home Diseases Inflammation of the joints and tissues of the foot. Purulent diseases of soft tissues

Inflammation of the joints and tissues of the foot. Purulent diseases of soft tissues

Periarticular tissues include muscle tendons, their synovial sheaths, places of attachment of tendons to bone - entheses, mucous bags - bursae, ligaments, fascia, aponeuroses, muscles surrounding the joint. The inflammatory process can be localized in any of these tissues and, accordingly, can be defined as tendonitis (inflammation of the tendon), tendovaginitis (inflammation of the tendon sheath), bursitis (inflammation of the joint capsule), tenobursitis (inflammation of the tendon and joint capsule), enthesopathy (inflammation of the enthesis ), ligamentitis (inflammation of the ligaments), fibrositis (inflammation of the aponeuroses and fascia), myotendinitis (inflammation of the muscle areas adjacent to the tendon).

Aponeurositis

Aponeurositis of the foot, or plantar aponeurositis, is an inflammation of the plantar aponeurosis (a wide connective tissue plate consisting of dense collagen and elastic fibers, which are located mostly parallel to each other). The aponeurosis connects the vastus muscles to bones or other tissues.

Aponeurositis of the feet is usually chronic and leads to progressive fibrous-scarring changes with the involvement of tendons and the development of persistent flexion contractures (Dupuytren's and Lederhosen's contractures, respectively). Plantar aponeurositis results in nodular thickening of the plantar aponeurosis with excessive flexion of the toes.

Bursitis is an inflammation of the joint capsule with accumulation of fluid in its cavity. Bursitis is divided into acute and chronic. In most cases, the cause of the disease is infection of abrasions and cuts in the area of the joint capsule. The disease can also develop after injuries (mainly bruises), especially with repeated and prolonged trauma.

Traumatic bursitis most often occurs in men under 35 years of age. Women suffer much less from this disease.

With purulent bursitis, the disease develops acutely - with sharp pain and increased body temperature. Chronic serous bursitis is characterized by gradual development, since fluid in the mucous bursa accumulates gradually, the pain is almost unnoticeable. The main symptom of this disease is local swelling that occurs in the area where the periarticular bursa is located. In most cases, the swelling is located on the front surface of the knee joint.

Acute bursitis is accompanied by pain, limited mobility, local tenderness on palpation, redness, hyperthermia of the skin with a superficial location of the bursa.

With chronic bursitis, the walls of the bursa become thicker, intracavitary adhesions, calcification and atrophy of regional muscles occur.

The disease should be treated at an early stage, otherwise a complication may occur in the form of phlegmon of the surrounding soft tissues (especially with purulent bursitis). Spontaneous opening, which results in fistulas, is also dangerous.

For acute serous bursitis, rest, joint immobilization, and various thermal procedures are recommended. In the chronic form of the disease, puncture of the bursa at aseptic levels with removal of exudate and its bacteriological examination and application of a pressure bandage is indicated. In case of recurrent course of chronic bursitis, it is necessary surgical treatment with excision of the mucous bursa. For purulent bursitis, an incision is also made to drain the bursa, after which a course of antibiotic treatment is prescribed.

With timely measures taken, the prognosis is usually favorable. In the future, protective bandages are used as preventive measures to eliminate chronic microtraumas of the joint, which are applied to the knee joint.

Rheumatic diseases

Rheumatic diseases are usually inflammatory nature. They can develop against the background of an allergy or infectious disease, as well as due to injury, trauma, hypothermia, etc.

Rheumatic diseases cause severe pain localized in the joints and difficulty moving.

Periarthritis of the knee joint

This disease most often affects the tendons that make up the so-called crow's foot(semitendinosus, gracilis, sartorius and semimembranosus muscles are inserted in the area of the medial condyle of the tibia).

Periarthritis of the knee joint is characterized by pain in the tibia during movement, both active and passive - with flexion, sharp extension or rotation of the leg. Painful sensations also occur upon palpation.

Periarthritis hip joint

This is an inflammation of the periarticular tissues of large joints, often resulting from overload, injury or hypothermia. Periarthritis is one of the most common causes of pain in the hip joint. The pain syndrome in this disease has its own characteristic features: pain is absent at rest and occurs if you lie on the affected side or sit with your legs crossed, as well as when moving, when taking the first steps. Then, when walking, the pain gradually decreases and completely subsides.

On palpation, local pain is detected in the area of the greater trochanter. The diagnosis can be made by radiography, which sometimes reveals specific features: fringed contours of the greater trochanter, linear shadows of calcification of the tendons of the muscles attached to it or the synovial bursae located here.

This is an inflammation of the synovial membrane of the joint with the formation of effusion in it. In most cases, the knee joint is affected. The disease occurs after injury, with arthritis, hemophilia and allergies, when infection can enter the joint.

There are acute and chronic synovitis. Acute synovitis is accompanied by severe pain in the joint and increased body temperature. An effusion forms in the area of the diseased joint. Chronic synovitis is accompanied by less acute pain. It occurs periodically when effusion accumulates in the joint. On late stages synovitis is characterized, as before, by slight changes in symptoms. If the disease is not treated in a timely manner, it leads to deforming arthrosis with impaired flexion contracture of the joint.

It is quite difficult to identify the disease, since radiographic examination excludes bone damage. The diagnosis is made only on the basis of the clinical picture and is clarified by examining the fluid obtained during joint puncture.

Tendinitis

Tendinitis is inflammation in or around a tendon. The pain syndrome in this disease persists for a very long time.

You should know that continuing to work the tendon in the same rhythm that initially provoked the disease will lead to its transition to the chronic stage.

The initial response of the tendon to chronic overload is swelling and microscopic breakdown of collagen with changes in the surrounding mucosa. In more severe cases, mucosal degeneration develops, in which the central portion of the tendon is replaced by a jelly-like mucous deposit.

Treatment of tendonitis is carried out through the use of physiotherapeutic methods, painkillers and anti-inflammatory drugs. For severe lesions can be used surgical intervention. During treatment, you should limit physical activity on the area of the affected ligament and wear a fixing bandage.

Tenosynovitis

This is an inflammation of the synovial tendon sheaths. Each such vagina is a connective tissue membrane, 2 leaves of which, forming a closed cavity, surround the muscle tendon. In this case, the inner leaf is fused with the tendon. In the cavity between the sheets there is synovial fluid, which helps facilitate the gliding of the tendon. Tenosynovitis occurs predominantly in the area of the hand and wrist, less commonly in the knee and elbow joints, and even more rarely in the area of the foot. The cause of inflammation is the penetration of pyogenic microbes into the tendon sheaths during wounds and purulent diseases of the surrounding tissues. Also, this disease can occur without the involvement of an infection - with excessive load on the tendons, constant, associated with the profession, or short-term, unusual for the body.

According to the clinical course, acute and chronic tendovaginitis are distinguished. Acute tenosynovitis develops after the penetration of pathogenic pyogenic microflora into the synovial vagina when it is damaged. This type of disease is characterized by the accumulation of serous and then purulent exudate in the cavity of the synovial vagina, followed by disruption of the blood supply to the tendon. Acute tenosynovitis is characterized by increased body temperature, sharp pain in the affected area, intensifying when attempting to move, and regional lymphadenitis. Swelling and forced fixed position of the damaged area also develop.

Chronic tendovaginitis is often caused by specific microflora (Koch's bacillus, Brucella, spirochetes). The disease is characterized by a slowly increasing, slightly painful swelling in the area of the tendon sheaths and joint capsules. The flexor tendon sheaths are affected approximately 2 times more often than the extensors.

At the first signs of illness, you should immediately consult a doctor. With a purulent disease, in some cases, urgent surgical intervention may be required. In case of tenosynovitis caused by overload, there is no need for surgical intervention, so the doctor is limited to prescribing heat, rest and other therapeutic procedures.

Prevention of infectious tendovaginitis consists of preventing microtraumas at work, constantly monitoring the cleanliness of hands and feet, early treatment of microtraumas using antiseptics, and observing the rules of personal hygiene. To prevent occupational tendovaginitis, you should take breaks from work, giving your limbs rest, and at the end of the working day, warm baths are indicated.

Plantar fasciitis

This is inflammation caused by excessive stretching of the plantar fascia. The plantar fascia is a wide band of fibrous tissue that runs along the sole of the foot from the heel to the forefoot. Severely stretched fascia can lead to plantar fasciitis. This disease in most cases causes pain in the heel, leads to heel spurs and provokes pain in the arch of the foot. Excessive stretching of the plantar fascia can occur for the following reasons:

– excessive pronation of the foot with flat feet, which leads to weakening of the arch of the foot under the influence of weight;

– unusually high instep of the foot;

– sudden increase in motor activity;

– incorrectly selected shoes.

The main cause of the disease is excessive pronation with flat feet. This occurs during walking when a person's arch weakens under weight, causing the plantar fascia to pull away from the heel bone.

Plantar fasciitis is characterized by pain on the inside of the foot. The pain is especially acute either immediately after getting out of bed, or after a long rest, because during rest plantar fascia returns to its original form. Over the course of the day, as the plantar fascia gradually stretches, the pain usually subsides.

The key to successfully treating plantar fasciitis is identifying the cause of the excessive stretching of the fascia. If it is due to excessive pronation due to flat feet, orthopedic shoes with a reinforced heel and arch support to support the longitudinal arch of the foot will help reduce pronation and allow the damage to heal.

If the foot has an arch that is too high, which leads to the development of plantar fasciitis, heel pads and comfortable shoes should be used.

Other treatments include stretching exercises, night splints for plantar fasciitis, wearing shoes with a padded heel pad and heel elevation using insoles or heel braces. Insoles and cushions provide additional comfort to the foot, reducing shock and stress experienced by the foot throughout the day.

Every time your foot hits the ground, the plantar fascia is stretched. You can reduce the load on the fascia by adhering to the following simple rules: stop running, try to lose weight and wear orthopedic shoes with devices to support the arch of the foot.

Enthesopathy

This is the term used to describe pathological changes where tendons and ligaments attach to bones (ankylosing spondylitis, psoriatic arthritis and Reiter's disease). The term “enthesopathy” means a pathological process in the entheses, that is, in the places of attachment of tendons, ligaments, and joint capsules to the bone. In a broader interpretation, this includes tendonitis of the end sections of tendons and inflammation of the adjacent mucous bursae.

Ankylosing spondylitis

Ankylosing spondylitis, or ankylosing spondylitis, or ankylosing spondylitis, is a chronic systemic disease of the joints with a predominant localization of the process in the sacroiliac joints, spinal joints and paravertebral soft tissues.

This disease is more common in men than in women. Average age Those affected are 25–26 years old. Ankylosing spondylitis affects an average of 0.05% of the population in Russia, and 1.1–0.4% in the northern regions.

The cause of ankylosing spondylitis is not known, but it has been established that hereditary predisposition, namely the B27 antigen, which occurs in 90% of patients.

When the disease occurs, the joints become inflamed, their mobility is limited, and ankylosis occurs, that is, the fusion of bones with each other. At the same time, ossification of the ligaments that strengthen the spine occurs. As a result, the spine can completely lose its flexibility and turn into solid bone.

As a rule, the disease develops gradually; slight pain appears in the lower back, which intensifies over time and spreads to other parts of the spine. The pain is usually persistent, decreasing only temporarily after taking painkillers. Gradually, a restriction in the mobility of the spine appears, which sometimes occurs unnoticed by the patient himself and is revealed only during a special examination by a doctor. Sometimes the pain is very mild or even absent, and the only manifestation of the disease is impaired mobility of the spine. Changes in the spine usually spread from bottom to top, so difficulties in moving the neck appear quite late. In some cases, restriction of movement and pain in cervical spine spine are observed from the first years of the disease. Along with a decrease in the flexibility of the spine, the mobility of the joints connecting the ribs with thoracic vertebrae. This leads to impaired respiratory movements and weakened ventilation of the lungs, which can contribute to the occurrence of chronic pulmonary disease.

In some patients, in addition to changes in the structure of the spine, pain and limitation of movements appear in the shoulder, hip, temporomandibular joints, less often pain and swelling of the joints of the arms and legs, pain in the sternum. These phenomena can be moderate and short-lived, but in some cases they are persistent and quite severe. Unlike arthritis in other diseases, inflammation of the joints in ankylosing spondylitis is rarely accompanied by their destruction, but helps limit their mobility.

In addition to the spine and joints, damage to various organs and systems is sometimes observed. In most cases, the eyes are affected, usually resulting in pain and redness in one eye and photophobia. In such cases, patients should be observed not only by a rheumatologist, but also by an ophthalmologist. Treatment should begin immediately after the diagnosis of uveitis (iridocyclitis) is made in order to avoid possible violation visual function. Other extra-articular manifestations are rare and include aortic valve lesions, cardiac conduction abnormalities, and pathological changes in the kidneys and lungs. Sometimes the disease is accompanied by renal amyloidosis, serious complication, which causes kidney failure.

Unfortunately, medicine does not know methods to completely stop the process of ankylosing spondylitis. The main goal of treatment is to reduce pain and maintain spinal mobility. Non-steroidal anti-inflammatory drugs (NSAIDs) are used for this. They do not cure the disease, but they can reduce the inflammatory process.

Inflammation is a pathological process that develops when cells and tissues are damaged. Inflammatory processes are accompanied by changes in blood composition. It threatens to damage individual organs and causes damage to the body.

Inflammation of joints and tendons becomes common. Similar processes can be observed in various diseases, for example, tendonitis, arthritis (inflammation of the joints), fasciitis. To facilitate recognition of the names of diseases accompanied by inflammation, the ending “itis” is added to the Latin name of the organ. You can tell that inflammation accompanies a disease by its name; there are exceptions to the general rule.

Any inflammation is accompanied by general symptoms: increased body temperature, swelling, redness and pain in the area of the inflammatory process, disruption of the normal functioning of the damaged organ or tissue. Inflammation of the soft tissues of the foot shows clear symptoms; it is often easily confused with other pathological processes.

The cause of redness is that when the mucous membrane or soft tissues are irritated, a reflex expansion of the blood vessels occurs, blood flows to the site of the foot with a pathological process. A local increase in body temperature is due to the fact that blood flow increases the speed metabolic processes in damaged tissue.

Damaged foot tissues feel much warmer to the touch than healthy tissues near inflamed tissues. Walls blood capillaries The liquid component of the blood begins to pass through, and blood cells penetrate into them. Due to such an invasion, exudate appears, which determines swelling. The cause of inflammation of the foot is capable of irritating local nerve endings, leading to pain. The pain is caused by the pressure exerted by the influx of large amounts of fluid.

The stage of pathology is alteration or damage, which is destructive to the cells of the body. Damaged cells and cellular structures are not capable of normal functioning, disturbances are observed normal operation organs or tissues.

Stages and types of inflammation

Doctors around the world usually distinguish three main stages of inflammation of soft areas of the body: the alteration stage (damage), the exudation stage (reaction) and the proliferation stage (recovery). The stages are divided into stages:

Alteration: primary and secondary;
Exudation and emigration;
Proliferation and repair: proliferation and the end of inflammation.

The stages of inflammation occur unequally in time, do not have clear boundaries, smoothly flowing into one another. Symptoms on different stages are also different. Treatment at each stage is multidirectional. At the first stages it is to eliminate the root cause of the disease, at the last it comes down to the restoration of destroyed cells and tissues.

Prevention of inflammation of the soft tissues of the foot

To preventive measures to prevent the occurrence and development inflammatory reactions soft areas include simple techniques that are easy to perform. This includes eliminating excessive monotonous loads on the musculoskeletal system. Lack of physical activity, which causes blood stagnation and circulation to be disrupted, causes inflammation.

Open and closed injuries lower limbs, causing inflammation soft tissues of the foot.

Always start the course physical exercise with a warm-up warm-up and stretching of muscle groups and tendons. This approach allows you to avoid limb injuries.

A greater risk of foot injury and inflammation for women is wearing high-heeled shoes. Tight, uncomfortable shoes can injure the tendons and skin of the feet.

Treatment of soft tissues of the foot for foot tendinitis

Tendinitis is a disease in which inflammation of the tendons is detected. If not treated promptly, inflammation leads to damage to muscle tissue.

There are many known causes of inflammation of the tendons of the leg. These include:

Increased physical activity;
Age-related changes in the musculoskeletal system;
Getting infected;
Mechanical damage to the foot;
Congenital anomalies in the structure of the leg bones;
Uncontrolled use of drugs that have a negative effect on the skeletal system.

Treatment of the pathology comes down to the use of anti-inflammatory and painkillers. In case of illness, medications are prescribed. Corticosteroid injections are used and placed in the tendon area. If inflammation is detected, the doctor will prescribe the use of non-steroidal anti-inflammatory drugs.

To eliminate pain, various pain-relieving ointments and gels rubbed into the skin are suitable. If the inflammation is caused by a bacterial infection that has entered the soft tissue area, it is logical to use antibacterial agents.

Excessive loads on the injured limb should be avoided and rest should be ensured. After the sharp pain ends, physical therapy exercises and leg massage will not be superfluous.

Treatment of tendonitis of the flexors and extensors of the toes in the initial stages is easily accomplished by using ointments containing active substance capsaicin. The mentioned ointments are rubbed into the painful area in a circular motion.

Treatment of tendonitis with surgical intervention is extremely rare; it is used if drug therapy does not give the expected result. If the damage is too extensive, the damaged areas are removed.

Tendinitis of the foot is a dangerous disease that, without treatment, can lead to serious consequences. A timely visit to a specialist will help you get rid of pain and avoid impending complications.

Treatment for ankle arthritis

Arthritis is a group of diseases accompanied by inflammation of the joints. The main symptoms are similar to any inflammatory process. However, on early stages During the course of the disease, most of the symptoms may not appear, and the work of the joints is not hampered in any way. Mild swelling indicates the onset of the disease. If previously comfortable shoes have become tight, this is a reason to think about it.

It can be acute or chronic. Inflammation of the interarticular disc leads to destruction cartilage tissue, the process is accompanied by severe pain during flexion and extension. Cartilage does not have blood vessels, so the joint is completely dependent on synovial fluid for nutrition.

To restore lost joint function in acute arthritis, anti-inflammatory drugs are prescribed. As a treatment for tendinitis, arthritis requires pain relief in the form of medications and rest for the patient. If there is a fever, antipyretic drugs are prescribed that can alleviate the course of the disease.

Treatment chronic form arthritis must be deeper than getting rid of acute form. First, you should eat foods rich in unsaturated fatty acids and vitamins, this includes fish, raw fruits and vegetables. Healthy eating accelerates the healing process of damaged joints and soft tissues. Secondly, the patient should be provided with chondroprotectors - a group of drugs that protect joint cartilage from destruction and restore damaged cartilage. The main components of most chondroprotectors are chondroitin sulfate and glucosamine. Third, massotherapy soft tissues and gymnastics provide an opportunity for the joint to maintain mobility.

Features of the treatment of inflammation due to injury to the soft tissues of the foot

There are frequent cases of injury to the soft tissues of the foot. Open wounds extremely dangerous, a lot of microorganisms penetrate the body, leading to inflammation. Bacteria also enter when a non-sterile dressing is applied.

The inflamed wound is washed with antiseptic substances, pus and dead tissue are removed. A cotton-gauze bandage soaked in antibiotics is applied to the wound site. If the wound is fresh, treatment should not involve the use of ointments and creams. Enzymatic anti-inflammatory drugs should be used.

Pus or purulent exudate is formed during purulent or serous-purulent inflammation of tissues. The bulk of pus consists of neutrophilic leukocytes (neutrophils), which phagocytose small bacterial cells and then die. To extract pus from the site of soft tissue injury, a vacuum is used to pump out dead cells, or surgical intervention is required. After suppressing the infection and relieving inflammation, treatment should be directed towards restoring damaged tissues. At this stage of recovery, the use of bactericidal ointments and creams is permissible. A compression plaster is applied to the wound, which brings the edges of the skin and soft tissue together and promotes rapid healing.

Drug treatment of inflammatory processes should be combined with physiotherapeutic procedures, for example, ultrasound and magnetic resonance therapy are used.

Inflammation of the foot without specialist intervention leads to severe complications, reaching the point of being unable to step on the affected leg. Incorrect treatment can prolong the course of the disease for a long time. If the first symptoms of disease appear, timely consultation with a doctor will reduce painful sensations and avoid further progression.

Surgical diseases included in this group, which can also be designated as “ surgical infection", are very diverse. Some of them are quite common and not severe (felons, various boils, etc.), while others are very serious, for example, phlegmon of newborns, osteomyelitis. With all its diversity, any disease based on microbial inflammation manifests itself with local and general symptoms.
Arrest symptoms: redness, swelling, pain on its own or when touched (palpation), increased local temperature (skin is hot to the touch), dysfunction (the child cannot, as before, actively move the affected arm or leg).

General symptoms: fever, anxiety, lethargy, loss of appetite, in young children - refusal to eat, nausea and even vomiting, sometimes pallor, in severe cases - convulsions, impaired consciousness, loose stools, etc.

Let us dwell on the most common purulent-inflammatory diseases. Let's start with newborns.

Inflammatory diseases of newborns

In newborns, the most common inflammatory surgical diseases are mastitis, phlegmon, and osteomyelitis. Whatever inflammatory disease occurs during the neonatal period, the child requires mandatory hospital treatment.

Neonatal mastitis

In almost all newborn children (both boys and girls), physiological hardening of the mammary glands occurs in the first two weeks of life, which is associated with the entry of special mother hormones (estrogens and progesterone) into the child’s blood through the placenta before birth, and after birth - With breast milk. Physiological hardening is expressed in one- or two-sided enlargement and hardening of the mammary glands, and if infection penetrates there by any means, purulent mastitis can develop. In this case, against the background of enlargement and thickening of the child’s mammary gland, its redness and soreness appear. The baby begins to worry and the temperature may rise.

Treatment of mastitis in newborns should be carried out in a hospital - this helps prevent the development of purulent inflammation. Mastitis in the infiltration stage is treated conservatively with physiotherapy, compresses, and antibiotics, which often leads to resorption of the infiltrate. Whenever purulent mastitis(abscessation) cuts are made to free the mammary gland from the pus that has accumulated in it.

Often, when a newborn child has mastitis, parents are concerned about the future, especially if it is a girl. There is no reason to worry, since the incisions, if they still have to be made, are made radially, while the milk ducts are not cut, and the function of the gland does not suffer in the future. Thus, the expectant mother, who suffered mastitis with incisions in early childhood, will be able to breastfeed her children without any hindrance.

Cellulitis of newborns

Newborn babies may experience a special type of skin inflammation and subcutaneous tissue, which is called “necrotic cellulitis of newborns.” The infection usually enters through easily vulnerable skin. Important Feature phlegmon of newborns - the ability to very quickly, rapidly spread throughout the subcutaneous tissue.
The disease often begins with general symptoms - the child becomes lethargic, restless, refuses to breastfeed, and has a fever. A red spot appears on the skin, most often in the area of the back, buttocks, front and side surface of the chest, which very quickly increases in size and acquires a purplish-bluish tint. The skin at the site of the lesion is swollen and dense.

Given the rapid spread of the process, treatment must begin as early as possible. It consists primarily of making multiple small incisions in the affected area and at the border with healthy skin, which helps prevent further spread of the disease. The surgeon must examine the child constantly and, if necessary, make additional incisions. Local treatment combined with massive general therapy, including antibiotics.

Neonatal osteomyelitis

Osteomyelitis is described in detail below, but the peculiarities of its course in newborns force us to dwell further on this disease. Newborn children are characterized by a “dangerous” localization of osteomyelitis - in the area of the epiphysis, that is, that part of the bone that is located in the joint area and is the zone due to which the bone grows in length. This means that if epiphyseal osteomyelitis is not treated in a timely manner in newborns and infants, the growth zone may be destroyed, the bone stops growing, the limb is shortened, and severe deformity occurs, since the entire joint may be destroyed.

The peculiarity of the course of osteomyelitis in newborns is that the picture of the disease is dominated by general symptoms- anxiety, refusal to eat, temperature. As for local manifestations, the child cannot complain of pain, and therefore the main sign of osteomyelitis is that the child stops moving the affected limb (arm or leg), which simply “hangs.” When swaddling or any touch, the baby cries due to pain.

Treatment of osteomyelitis in newborns, as well as at any other age, should begin as early as possible. In case of epiphyseal osteomyelitis, a puncture of the joint is performed, a tube is placed in the joint, through which antibiotics are injected into the joint cavity over the course of several days. Local treatment is carried out against the background of massive general therapy, including antibiotics.

Furuncle, carbuncle

Humans have sebaceous glands in their skin that open in the area of the hair follicles. We often say “oily” or “dry” skin, meaning how actively the sebaceous glands are working. Acute purulent inflammation of the hair follicle of the sebaceous gland is called a boil. Multiple boils are called furunculosis. If several adjacent boils merge into one lesion, a carbuncle appears. Most often, boils and carbuncles are localized in areas of hair growth, the greatest sebum and sweating, and constant microtrauma: on the face, neck, back, and in the gluteal region.

It should be especially emphasized that the predisposing factors contributing to the occurrence of these diseases are, first of all, violation of hygiene rules, lack of nutrition and vitamins, various gastrointestinal disorders, metabolic disorders ( diabetes) or decrease immune defense body. Without eliminating what underlies the occurrence of boils or carbuncles, it is almost impossible to cure them.

Furuncle

The boil usually occurs without general symptoms. Locally, a small painful area of redness and swelling is noted, in the center of which a slight accumulation of pus in the form of a yellow-white dot quite quickly forms. Sometimes edema (swelling) of the surrounding tissues quickly occurs and spreads - this is typical for boils specific localization, especially in the area upper lip and forehead. When the boil is located in the area of the nose or ear, severe local pain is noted.

Treatment of a boil can most often be carried out on an outpatient basis, but if the boil is localized on the face, hospitalization of the child is required, since inflammation can spread to the eye and even into the cranial cavity and cause very dangerous complications- meningitis, sinus thrombosis, etc. Treatment depends on the stage of inflammation. Under no circumstances should you squeeze out the pus yourself, especially if the boil is localized on the face! If swelling without suppuration predominates, then local conservative treatment is carried out in the form of semi-alcohol compresses and physiotherapy. If pus forms, the doctor removes purulent rod using a small incision.

Furunculosis

In the presence of furunculosis, that is, multiple boils, especially if the furunculosis constantly recurs (repeats), it is necessary to expand the examination of the child. Often, such children are diagnosed, as mentioned above, with disturbances in the immunological state of the body, sometimes with diabetes mellitus. These diseases require special treatment, without which it is very difficult, and sometimes even impossible, to cope with boils.

Carbuncle

A carbuncle, compared to a boil, usually proceeds more violently, with an increase in temperature to high numbers, chills, and manifestations of intoxication. Treatment for carbuncle is surgical only.

Felon

Panaritium is an acute purulent inflammation of the soft tissues of the finger. Literally translated from Latin word"felon" means "nail eater." Depending on the depth of the damage to the finger, there are cutaneous felon, subcutaneous, nail, called paronychia, tendon, bone and articular. Diagnosing felon is not difficult even for parents - pain, redness and swelling of the finger occur. The pain, especially with purulent inflammation, can be pulsating and “twitching.” The child stops moving his finger, and sometimes his hand.

Treatment, as with any inflammatory process, depends on the stage of the disease: at the initial stage - conservative, at a later stage - surgical. It is very important to understand that felon is never immediately deep - inflammation develops from superficial, skin felon to bone, passing through all stages. Therefore, it is completely clear that the earlier treatment is started, the better the results. If even superficial cutaneous panaritium occurs, you must immediately consult a doctor, do not self-medicate and do not bring the lesion to the deep bone stage.

Erysipelas(erysipelas)

Erysipelas is an acute progressive serous (not purulent!) inflammation of the subcutaneous soft tissues or mucous membranes. The causative agent of erysipelas is usually streptococcus, in contrast to purulent-inflammatory diseases caused by staphylococcus. Erysipelas is characterized by the appearance on the skin of the lower extremities or face of a bright red, sometimes copper-red, area with very clear scalloped boundaries. In the area of this lesion there is a burning sensation (the skin becomes hot to the touch) and swelling. The child’s general condition also worsens - the temperature rises, chills, malaise, and sometimes headache and vomiting. Erysipelas tends to spread very quickly; it “dissolves like an oil slick.”

Treatment of erysipelas is conservative, but it should be carried out in a hospital.

Lymphadenitis

Inflammation of the lymph nodes is called lymphadenitis. Lymphadenitis is often observed in childhood, is always localized in the area where the lymph nodes are located, most often in the maxillofacial area (submandibular, chin, cervical lymph nodes), less commonly the axillary, popliteal, and inguinal lymph nodes are affected.

The causes of lymphadenitis are varied - it can be sore throat, otitis media, chronic tonsillitis, otitis, pyoderma. Viral diseases - ARVI, influenza, exudative diathesis - contribute to the occurrence of lymphadenitis. Lymphadenitis often occurs as a result of an infected injury to the skin and mucous membranes. Lymphadenitis of the maxillofacial area is usually odontogenic, that is, it develops as a complication of dental disease - caries, therefore, with lymphadenitis of this localization, the doctor must examine not only the lymph nodes, but also oral cavity and teeth.

Lymphadenitis is manifested by enlargement and soreness of one or more lymph nodes. As a rule, a general reaction of the body is noted: fever, chills, malaise. To a doctor examining a child with lymphadenitis and trying to detect the source of infection (carious teeth, wound, abrasion, etc.), the parents should tell what diseases preceded the lymphadenitis. If a child has an enlarged large number of lymph nodes at once, especially if they are painless, consultation with a hematologist and oncologist is necessary, since multiple lesions lymph nodes may be a manifestation of serious blood diseases or tumors.

Treatment of lymphadenitis depends on the stage of the disease. Before suppuration, in the infiltrative stage, conservative treatment is carried out; purulent inflammation lymph node requires surgical treatment(incision).

11-01-2013, 16:05

Description

They can manifest themselves both in the form of simple, non-purulent inflammation, and in the form of purulent processes.

Serous impregnation of the tissues of the orbit occurs most often in children, even in newborns; in adults, non-purulent inflammation of the orbital tissue and eyelids is observed very rarely; Therefore, some authors regard non-purulent forms of inflammation of the soft tissues of the orbit as a symptom of all ethmoiditis in children, since in childhood only the ethmoid labyrinth is formed from all the sinuses.

In children, serous permeation of the orbital tissue occurs even with catarrhal inflammation of the ethmoidal labyrinth, while in adults it occurs only in the presence of rarefied osteitis of the orbital wall or a purulent focus in the sinus.

Most often, the occurrence of inflammatory edema of the orbit is associated with infectious diseases suffered by children - scarlet fever, influenza, leading to ethmoiditis.

Inflammatory changes in the orbit in children with ethmoiditis are so pronounced that there is an erroneous assumption about the presence of an abscess, which is not detected during surgery.

The uniqueness of the clinical picture of non-purulent inflammatory edema of the orbit prompted some foreign authors to distinguish such forms into separate nosological groups(Rolle, for example, talks about false phlegmons of the orbit, etc.).

Non-purulent inflammation of the soft tissues of the orbit can be divided into two groups.

“The last decade of the 19th century,” writes S. V. Ochapovsky in his monograph (1904), “drastically changed our ideas about the etiology of phlegmon, highlighting diseases of the nose and its paranasal sinuses as important sources of orbital disease.”

Prof. K. X. Orlov in the article “On the pathology and therapy of thrombosis of the veins of the orbit and venous sinuses of the skull” notes that the development of the doctrine of purulent inflammation of the orbit and adjacent cavities was helped by the dissertation of M. S. Gurvich (Rostov), which gave an exhaustive description of the venous system the orbit and all its connections with the venous systems of the cavities and sinuses.

Nowadays, thanks to a well-established X-ray service, no one doubts these provisions. Moreover, material from any ophthalmological institution confirms the importance of the paranasal cavities in the occurrence of phlegmonous lesions of the orbit.

S.I. Talkovsky notes that for 495,000 eye patients at the Helmholtz Institute of Eye Diseases for 1900-1935. phlegmon of the orbit was detected in 93 patients, and in 38.7% the phlegmonous lesion of the orbit was based on pathological changes in the paranasal sinuses. He suggested that the noted disease process is even lower than the actual one due to the inadequacy of the X-ray service in the pre-Soviet period.

Recognizing that phlegmon of the orbit most often arises as a result of the spread of purulent contents from the adnexal cavity to the orbital tissue, it should, as S.I. Talkovsky notes, indicate that from this one cannot conclude that eye complications with sinusitis are common. The percentage of complications from the orbit with sinusitis ranges from 3 to 4 (P. E. Tikhomirov et al.).

Among other reasons causing the development of orbital phlegmon, a significant place is occupied by infectious diseases , especially erysipelas; boils of the nose, skin of the eyelids, etc. also often lead either directly to the development of orbital phlegmon, or initially to erysipelas, and then to orbital phlegmon.

In addition to erysipelas, the cause of orbital phlegmon can be other infectious diseases - scarlet fever, measles, etc., as well as postpartum sepsis and septicemia, however, such purely metastatic orbital phlegmon is extremely rare.

A significant role in the occurrence of orbital phlegmon is played by injuries. There are indications in the literature that phlegmon of the orbit occurred after surgery on the eyelids, lacrimal sac and paranasal cavities.

In observation 8, phlegmon was caused by purulent dacryocystitis; the possibility of such a transition of infection can be imagined if we remember that the venous plexus around the lacrimal sac widely anastomoses with the orbital veins.

The pathological anatomy of changes in orbital phlegmon was studied in detail by S. V. Ochapovsky. These changes are characterized by a pronounced reaction of blood vessels and cellular elements connective tissue eye sockets. In the first phase of the development of the phlegmonous process, there is an expansion of the lumen of the vessels and their filling with red and white blood cells.

The emigration of leukocytes from the vessels leads to their filling of all loose fiber; large cluster they are noted around the vessels and in the area of the muscles, and leukocytes penetrate into the muscle tissue, pushing apart muscle fibers and destroy them.

Other tissues of the orbit do not remain unchanged: periorbita and nerves, including the optic nerve, although it has a dense sheath. In severe cases, with orbital phlegmon, the ciliary ganglion is also affected. Due to the disappearance of fat cells, in the place of which white blood cells appear, the fiber loses its fatty character.

As a result of abundant effusion from the vessels, which acquires the character of fibrinous exudate, the orbital tissue is sharply infiltrated, which leads to a significant increase in the volume and tension of the soft tissues of the orbit and gives the infiltration a particularly hard consistency, reaching in some cases a state of density.

Characteristic of phlegmon and thrombosis of blood vessels, mainly veins. Thrombophlebitis and thromboarteritis cause necrosis of areas of tissue, softening of foci, resulting in the formation of purulent cavities, so-called secondary abscesses. The orbital tissue usually suppurates by the end of the first week, and the routes for the release of pus are different. Most often, it makes its way through soft tissues - the skin of the eyelids or the conjunctiva - along the fascia and nerves.

Elimination of the phlegmonous process requires a long time. In S. V. Ochapovsky's experiments on animals, regenerative phenomena, if the process tends to develop backwards, begin on the 4th day and reach an optimum on the 8th day.

The essence of regenerative changes consists in the appearance of elements granulation tissue(young connective tissue elements, karyokinetic figures) delimiting the affected area from healthy tissue, and in some places it replaces destroyed muscle tissue. Simultaneously with the formation of such a barrier, blood clots begin to organize, inflammatory foci resolve, and phlegmon turns into one large or several small abscesses with a further course characteristic of this form of orbital disease.

Pathogenesis. The above picture of pathological changes gives only an idea of the gross and mostly irreversible morphological conditions of tissues, without revealing the mechanisms that lead to phlegmon.

Empyema of the adnexal cavities as an etiological factor causes in some cases periostitis, in others - an abscess of the eyelids or subperiosteal accumulation of pus, in others - a retrobulbar abscess or, finally, phlegmon of the orbit.

With phlegmon of the orbit, the most severe, life-threatening patient with an orbital complication, a series of successive shifts occur in various physiological systems of the body, leading to a sharp change in its reactivity.

A significant role is played by the permeability of such a powerful barrier as the tarso-orbital fascia, the condition of the vascular walls of the orbitosinus region, some features of the blood supply to this area, etc.

Most often, the infection penetrates from the paranasal cavity into the orbit directly, the so-called by contact. A prerequisite for the development of orbital phlegmon during contact spread of infection is a violation of the integrity of not only the bone wall, but also the periorbita - a dense fibrous plate that represents a serious barrier to the further spread of suppuration; the intermediate phase of phlegmon development may be the formation of a subperiosteal abscess. However, since the development of phlegmon occurs acutely, in the extreme short time- 12-24 hours, individual stages of orbital damage (periostitis, subperiosteal abscess) are usually clinically visible.

Although there is no irrefutable evidence in favor of hematogenous introduction of infection from the paranasal cavities into the orbit, nevertheless, the detection of periphlebitis and thrombophlebitis, as well as a large number of small abscesses located near small veins, is known evidence metastatic origin orbital phlegmon. In this case, the infection spreads through the veins that pierce the bony walls of the sinus and connect with the veins of the orbit.

Orbital phlegmon can occur when an infected thrombus of any vein of the mucous membrane of the adnexal cavity spreads into the orbital vein, and the developed thrombus of the orbital tissue undergoes disintegration, and first small and then large abscesses are formed.

The anatomical conditions of outflow through the veins of the nose and accessory cavities favor the introduction of infection towards the orbit, as well as into the brain. The spread of infection is facilitated by absence of valves in the orbital veins; this contributes to the fact that blood flows through them, depending on the position of the head, either into the veins of the face, or into the cavernous sinus. This explains why, with inflammation of the paranasal cavities, they can arise through v. ophthalmica associated with the cavernous sinus not only orbital, but also intracranial complications.

The infection can also spread through the lymphatic pathways connecting the orbit with the paranasal cavities, but this route has been poorly studied.

However, whatever the route of infection, the pathogens - usually white and aureus staphylococci, hemolytic and viridans streptococci, less often Frenkel's diplococcus and Friedlander's pneumobacilli - having penetrated the orbit, find enough there favorable conditions for its development and dissemination. We mean a wide network of fissure spaces located near the vessels and penetrating the retrobulbar tissue in all directions; they can be equated to lymphatic spaces.

Although the root cause of orbital phlegmon is for the most part not a lesion of one of the paranasal sinuses, but usually pansinuit, how in acute period their development, and in the chronic stage, however, the defeat of not all accessory cavities equally leads to the development of phlegmon; Most often, phlegmon is a consequence of damage to the maxillary sinus.

The development of orbital phlegmon with empyema of the maxillary sinus is facilitated by the presence in the orbit of a wide venous network connected to the orbital veins, as well as the possibility of thrombosis spreading through fissura orbitalis inferior.

Orbital phlegmon in infancy and early childhood is almost always caused by lesion of the maxillary bone, most often of osteomyelitis origin. In diseases of the maxillary bone, not only exogenous factors, but especially endogenous ones, play an important role. Remains of myxomatous tissue and somewhat different vascularization than in adults, on the one hand, and low resistance child's body- on the other hand, they create favorable conditions for the development of the process. As a result, inflammation occurs bone tissue with rapid melting and sequestration with insufficient drainage of pus due to the cellular structure of the upper jaw.

It should also be remembered that phlegmon of the orbit can occur as a result of dental damage with subsequent development of empyema of the maxillary cavity. The mechanism of infection is as follows: either in acute periostitis of the upper jaw, the process spreads to the lower wall of the orbit, or the infection enters the maxillary sinus through an open passage in the alveolus of the tooth, and then reaches the lower wall and the orbital tissue both through the veins and by contact. This route of infection in children is explained by the fact that the fangs penetrate into the thickness of the maxillary bone (since there is no cavity in it yet) so deeply that their roots reach the lower wall of the orbit.

Damage to the ethmoidal labyrinth is also often the cause of orbital phlegmon, especially in children due to their history of acute infections- measles, scarlet fever, etc.

Empyema of the sphenoid sinus are rare and also rarely cause the development of orbital phlegmon. With phlegmon of the orbit caused by a disease of the main cavity, the cerebral sinuses, primarily the cavernous, as well as the transverse and longitudinal sinuses may simultaneously be thrombosed due to osteomyelitis of the main bone.

First, thrombosis of the cavernous sinus occurs, followed by thrombosis of the orbital veins, and then orbital phlegmon develops. This mechanism of rhinogenic occurrence of phlegmon of the orbit is similar to the genesis of phlegmon of the orbit of otogenic origin, in which the suppurative process from the cells of the mastoid process passes to the nearby sigmoid, and from it to other cerebral sinuses, including the cavernous sinus, causing in them the phenomena of thrombophlebitis, spreading then to the orbital veins.

Clinical manifestations of orbital phlegmon due to damage to individual sinuses. Phlegmon of the orbit develops acutely, which is especially typical in cases of metastatic development.

In the overall picture of the disease, first of all, it should be noted serious condition of the patient: high temperature of a constant or hectic type, chills, headaches and weakness, discrepancy between high temperature (above 39°) and non-rapid pulse (70-80 beats per minute), regarded as an oculocardiac reflex (S. I. Talkovsky). This allows us to consider such patients as septic. Remissions indicate either the development of purulent foci, or (in severe general condition and tremendous chills) about a septic condition.

Signs of a severe septic condition are especially pronounced in cases where thrombophlebitis has gone beyond the orbit and the process involves the system of both the vascular circulation of the face and neck, mainly v. jugularis and its branches, as well as cerebral vessels.

They are especially difficult diseases affecting the cavernous sinus, which can be judged by a pale, sallow complexion, chills, high fever, insomnia, convulsions, trismus, nystagmus and other signs indicating the involvement of the cerebral sinuses - cavernous, transverse and longitudinal - in the process.

Local manifestations orbital disease can be reduced to signs caused by circulatory disorders, to a significant dilation of the vessels in the fundus of the eye and to phenomena associated with squeezing of the eyeball. The latter signs include: protrusion of the eyeball forward, limited mobility of the eye in all directions, severe pain when pressing on the eyeball and pain in the depths of the orbit; at the same time, there is no pain when there is pressure on the bony edges of the orbit. In addition, with phlegmon of the orbit, optic nerve atrophy, neuritis, and persistent muscle paralysis often develop.

Differences in the clinical manifestations of orbital phlegmon are associated primarily with the general reaction of the body and local manifestations caused by damage to one or another paranasal sinus. Thus, with phlegmon of the orbit caused by empyema of the maxillary sinus, serious disorders of the eyeball and optic nerve are observed: exophthalmos, muscle paralysis develops, a drop in visual acuity is noted, the phenomenon of congestive nipple and retrobulbar neuritis.

With phlegmon of the orbit of ethmoidal origin, the first place is played by progressive decline in visual acuity.

The symptomatology of orbital phlegmon with empyema of the sphenoid sinus must be presented based on the existing anatomical relationships between the main cavity, the optic nerve and the cavernous sinus, on the one hand, and between the cavernous sinus and the ophthalmic veins, as well as the III, IV, V and VI pairs of cranial nerves - with another.

First place comes phenomena characteristic of cavernous sinus thrombosis and: bilateral exophthalmos with protrusion of the eyeball straight forward, icteric discoloration of the sclera, swelling of the eyelids, chemosis, then loss of vision and paralysis of the eye muscles. The immediate cause of blindness is the transfer of a purulent process to the optic nerve, which is compressed in the canal. Often, thrombosis of the cavernous sinus leads to death as a result of the development of meningitis and even brain abscess.

The complication of orbital phlegmon with thrombophlebitis of the cavernous sinus can be judged by the fact that within a very short time the second, previously completely healthy, eye is also involved in the process.

For thrombosis of the transverse and longitudinal sinuses, along with the general symptoms observed with thrombosis of the cavernous sinus, it is characteristic the appearance of swelling of the skin in the mastoid area- thrombosis of the transverse sinus, as well as the forehead and temple - thrombosis of the longitudinal sinus.

Orbital phlegmon resulting from inflammation of the frontal sinuses, are rare, and septic thrombosis of the upper longitudinal sinus develops first, and then orbital phlegmon. In patient Müller (cited from S.I. Agroskin), when not only the clinical picture (severe orbital complications resulting from acute left-sided frontal sinusitis), but also the data found during the operation (suppuration and defect of the orbital roof), spoke in favor of Although the infection from the frontal sinus spread through contact, the autopsy still revealed thrombophlebitis of the superior longitudinal sinus. The transition of the infectious origin from the frontal sinus to the superior longitudinal sinus is facilitated by the fact that deoxygenated blood from the frontal sinus and its walls it is collected through the bony diploetic veins into the external frontal vein. The latter anastomoses with the superior longitudinal sinus. In turn, the longitudinal sinus is connected through vv. ethmoidales anterior et posterior with v. ophthalmica superior, the intracranial part of which anastomoses with the veins of the dura meninges and superior longitudinal sinus. In Muller's observation cited above, it is possible that the process first spread by contact (development of a subperiosteal abscess and destruction of the upper wall of the orbit), and only then thrombophlebitis of the ophthalmic veins developed.

S.I. Agroskin collected from the literature 30 cases of septic thrombosis due to damage to the frontal sinus. At the same time, it is not without interest that in the hospital named after S.P. Botkin in Moscow during the period from 1936 to 1950, 19 patients with septic thrombosis of the upper longitudinal sinus were treated, and frontal sinusitis was the etiological factor in only one patient.

Symptoms of septic thrombosis of the upper longitudinal sinus are high temperature, metastases in various organs, headache in the vertex area, meningeal syndrome, and according to O. S. Nikonova - tonic and clonic convulsions. Local signs consist of swelling of the crown, forehead, eyelids and root of the tongue; often there is a subperiosteal abscess on the forehead and crown.

Inflammatory processes of soft tissues can occur in various forms and be located in a variety of places. The clinical picture, however, has general manifestations. With a small depth of the process, painful swelling develops with redness and increased skin temperature. If the inflammation goes deeper, the patient experiences attacks of fever, and signs of intoxication appear. This indicates the beginning of the purulent-necrotic stage.

If you suspect inflammation of the soft tissues of the leg, you should immediately consult a doctor, since a rapidly developing inflammatory process may ultimately lead to the need for amputation.

Types of leg inflammation

It is very easy to get inflammation even in everyday life. Broken knees, abrasions, scratches are typical causes of the development of various inflammations of the leg. Penetration of microbes into the soft tissues of the legs can also occur:

with skin scratching - for example, with an allergy to insect bites;
for fungal diseases accompanied by cracks in the skin;
for diabetic ulcers;
at varicose veins veins;
when injected into unsanitary conditions– for example, in cases of drug addiction;
for injuries and wounds - for example, in athletes or military personnel;
when microflora is introduced from primary inflammatory foci with blood or lymph.

The causative agents of purulent inflammation of soft tissues are pyogenic bacteria, mainly staphylococcal bacteria. At the initial stage, blood microcirculation is disrupted, which is associated with damage to the tissue structure. If you do not immediately begin to treat inflammation of the soft tissues of the leg, swelling begins, already painful, When muscle tissue bursting with accumulated fluid, and they signal this through the neuromuscular junction. In the vast majority of situations, the patient takes pain medication and forgets about the problem. Meanwhile, the inflammation enters the purulent stage, when the neuromuscular connection is lost, there is no more pain, but pus accumulates. There are two known variants of purulent inflammation:

Abscess. In common parlance - an abscess. It develops in the muscles and subcutaneous tissue, has clearly defined boundaries within the purulent capsule, which is formed as defensive reaction body for infection.
Phlegmon. Acute diffuse inflammation of the subcutaneous tissue, has no clear boundaries, easily spreads to the entire limb.

They also pose a great danger to the feet. anaerobic infections. The most common inflammations of the soft tissues of the leg associated with this type of infection are:

Erysipelas. Manifests itself in the form of blisters on the skin, redness, and hemorrhages. The causative agent is streptococcus, inflammation can develop upon contact with a person infected streptococcal infection, for example, sore throat. In rare cases, this type of inflammation goes away on its own, but you shouldn’t count on it. Advanced cases of erysipelas will have to be treated for several months.
Gangrene– tissue necrosis. The causative agent is bacteria of the Clostridia family, “living” in soil and dust. Gangrene can only be treated by amputation, so in case of injuries it is very important to disinfect the wounds and immediately consult a doctor.

Treatment methods for leg inflammation

Inflammatory processes are treated in several stages. If the disease has entered the purulent stage, it is necessary surgical removal pus and wound treatment. Further, and in milder stages, anti-inflammatory drug therapy is prescribed - a course of antibiotics in the form of tablets or injections, depending on the origin and severity of the infection. It is very important to choose the right drugs; for this, bacterial culture is done. The patient is prescribed to drink plenty of fluids to quickly remove toxins from the body.

At the recovery stage, physiotherapy is prescribed, aimed at regenerating the circulatory system and lymph flow. Copes with this successfully, promoting speedy recovery soft tissues. You can go through it in ours.