Spinal conditions, paget disease, and foot disorders

Spinal stenosis

Spinal stenosis is the narrowing of the spine. The stenosis puts pressure on the nerves and spinal cord. Usually, spinal stenosis occurs in people over age 50, but it can affect younger people with spinal injuries. Cervical stenosis causes narrowing of the cervical spine in the neck. Lumbar stenosis causes narrowing of the lumbar spine in the lower back.

Causes of spinal stenosis include overgrowth of bone, herniated disks, tumors, spinal injury, and thickening of ligaments. Cervical spinal stenosis causes numbness, tingling, and weakness in the extremities. Neck pain, difficulty walking, and bowel and bladder incontinence can occur. With lumbar spinal stenosis, a person can experience weakness, tingling, numbness, cramping, and pain in the legs and feet. It can also cause back pain.

After an exam, the provider may order x-rays, an MRI, and a CT scan. Sometimes a CT myelogram is done. With a CT myelogram, a contrast dye is injected, which outlines the spinal cord and nerves, showing abnormalities. Spinal stenosis can be treated with surgery, analgesics, physical therapy, and steroid injections.

Paget’s disease

Learning Objective: Discuss Paget’s disease, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

Paget disease is also called osteitis deformans. Paget’s disease causes abnormal bone destruction and regrowth. The new bone is larger but weaker, leading to deformities. Often, the bones in the arms, legs, spine, skull, pelvis, and collarbones are involved.

The etiology is unknown. It may be related to genetic factors or a viral infection. Most patients experience no symptoms. If symptoms occur, the person may experience bone pain, joint stiffness and pain, and fractures. Deformities, such as an enlarged skull and bowing of the legs, can occur. A person can experience a reduction in height, kyphosis, and spinal stenosis. Hearing loss can also occur.

After an examination, the provider may order a bone scan and X-rays. Laboratory tests such as alkaline phosphatase (ALP), bone-specific isoenzyme, and serum calcium may be performed. Not all patients with Paget’s disease require treatment. Patients with deformities and other symptoms may be treated with medications to reduce bone remodeling, such as bisphosphonates and calcitonin. For lumbar spinal stenosis due to a thickened ligament, percutaneous image-guided lumbar decompression (PILD) can be done. For this procedure, needle-like instruments are used to remove parts of the thickened ligament, thus widening the narrowed spinal canal.

Plantar fasciitis

The plantar fascia is a tough fibrous tissue that connects the toes to the heel on the bottom of the feet, creating the arch of the foot. Plantar fasciitis occurs when the plantar fascia becomes inflamed or swollen from being overstretched or overused. Plantar fasciitis is one of the most common foot issues.

People with flat feet or high arches are at risk for plantar fasciitis. Other risk factors include running long distances, obesity, wearing shoes with poor arch support, and having a tight Achilles tendon. Signs and symptoms include foot pain immediately in the morning, after standing, sitting, or intense exercise, and when climbing stairs. The pain can be on the bottom of the foot or along the sole. Mild foot swelling, redness, or stiffness can also be seen.

The provider will do an examination. A foot x-ray may be ordered to rule out other issues. Treatment involves over-the-counter analgesics, heel and foot stretches, and good arch supports in shoes. Severe cases may require immobilization, custom-made shoe inserts, steroid injections in the heel, and surgery. Plantar fasciitis usually resolves with treatment.

Additional skeletal system disorders

There are many skeletal disorders. The following are some examples:

Definitions

Amputation

The removal of a leg, foot, toes, fingers, or arm as a result of a trauma, accident, poor blood flow to the extremity, uncontrolled or worsening infection, tumor, or severe frostbite or burn. Risks of amputations include blood clots, bleeding, infection, poor surgical wound healing, and phantom sensations. After a limb is removed, a person may feel that the limb is still there. This can include experiencing numbness, hot or cold sensations, and pain (called phantom pain) in the limb that is no longer there. Depending on the type of amputation, many amputees use an artificial limb. Recovering from an amputation may require physical therapy, treatment with medicine, or counseling to help deal with sadness, anger, and frustration.

Chondrosarcoma

A rare type of cancer that begins in bones or soft tissue near the bones. Ewing sarcoma

A rare type of cancer that starts in the bone or soft tissue near the bone. More common in children and teenagers.

Fibrous dysplasia

Abnormal fibrous tissue replaces bone, leading to weak bones.

Mastoiditis

Infection of the mastoid bone, commonly related to middle ear infections (acute otitis media).

Osteogenesis imperfecta

Also called brittle bone disease, a genetic condition that causes bones to fracture easily.

Osteomyelitis

A bacterial or fungal infection of the bone that comes from the bloodstream, surgery, or an injury. Signs and symptoms include chills and fever. The infected area can be painful, warm, red, and swollen. Antibiotics and surgery, if needed to remove dead bone tissue, can be done to treat the infection.

Osteosarcoma

Most common bone cancer in children but can occur in adults; usually found in large bones, although it can occur in any bone.

Polydactyly

Often a genetic condition in which a person has more than five toes per foot or five fingers per hand. The extra digit is often poorly formed and is usually surgically removed.

Spina bifida occulta

Mildest form of spina bifida; no spinal nerves are involved, but one or more vertebrae are malformed; no signs or symptoms may be present. The only indication may be an abnormal cluster of hair, a small dimple, or a birthmark on the infant’s back.

Spondylolisthesis

A forward displacement of a vertebra over the one below it; usually occurs in the lumbar or sacral area; can be related to a birth defect or acute trauma.

Syndactyly

The digits (fingers and toes) are fused together or are webbed together. Most commonly seen with the second and third toes.

Talipes (clubfoot)

Most common congenital disorder of the legs; one foot or both feet are turned inward and downward; the calf and foot may be slightly smaller; treatment depends on the severity and can include stretching, casting, braces, and surgery.