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Fuss-Überlastungsschäden im Sport

Fuss-Überlastungsschäden im Sport

Überlastungsschäden nehmen im Sport zu: Der Fuß ist oft betroffen, die Diagnose schwer zu stellen

Der Fuß, bestehend aus 26 verschiedenen Knochen und über 30 Gelenken, die durch unzählige Bänder und Sehnen stabilisiert und geführt werden, weist eine komplexe funktionelle Anatomie und Biomechanik auf. Der Fuß bildet das statische und dynamische Glied in der Bewegungskette zwischen Körper und Boden und ermöglicht dadurch das Stehen und die Fortbewegung. Im Sport wird der Fuß enorm belastet. Stehen, laufen, starten, bremsen, springen, landen – Fuß und Sprunggelenk sind immer gefordert, die Bewegungen mitzumachen und die zwischen dem Körper und Boden entstehenden Kräfte aufzunehmen, umzuwandeln, weiterzuleiten oder zu absorbieren.

Der Sport hat zwar unbestritten positive Auswirkungen auf den menschlichen Organismus, kann aber ab einem gewissen Grad auch gesundheitsschädigend sein. Dazu gehören im muskulosekeletalen Bereich die Überlastungsschäden, welche in den letzten Jahren im Sport tendenziell zugenommen haben. Die genaue Anzahl ist aber nicht bekannt, da viele Überlastungsschäden als solche nicht erkannt werden. Es dürften heute 50 bis 60 Prozent sämtlicher Sportverletzungen sein.

Überlastungsschäden entstehen im Normalfall dann, wenn ein Missverhältnis zwischen Belastbarkeit und Belastung vorliegt. Überlastungsschäden stellen große diagnostische und therapeutische Probleme dar, weil die Symptome häufig diffus oder uncharakteristisch sind. Trotz verbesserter diagnostischer Möglichkeiten (Röntgen, Computertomographie, MRT, Ganganalyse, Pedobarographie) ist die Diagnosestellung bei Überlastungsschäden alles andere als einfach. Die präzise Diagnose von Überlastungsschäden, die für eine kausale und effiziente Therapie notwendig ist, stützt sich hauptsächlich auf die klinische Erfahrung sowie das pathobiomechanische Verständnis des behandelnden Arztes. Denn therapeutisch sollten nicht nur die vorliegenden Symptome behandelt, sondern auch die primäre Ursache angegangen werden. Überlastungsschäden sind demnach eine Herausforderung für jeden Sportmediziner.

Aetiologisch entstehen Überlastungsschäden im Sport meist aufgrund von Überlastung und repetitiven Traumatas. Die verursachenden Faktoren werden in intrinsische und extrinsische Faktoren unterteilt. Zu den extrensischen Faktoren gehören: Leistung über der persönlichen Belastungsgrenze (Ausdauer, repetitive Höchstleistungen), ungeeignetes Gelände, qualitativ schlechtes Schuhwerk, inadäquates Trainingsprogramm, unphysiologische Technik. Zu den intrinsischen Faktoren werden die anatomisch-funktionellen Ursachen gezählt. Beim Fuß sind die häufigsten und wichtigsten intrinsischen Faktoren die Fehlstellungen, wie zum Beispiel der pronierte Fuss (Pes planovalgus) oder der Hohlfuss (Pes cavus).

Übermässige oder zu lange Pronation während der Standphase kann durch die vermehrte Innenrotation des Unterschenkels und die Knicksenkfußdeformität zu Überlastungsschäden an der medialen Seite des Fusses und der unteren Extremität führen: Tendinitis und Dysfunktion des M. tibialis posterior, ventrales OSG-Impingement, Bursitis und Tendinitis der Achillessehne, Fasciitis plantaris, Einklemmung des Nervus plantaris medialis (Läufer-Fuß), Störungen im femoropatellären Gleitlager, Irritationssyndrom des iliotibialen Bandes und Stressfrakturen der unteren Extremität.

Der Hohlfuß (Pes cavus) stellt ebenfalls einen prädisponierenden Faktor für Überlastungsschäden dar. Bei Läufern werden Überlastungsschäden viel häufiger bei Athleten mit Hohlfuss beschrieben. Beim Abrollen weist der Hohlfuß in der Standphase eine ausgeprägte Rigidität auf und schränkt die Tibiainnenrotation ein. Bedingt durch die Varusfehlstellung des Rückfußes ist die gewichtstragende Kontaktfläche beim Hohlfuß stark vermindert und auf dem lateralen Fussbereich limitiert, was zu schmerzhaften Hornschwielen, Fasziitis plantaris, Hammerzehen, Peronealsehnen-probleme und Stressfrakturen führen kann.

Eins der häufigsten Symptome im Bereich der Fuß-Überlastungssyndrome ist der Fersenschmerz, welcher differentialdiagnostisch durchaus zum therapeutischen Challenge für den Sportarzt werden kann. Dahinter können sich zum Beipsiel folgende Pathologien verbergen: Achillodynie (Bursitis und Tendinitis der Achillessehne), Fersen-Fettpolsterhypotrophie, Fersensporn/Fasciitis plantaris, Nervenkompressionssyndrome (Tarsaltunnelsyndrom, Einklemmung des ersten Astes des Nervus plantaris lateralis – sog. Baxters-Nerv – etc.), Verletzung der Plantaraponeurose, Haglund-Exostose, Stressfrakturen (z.B. Kalkaneus, Talus), Coalitio talocalcanearis/calcaneonavicularis/-talonavicularis, osteochondrale Läsionen am Sprunggelenk.

Bei Sportlern mit chronischen diffussen Fußschmerzen sollte stets an die Stressfrakturen gedacht werden. Stressfrakturen kommen bei Sportlern häufig vor und sind vor allem im Bereich der distalen Fibula/Tibia, des Talus, des Os naviculare, des Kalkaneus, des fünften Os metarsale (Jones-Fracture; Abb. 2), des zweiten Os Metarsale (Marschfraktur) zu finden. Bilddiagnostisch können solche Frakturen im konventionellen Röntgenbild in vielen Fällen nicht diagnostiziert oder erst sehr spät verifiziert werden, ein MRI oder Knochenszintigramm kann die Diagnose sicher bestätigen.

Anhaltende Schmerzen im oberen Sprunggelenk beim Sportler können durch osteochondrale oder chondrale Läsion des Talus, Osteochondrosis dissecans, ventrales Impingement (Fussballer-Sprunggelenk mit ventralen Tibia- und/oder Talusosteophyten am Kapselansatz), chronische OSG-Bandinstabilität, Läsion der vorderen Syndesmose, Meniskoid-Syndrom (laterales OSG-Impingement bei St. n. rezidivierenden lateralen OSG-Distorsionen) verursacht werden.

Überlastungsschäden sind im Sport häufig und stellen sowohl diagnostisch als auch therapeutisch höchste Anforderungen an den Sportarzt dar. Die Behandlung von festgestellten Überlastungsschäden soll symptomatisch und kausal gerichtet sein, mit dem Ziel baldmöglichst eine normale Funktion, Belastbarkeit und somit Sportfähigkeit zu erreichen. Bei der Vorbeugung, Behandlung und Rehabilitation von Überlastungsschäden sollte nicht nur die ärztliche Betreuung des Athleten allein im Vordergrund stehen, sondern auch der Einbezug des Physiotherapeuten, Trainers und anderer Athleten-Betreuer gewährleistet sein.

Professor Dr. med. Beat Hintermann & Dr. med. Victor Valderrabano

Orthopädische Universitätsklinik Basel
Kantonsspital
4031 Basel, Schweiz
Tel. 0041-61-2657197
Fax 0041-61-2657322
e-mail: bhintermann@datacomm.ch, v.valderrabano@bluewin.ch
Web: www.otbasel.ch

4. Juli 2003

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  283. After I initially left a comment I appear to have clicked the -Notify me when new comments are added- checkbox and from now on every time a comment is added I recieve 4 emails with the same comment. There has to be an easy method you can remove me from that service? Thanks a lot.

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  468. An impressive share! I have just forwarded this onto a co-worker who was conducting a little homework on this. And he actually ordered me lunch simply because I found it for him… lol. So let me reword this…. Thanks for the meal!! But yeah, thanks for spending the time to talk about this subject here on your site.

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  481. An impressive share! I’ve just forwarded this onto a coworker who had been doing a little homework on this. And he actually bought me dinner because I found it for him… lol. So let me reword this…. Thanks for the meal!! But yeah, thanx for spending the time to talk about this issue here on your blog.

  483. You are so cool! I do not think I’ve read through anything like this before. So nice to discover another person with a few genuine thoughts on this subject. Really.. many thanks for starting this up. This web site is something that is needed on the web, someone with a bit of originality.

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  591. Having read this I thought it was very enlightening. I appreciate you taking the time and effort to put this short article together. I once again find myself personally spending a lot of time both reading and leaving comments. But so what, it was still worthwhile.

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  633. An impressive share! I’ve just forwarded this onto a colleague who was doing a little homework on this. And he actually bought me dinner simply because I discovered it for him… lol. So let me reword this…. Thanks for the meal!! But yeah, thanks for spending time to discuss this issue here on your site.

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eMail: info@gots.org

Presse

Pressestelle
Kathrin Reisinger
Tel.: 0 36 41 / 47 24 158

eMail: presse@gots.org

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