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
Hello there, just became aware of your blog through Google, and found that it’s really informative.
I am going to watch out for brussels. I will be grateful if you continue this in future.
Many people will be benefited from your writing.
Cheers! Lista escape room
Real fantastic info can be found on web blog.?
Spot on with this write-up, I absolutely believe this amazing site needs far more attention. I’ll probably be returning to read more, thanks for the advice.
Excellent post. I definitely love this site. Keep it up!
I’m amazed, I must say. Seldom do I encounter a blog that’s equally educative and engaging, and without a doubt, you have hit the nail on the head. The issue is an issue that not enough people are speaking intelligently about. I’m very happy I found this in my hunt for something regarding this.
bookmarked!!, I love your website!
I was very pleased to uncover this website. I need to to thank you for ones time for this wonderful read!! I definitely enjoyed every bit of it and i also have you book-marked to look at new stuff on your website.
Hi there, There’s no doubt that your website may be having internet browser compatibility problems. When I take a look at your website in Safari, it looks fine but when opening in IE, it has some overlapping issues. I just wanted to give you a quick heads up! Aside from that, fantastic site.
I was extremely pleased to uncover this great site. I want to to thank you for ones time just for this wonderful read!! I definitely liked every little bit of it and i also have you saved as a favorite to check out new information in your site.
Hi, I do believe this is a great website. I stumbledupon it 😉 I may return once again since i have book marked it. Money and freedom is the greatest way to change, may you be rich and continue to guide other people.
I love looking through an article that will make people think. Also, thank you for allowing for me to comment.
Very interesting information!Perfect just what I was looking for!
Travel guide
An outstanding share! I have just forwarded this onto a colleague who has been doing a little homework on this. And he actually bought me dinner due to the fact that I discovered it for him… lol. So let me reword this…. Thanks for the meal!! But yeah, thanx for spending the time to discuss this matter here on your website.
I used to be able to find good advice from your content.
Great info. Lucky me I recently found your blog by chance (stumbleupon). I have book-marked it for later!
Saved as a favorite, I like your site!
Having read this I thought it was rather enlightening. I appreciate you taking the time and energy to put this content together. I once again find myself personally spending a lot of time both reading and posting comments. But so what, it was still worth it.
It’s nearly impossible to find experienced people for this topic, however, you seem like you know what you’re talking about! Thanks
I wanted to thank you for this excellent read!! I certainly enjoyed every bit of it. I’ve got you bookmarked to look at new things you post…
Having read this I believed it was very informative. I appreciate you spending some time and effort to put this informative article together. I once again find myself spending a lot of time both reading and commenting. But so what, it was still worthwhile!
I quite like looking through a post that can make men and women think. Also, many thanks for allowing for me to comment.
This blog was… how do you say it? Relevant!! Finally I’ve found something that helped me. Many thanks.
I need to to thank you for this excellent read!! I absolutely loved every bit of it. I’ve got you saved as a favorite to check out new things you post…
I’d like to thank you for the efforts you have put in writing this blog. I really hope to see the same high-grade blog posts by you in the future as well. In fact, your creative writing abilities has encouraged me to get my own, personal blog now 😉
Having read this I believed it was extremely enlightening. I appreciate you spending some time and energy to put this article together. I once again find myself personally spending way too much time both reading and commenting. But so what, it was still worthwhile.
Great web site you have got here.. It’s hard to find high-quality writing like yours nowadays. I honestly appreciate individuals like you! Take care!!
I really like this article. You can send any article like this. Playmods
What’s up, future millionaires? Charles here, your captain on this journey to the treasure island of affiliate marketing. Ever imagined making $1,000 a day without breaking a sweat? Well, pinch yourself, because you’re not dreaming! Grab your eye spot and your sense of adventure, and let’s cruise the high seas of chance. All aboard the revenue ship!
Can you be more specific about the content of your article? After reading it, I still have some doubts. Hope you can help me. phieuguige-grab-bat-net
What’s up, future millionaires? Charles here, your captain on this journey to the treasure island of affiliate marketing. Ever dreamt of earning $1,000 a day without breaking a sweat? Well, pinch yourself, since you’re not dreaming! Grab your eye spot and your sense of experience, and let’s cruise the high seas of opportunity. All aboard the profit ship!
Hey, just wanted to pop by and commend your remarkable blog. Your insight on making money online is truly inspiring. Making money from home is more attainable than ever with affiliate promotion. It’s a great opportunity to create additional income by promoting products or services you believe in. With perseverance and the correct strategies, anyone can prosper in this profitable field. Keep up the excellent work! Readers, be sure to explore [Your Blog Name|your blog|this blog] for more helpful tips and tricks on making money from home. You’ll be glad you did!
There is definately a great deal to learn about this issue. I love all of the points you have made.
Hey there! Just felt like stopping by to let you know how much I admire your blog. Your insights on making money online are genuinely impressive. Earning an income from home has never been easier thanks to affiliate promotion. It’s all about discovering the ideal items to promote and nurturing connections with your audience. Your blog is a treasure trove of insights for emerging online entrepreneurs. Keep doing the great work!
Good post. I absolutely love this website. Continue the good work!
Hi there! Just wanted saying hello to commend your amazing blog. Your expertise on making money online are really impressive. Making money from home has never been more achievable with affiliate marketing. It’s all about leveraging your online presence and promoting products or services that resonate with your audience. Your blog is a precious resource for those curious about affiliate marketing. Keep on the great work!
bookmarked!!, I love your website!
This is a topic that’s near to my heart… Many thanks! Where can I find the contact details for questions?
I could not resist commenting. Perfectly written.
Great article. I will be going through many of these issues as well..
I was extremely pleased to find this great site. I wanted to thank you for your time just for this wonderful read!! I definitely really liked every little bit of it and i also have you bookmarked to see new stuff on your blog.
I absolutely love your blog.. Great colors & theme. Did you develop this site yourself? Please reply back as I’m wanting to create my own personal website and would love to know where you got this from or what the theme is named. Thanks.
I was able to find good advice from your blog articles.
You ought to be a part of a contest for one of the greatest sites on the internet. I am going to highly recommend this website!
I quite like reading through an article that will make people think. Also, thank you for permitting me to comment.
Very good info. Lucky me I ran across your blog by accident (stumbleupon). I have saved it for later.
You ought to be a part of a contest for one of the greatest blogs on the internet. I will highly recommend this site!
I’m excited to uncover this website. I wanted to thank you for ones time for this wonderful read!! I definitely really liked every part of it and i also have you saved as a favorite to check out new stuff in your site.
Pretty! This was an incredibly wonderful article. Many thanks for supplying this information.
I’m impressed, I must say. Rarely do I encounter a blog that’s both educative and engaging, and let me tell you, you have hit the nail on the head. The problem is something which too few people are speaking intelligently about. I’m very happy I stumbled across this in my search for something concerning this.
An outstanding share! I have just forwarded this onto a co-worker who has been conducting a little homework on this. And he in fact bought me breakfast simply because I found it for him… lol. So let me reword this…. Thank YOU for the meal!! But yeah, thanks for spending the time to talk about this issue here on your internet site.
I was extremely pleased to find this great site. I wanted to thank you for your time just for this wonderful read!! I definitely savored every part of it and i also have you bookmarked to check out new things in your website.
Everyone loves it when folks come together and share opinions. Great blog, keep it up.
Pretty! This was a really wonderful article. Thank you for providing this information.
Hi, I do think this is a great site. I stumbledupon it 😉 I may revisit once again since I bookmarked it. Money and freedom is the best way to change, may you be rich and continue to help other people.
Right here is the perfect webpage for everyone who would like to understand this topic. You know a whole lot its almost tough to argue with you (not that I personally would want to…HaHa). You certainly put a new spin on a topic that’s been discussed for decades. Wonderful stuff, just wonderful.
I love it whenever people come together and share thoughts. Great website, stick with it.
You ought to be a part of a contest for one of the highest quality sites on the net. I will recommend this website!
Having read this I thought it was really informative. I appreciate you taking the time and energy to put this content together. I once again find myself personally spending a significant amount of time both reading and posting comments. But so what, it was still worthwhile!