadirde olsa Ewing\u2019s sarkomu ve metastatik t\u00fcm\u00f6rler topuk a\u011fr\u0131lar\u0131na yola\u00e7abilir<\/p>\n
Periferik sinir lezyonlar\u0131<\/h3>\n
Tarsal t\u00fcnel, topu\u011fun i\u00e7 y\u00fcz\u00fcnde bulunur. Fleksor retinakulum ile talus ve kalkeneusun i\u00e7 y\u00fczleri ile s\u0131n\u0131rland\u0131r\u0131l\u0131r. Posterior tibial sinir, bu t\u00fcnelden ge\u00e7tikten sonra i\u00e7 ve d\u0131\u015f dallara ayr\u0131l\u0131r. Sinirin innerve etti\u011fi alanlarda kar\u0131ncalanma, yanma, uyu\u015fma gibi belirtiler olur. Bu duruma TTS ad\u0131 verilir. Tarsal t\u00fcnel hassast\u0131r. Aya\u011f\u0131n ayn\u0131 anda dorsifleksionu ve eversiyonu (d\u0131\u015f rotasyonu) a\u011fr\u0131y\u0131 ortaya \u00e7\u0131kar\u0131r. D\u00fcz tabanl\u0131k TTS\u2019 unun en \u00f6nemli sebebidir.<\/p>\n
EMG sinirdeki dejenerasyonu g\u00f6sterebilir. Medial kalkeneal sinirdeki n\u00f6romalar nadiren plantar fasiiti taklit eden semptomlara yol a\u00e7abilir. Topu\u011fun ve ayak ortas\u0131n\u0131n proksimalinin palpasyonunda a\u011fr\u0131l\u0131 bir lump ele gelebilir. Bu durum yang\u0131l\u0131 plantar fasiit ile kar\u0131\u015ft\u0131r\u0131labilir.<\/p>\n
Topuk pedi bozukluklar\u0131<\/strong><\/p>\n
Topuk yast\u0131\u011f\u0131 (ped), fibroz septalarla ayr\u0131lan ya\u011f dokusu kitlelerinden olu\u015fmu\u015ftur. Kalkeneusun alt\u0131nda \u015fok emici bir \u00f6zellik g\u00f6sterir. Ya\u015fl\u0131larda ve obezlerde topuk deste\u011findeki artrofiler s\u0131k g\u00f6r\u00fcl\u00fcr. Gen\u00e7 sporcularda da g\u00f6r\u00fclebilir. Topuk yast\u0131\u011f\u0131ndaki defektten kaynaklanan a\u011fr\u0131lar daha yayg\u0131nd\u0131r, kalkaneusun ta\u015f\u0131y\u0131c\u0131 k\u0131sm\u0131n\u0131n
\ntam alt\u0131ndad\u0131r. Plantar fasiitteki gibi tuberositas (\u00e7\u0131k\u0131nt\u0131) \u00fczerinde de\u011fildir. A\u011fr\u0131 \u00f6ne do\u011fru yay\u0131lmaz, ba\u015fparmak dorsifleksionu a\u011fr\u0131y\u0131 provake etmez. Bazen plantar fasiitle birlikte olabilir.<\/p>\nEnfeksiyonlar<\/strong><\/p>\n
Kalkaneusta osteomiyelit \u00e7ok nadirdir. Diabetli ve vask\u00fcler yetmezlik olan hastalarda g\u00f6r\u00fcl\u00fcr.<\/p>\n
Sistemik hastal\u0131klar<\/strong><\/p>\n
Bu durumda topuk a\u011fr\u0131s\u0131 iki tarafl\u0131d\u0131r. Seronegatif artritler; AS, PsA, ReA, iltihabi barsak hastal\u0131klar\u0131na ba\u011fl\u0131 artrit, RA, gut, topuk a\u011fr\u0131lar\u0131na yol a\u00e7abilir.<\/p>\n
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Topuk A\u011fr\u0131lar\u0131 Topuk a\u011fr\u0131lar\u0131 s\u0131k kar\u015f\u0131la\u015f\u0131lan bir hastal\u0131kt\u0131r ve bazen […]<\/p>\n","protected":false},"author":1,"featured_media":8545,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[478],"tags":[937,938,939,940,941],"class_list":["post-1011","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ayak-ve-ayak-bilegi-agrilari","tag-topuk-agrilari","tag-topuk-agrilari-fizik-tedavi","tag-topuk-agrilari-neden-olur","tag-topuk-agrilari-sebepleri","tag-topuk-agrilari-tedavisi"],"jetpack_featured_media_url":"https:\/\/turanuslu.net\/wp-content\/uploads\/2010\/04\/topuk-agrilari.jpg","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/posts\/1011","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/comments?post=1011"}],"version-history":[{"count":2,"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/posts\/1011\/revisions"}],"predecessor-version":[{"id":10130,"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/posts\/1011\/revisions\/10130"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/media\/8545"}],"wp:attachment":[{"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/media?parent=1011"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/categories?post=1011"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/turanuslu.net\/ar\/wp-json\/wp\/v2\/tags?post=1011"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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