跟骨後滑囊炎

跟骨後滑囊 (retrocalcaneal bursa) 位於跟骨與阿基里斯腱中間，是腳跟最常見的滑囊炎。常見於運動員，主因過度使用，例如長時間的走路與跑步，或是穿著太緊的鞋子或後跟太硬的鞋子。

症狀

• 腳後跟痛
• 跑步或走路上坡時易誘發疼痛
• 墊腳尖時會痛
• 足跟上緣腫脹

診斷方式

• 勾腳背會痛
• 用力墊腳尖時會痛
• 兩指擠壓測試 (two fingers squeeze test)

 

兩指擠壓測試

危險因子

• 過度訓練：走路或跑步
• 踝關節背屈不足
• 習慣穿足跟較高的鞋，轉換成平底鞋後
• 鞋子太緊或鞋跟太硬
• 大腳趾掌趾關節僵硬 (背屈不足) 
• 足跟內翻 (hindfoot varus)
• 跟骨後側骨頭過度增生 (Haglund deformity)
• 若雙側同時有，要排除發炎性關節炎 (請掛風濕免疫科)

治療

• 冰敷 
• 消炎止痛藥
• 小腿伸展
• 將鞋跟墊高 (足跟墊) 
• 避免穿硬後跟的鞋子
• 滑囊內注射類固醇

將鞋跟墊高，避免穿後跟太硬的鞋子很重要。真的怎麼治療效果都不好，再考慮打類固醇。

板機指的注射治療 (投影片格式)

作者：許文彥 醫師

板機指 (trigger finger) 是俗名，學名是「手指屈指肌腱狹窄性肌腱鞘炎」(stenosing tenosynovitis of flexor digitorum tendons)。一般人的盛行率約2-3%，糖尿病患者的盛行率約20%。最常發生在無名指及中指，但小指及大拇指也不算少見。好發在40-60歲的人，女性發病率是男性的2-6倍。

參考文獻

1. Johnson, Evan, et al. "Recognizing and treating trigger finger." The Journal of family practice 70.7 (2021): 334-340.
2. Salim, N., et al. "Outcome of corticosteroid injection versus physiotherapy in the treatment of mild trigger fingers." Journal of Hand Surgery (European Volume) 37.1 (2012): 27-34.
3. Shinomiya, Rikuo, et al. "Impact of corticosteroid injection site on the treatment success rate of trigger finger: a prospective study comparing ultrasound-guided true intra-sheath and true extra-sheath injections." Ultrasound in Medicine & Biology 42.9 (2016): 2203-2208.
4. Kanchanathepsak, Thepparat, et al. "Efficacy comparison of hyaluronic acid and corticosteroid injection in treatment of trigger digits: a randomized controlled trial." The Journal of Hand Surgery (Asian-Pacific Volume) 25.01 (2020): 76-81.
5. Wu, Yan-Yan, et al. "Comparison of the clinical effectiveness of ultrasound-guided corticosteroid injection with and without needle release of the A1 pulley in treating trigger finger." Journal of X-Ray Science and Technology 28.3 (2020): 573-581.