Why does the Achilles tendon hurt than to treat. Wearing uncomfortable shoes

Achilles tendonitis is a collective term that includes both Achilles tendonitis proper and insertional tendinitis, retrocalcaneal bursitis, and Haglund's disease.

Achilles tendonitis is a widespread pathology. The Achilles tendon is the largest and most powerful of all tendons in the human body, it also experiences the most significant stress during walking, running, jumping, and is the most frequently damaged tendon of all.

talking plain language tendinitis is an inflammatory lesion of the tendon. Inflammation is one of the main forms of the body's natural response to injury, and is characterized by swelling, pain, and dysfunction.

Tendonitis of the Achilles tendon proper or non-insertional tendonitis is characterized by degenerative changes, micro-tears, thickening and swelling of the body of the Achilles tendon. This type tendonitis is most common in young active people.

Achilles tendonitis

Insertional tendonitis of the Achilles tendon is the same process, but in the area of attachment of the Achilles tendon to calcaneus. Insertional tendinitis is also common in older, inactive patients.

Insertional tendonitis of the Achilles tendon

Both in the case of tendinitis of the Achilles tendon proper and in insertional tendonitis, with a sufficient duration of the process, calcification of damaged tendon fibers can occur. In insertional tendonitis, this often results in the formation of bony outgrowths, sometimes referred to as a heel spur.

Diagram of the location of the Achilles tendon and its attachment to the calcaneus

Etiology of Achilles tendinitis.

More often than not, Achilles tendonitis cannot be traced to a specific injury. The problem is formed over a long time as a result of constant overload of the tendon. That is, tendinitis is usually formed against the background of excessive load, but a number of provoking factors determine the excessive load.

1) A sudden increase in training volume, such as increasing the running distance every day by a mile for a week, which makes it impossible to adapt to the increased load.

2) Hard, rigid, insufficiently elastic calf muscles - with a sharp increase in load, they create additional opportunities for damage to the Achilles tendon.

3) The presence of a bone outgrowth - Haglund's deformity, leads to additional traumatization of the Achilles tendon closer to the place of attachment.

4) Sudden change in training regimen, such as a sudden change from long jogs to sprints or competitive sports.

Symptoms of Achilles tendinitis.

The most common symptoms of Achilles tendonitis are: pain and swelling, thickening in the Achilles tendon area in the morning, pain in the projection of the tendon and calcaneus that increases with exercise, severe pain in the Achilles tendon the next day after training, thickening of the tendon, formation a bone spike in the area of attachment of the Achilles tendon, edema in the area of \u200b\u200bthe tendon is observed constantly and worsens during the day after exercise. As tendinitis progresses, the risk of spontaneous Achilles tendon rupture also increases. On examination, it is necessary to determine the point of greatest pain, with insertional tendonitis, pain is determined in the area of attachment of the tendon to the calcaneus, with tendinitis of the Achilles tendon proper, it is located more often 3-4 cm above the attachment site. Also, during examination, it is important to determine whether there is a restriction in the dorsiflexion of the foot.

Diagnosis of Achilles tendinitis.

In the diagnosis of Achilles tendinitis, the most commonly used studies are radiography, sonography, and MRI. Radiography is easily accessible and allows detecting such gross changes as tendon calcification, the formation of a bone spike in the area of its attachment, bone damage the calcaneus itself. MRI is indicated if planned invasive methods treatment, as well as to determine the degree of damage to the tendon itself. Planning operational tactics is extremely difficult if the level and extent of damage is not determined in advance, which leads to a significant increase in the volume of intervention. Ultrasonic Methods studies in experienced hands are not inferior in their sensitivity to MRI, unfortunately it is difficult to find specialists in sonography of a sufficiently high level.

Conservative treatment of Achilles tendinitis.

Conservative treatment of tendonitis is characterized by a high duration - from the beginning of treatment to the therapeutic effect, as a rule, 3-6 months pass. Conservative treatment is also characterized not very well. high efficiency- about 40-50% of patients are satisfied with the treatment.

Rest is the first and perhaps decisive factor in conservative treatment, a decrease in the level physical activity avoids pain and additional injury to the tendon. At the same time, you can keep fit due to the exercise bike, elliptical trainer, swimming and other sports that are not accompanied by a significant load on the Achilles tendon.

The second important point is the cold. Cryotherapy with ice wrapped in a towel for 20 minutes as needed during the day is highly effective in reducing pain symptoms and swelling. If you use a rubber or plastic heating pad for freezing, you can give it the shape of a tendon, which increases the efficiency and comfort of its implementation.

Ibuprofen and naproxen also reduce pain and swelling, but they do not reduce the severity of degenerative changes. At long-term use increased risk side effects and complications.

Exercises for Achilles tendinitis.

In the conservative treatment of tendonitis, special importance is attached to exercises aimed at stretching and developing the muscle balance of the calf muscles.

Stretching calf muscles and Achilles tendon.

Stand directly in front of the wall, rest your straight arms against the wall, put one foot in front and the other behind you, gradually squat without taking your feet off the floor. Hold the maximum squat position for 10 seconds, then straighten your legs. Repeat 20 times a day.

Stretching the calf muscles and Achilles tendon

Eccentric muscle training is called such exercises in which muscle tension occurs during its lengthening. This type of exercise can cause additional damage to the Achilles tendon if performed incorrectly. It is best to perform them under the guidance of a physiotherapy instructor.

You will need a ladder for double heel hanging. You need to stand on the edge of two adjacent steps with the toes of your feet. This position allows the heels to move up and down without touching the steps. Hold onto the railing with your hands to maintain balance. First stand on your toes, then slowly lower your heels down to the maximum point, stay in this position for 10 seconds, repeat 20 times a day.

Eccentric calf workout

A more challenging version of this exercise is to do it on one leg or with extra weight.

Steroid injections into or around the Achilles tendon are not recommended due to the possibility of dystrophic changes and subsequent rupture.

In the fight against Achilles tendonitis, it is important to choose the right shoes. Most suitable option there will be shoes with a soft heel or no heel at all. A small heel will reduce the tension on the Achilles tendon and will reduce the load on it. In an acute situation, when the pain is extremely pronounced, wearing a special orthosis is indicated, which completely excludes movement in the ankle joint.

Extracorporeal shock wave therapy in a number of studies has proven its effectiveness and the absence of side effects. There are two options for therapy - low-intensity, which requires 3 procedures and high-intensity, which requires one procedure, but is accompanied by severe pain, which requires the use of anesthesia.

Surgical treatment of Achilles tendinitis.

In 30-40% of cases, conservative treatment does not bring relief for 3 months, in such cases the question arises of surgical intervention. Surgical treatment according to different authors is effective in 80-95% of cases. Required for preoperative stage determine the presence of concomitant diseases: Haglund's deformity, retrocalcaneal bursitis, insertional tendinitis, as well as the depth and extent of the tendon involved in the pathological process, as this affects the surgical tactics. Access is dictated by the points of greatest pain, so if the pain is located more medially, it is advisable to use medial access and vice versa. It must be determined whether the pathological process involves the parathenon, the tendon, or both. With paratendinitis, the surgeon excises all adhesions and also removes scar-modified areas of the paratenon. After the operation, a 3-5 day period of immobilization follows, followed by the development of movements and exercise therapy.

For tendonitis involving less than 50% of the tendon thickness, percutaneous longitudinal tenotomy can be used using a #11 or #15 narrow scalpel. After a longitudinal skin puncture, the blade is directed proximally and the foot is dorsiflexed, then the blade position is reversed and plantar flexion is performed. 5-7 similar cuts are used. The technique can significantly reduce the risk of infectious complications; according to the author of the technique, it is effective in 70% of cases.

Minimally invasive technique for the treatment of Achilles tendonitis - percutaneous longitudinal tenotomy

The main principle of operations for tendinopathies is the excision of cicatricial adhesions and the removal of degeneratively altered tendon tissues. After excision of the thickened scar-changed parathenon (tendon sheath), the fascia of the lower leg is released on both sides of the Achilles tendon. Then, several longitudinal incisions of the tendon are performed, which, on the one hand, makes it possible to detect areas of mucinous degeneration that are then removed, on the other hand, stimulates the remaining tenocytes to proliferate and synthesize intercellular substance, and, on the third hand, promotes angiogenesis (growth of new vessels). If less than 50% of the Achilles tendon is involved in the pathological process, the degenerative area is excised in the thickness of the tendon in the form of an ellipse, followed by its longitudinal suturing.

With severe tendinosis (long-term tendinitis), there is often a problem associated with the involvement of more than 50% of the tendon thickness in the pathological process. If 50-80% of the tendon thickness is involved, the tactics are determined by the preferences of the surgeon, the patient and the volume of future sports loads. If more than 80% of the tendon thickness is involved in the degenerative process, plasty is required, for which tendon transfer, V-Y plasty, inverted flap reduction, or the use of an allograft can be used.

The most commonly used tendon graft is the long flexor tendon. thumb feet. This intervention is contraindicated if the patient plans to engage in rock climbing or ballroom dancing, as these sports require maximum plantar flexion strength of the first toe. A medial approach is used, the tendon is released from all adhesions, degenerative areas of the paratenon and tendon are removed, a sheet of deep fascia of the lower leg is dissected, which opens access to the abdomen of the long flexor of the big toe. The tendon of the long flexor of the big toe is dissected and dissected at the level of the fibrous canal in the area between the medial and lateral tubercles of the posterior surface of the talus. It is worth crossing the tendon as distally as possible. The tendon of the long flexor of the thumb, depending on its length, is fixed to the calcaneus either with an anchor or inserted into a tunnel and fixed with an interference screw.

Release of the Achilles tendon from its parathenon, removal of paratenon scar tissues

Excision of degenerative areas of the Achilles tendon

Dissection of the deep sheet of the fascia of the lower leg, isolation of the tendon of the long flexor of the big toe

Transposition of the tendon of the long flexor of the big toe to the place of attachment of the Achilles tendon, preparation of the Achilles tendon for the longitudinal suture after removal of degenerative areas.

Longitudinal suture of the Achilles tendon

Achilles tendon parathenon suture

V-Y plasty (in the domestic literature - dovetail) may be needed when more than 80% of the tendon thickness is involved in the degenerative process over 2-3 cm. With such a significant defect, it is difficult to compare the refreshed ends of the tendon. V-Y repair will require a wider approach extending proximally by 12-15 cm. After preparing the Achilles tendon for anastomosis, the degree of tendon length deficiency is determined using a reverse “springiness” test (both lower legs are flexed at an angle of 90 ° at the knee joint, then assessed the angle of passive plantar flexion of the feet on the healthy and injured side, normally it should be 15-20 °), when the foot is brought to its normal position, the extent of the defect is assessed. After that, a V-shaped incision ("dovetail") is made to correct the missing length. After the anastomosis is completed, a second “springiness” test is performed for control purposes.

The fresh ends of the Achilles tendon are sutured, when trying to match them, excessive tension is determined, which can lead to hypercorrection and subsequent equinus of the foot, suture failure

A V-shaped incision was made proximal to the site of the Achilles tendon rupture, after which it becomes possible to match and suture the ends of the Achilles tendon at the site of its rupture

After suturing the tendon at the site of its rupture, the missing length is assessed using a “springiness” test, after which the Achilles tendon is sutured at the site of the V-shaped incision with its lengthening.

For even larger defects, 3-5 cm or more in length, it may be necessary to repair with an inverted flap or use an allograft. If, after release of the proximal Achilles tendon and gradual traction for 10 minutes, the defect between the ends of the tendon is 5 cm or more, it is advisable to perform plasty with an inverted flap. To this end, the incision is extended proximally by 25 cm in order to expose the fascia of the lower leg over a considerable extent. Then, retreating 2 cm from the edge of the tendon proximally from the fascia, a U-shaped flap is cut out with a thickness and width of 1/1 cm and the required length (for example, with a defect of 6 cm, it is necessary to use a flap 12 cm long: 6 cm defect + 3x2 cm per crossed area). In order to reduce the thickness in the area of tendon duplication, it is advisable to turn the tendon not outward but inward, the distal region of the formed fascia defect is sutured in order to reinforce the graft origin.

A significant defect in the Achilles tendon is determined in the normal position of the foot

Defect length 6 cm

Marker denotes upper bound graft sampling sites, taking into account the length of the defect and the length of the duplication - 12 cm

Selection of a site for transplantation

Bringing down the graft site

Evaluation of the length of the reduced section

The grafted area is drawn inward to reduce the thickness of the duplication

Surgical treatment of insertional tendinitis consists in excision of the retrocalcaneal bursa and protruding sections of the calcaneus, as well as in the removal of degenerative areas of the tendon. Subsequently, the tendon may need to be reinserted with anchors or interference screws. For optimal visualization, a central transachillary approach to the distal tendon can be used. If the tendon is involved in the process for a significant extent, plastic surgery by the above methods may be required.

Medial transachillary approach

With the help of gomens, the tendon is spread apart

Excision of excess bone tissue is performed using an oscillatory saw

The removed bone fragment is shown, an anchor fixator is installed in the calcaneus to strengthen the subsequent longitudinal suture of the Achilles tendon

X-ray showing the size of the resulting bone defect and the location of the anchor in the calcaneus

Longitudinal suture of the Achilles tendon with threads from the anchor

Postoperative management of patients with Achilles tendinitis.

In uncomplicated cases, when plastic surgery is not required, in early postoperative period shows the use of a U-shaped + anterior splint bandage in the equinus position of plaster or polymer bandage for 10 days. After removal of the sutures, walking with a full load in a neutral position in a special rigid orthosis is allowed.

Rigid adjustable ankle brace

From 6 to 12 weeks, the development of passive and active range of motion with isometric exercises is carried out. Swimming is allowed from 3 weeks, exercises on an elliptical trainer from 4 weeks. From 12 weeks you can start light training. Full recovery will take an average of 3-6 months.

After plastic surgery, a more gentle rehabilitation regimen is required. The first 10 days shows the use of a U-shaped + anterior splint bandage in the equinus position (25-45 °) made of plaster or polymer bandage. Then the wearing of the orthosis in the 20° equinus position is shown for another 6 weeks with a gradual transition to a neutral position with a dosed load, while active dosiflexion of the foot is allowed as far as the pain syndrome in the flexion position in the knee joint allows. Swimming starts from 6 weeks, from 12 weeks immobilization in the orthosis stops and training on the elliptical trainer is allowed. Full recovery may take 6-9 months.

Surgical treatment of tendinitis is characterized by good early postoperative results in 85-90% of cases, however, over time, patients often note the return of the pathology, especially in cases where they continue to actively engage in sports.

Pain in the ankle area is caused by inflammation of the Achilles tendon. This is a disease of athletes who overload themselves with training, and women who prefer to wear shoes with high heels. At the same time, there are more prosaic situations - birth defects, for example, a shortened tendon, salt deposits, arthritis, gout. All these diseases are united by a common term - inflammation of the Achilles.

Inflammation of the Achilles tendon

Several types of diseases in the ankle joint are hidden under one name - inflammation of the Achilles tendon. They are united by common symptoms, the rate of development of the disease, and, of course, the place where the disease is localized. The main symptom is severe pain at the junction of the heel bone with the Achilles tendon. Treatment has traditionally been aimed at pain syndrome and inflammatory processes, to relieve edema, to get rid of fibrous accumulations, to restore blood flow.

Attention! Another name for the Achilles tendon is the heel tendon, it is the most durable in the human body, as it can withstand a weight of more than 350 kg when stretched. However, this tendon is more likely to be injured and inflamed than others.

Types of inflammatory diseases of the Achilles tendon

In the Achilles tendon, inflammatory processes are localized, which differ in symptoms, the type of tissue damage, and the degree of movement restriction. Treatment of the Achilles tendon is required when there are persistent pain in the ankle, in the ankles that occur after rest, after getting out of bed and starting to move.

When resting, the tendons are in a relaxed state, and when loads appear, the pain quickly returns, preventing walking and moving the legs. Anyone can get sick, but most often such inflammation is the result of high physical exertion, from which rupture and stretching of the tendon can occur.

Diseases are very diverse! Diseases of the Achilles tendon are diverse, a large number of them have been studied, and they all affect the bone membranes, connective tissues and the ligamentous apparatus ankle.

Pain symptoms in the area of the Achilles tendon indicate the manifestation of various diseases:

calcifications when developing plantar fasciitis against the background of deposits of calcium salts;
hygromas;
tendinosis;
tendopathy;
Haglund's deformities;
peritendinitis;
enthesopathy;
Achilles bursitis;
paratenonitis;
achilles of the ankle;
crepitating tendovaginitis of the tendon.

The beginning of each of these inflammatory diseases, and the list is far from complete, is characterized by the appearance of a thickening on the tendon, reddening of the skin, some swelling of the entire zone, crunchy sounds in motion. On the video you can see what the leg of a sick person looks like, how a doctor examines it. At the beginning of inflammation, when hyperemia and burning appear in the heel area, one might still think that a fungus is developing. However, after a day or two, the symptoms increase sharply, and it becomes clear that this is not fungal disease, but a real inflammation of the tendon, in which the leg begins to swell.

Achilles tendon hygroma is a special type of cyst that develops on tendon tissues. Typically, this cyst is very painful bump filled with liquid, hence the name "hygro ...". The consistency of the liquid is jelly-like, transparent, the bump on palpation is determined by both hard and softened. Hygroma is benign education, amenable to medical, physiotherapeutic treatment. The Achilles tendon is often exposed surgical operation. This pathology has a high chance of a complete cure, since the postoperative period usually proceeds without any complications and consequences.

Quite common is a disease such as enthesopathy of the Achilles tendon. It is one of the types of achilles tendonites, but has its own features and flow characteristics. inflammatory process. Enthesopathy is an inflammatory degenerative process that develops at the site of attachment of the tendons to the bone, where calcifications accumulate and form a serious obstacle to full leg movements.

At first, it may seem to a person that he just pulled his leg, and he, limping, goes to the healers to correct the joint. However, things are much more serious. Due to tissue degeneration, calcification develops, a heel spur is formed. This will require long-term maintenance treatment based on the constant intake of anti-inflammatory drugs.

Increased loads on the feet and calf muscles lead to the development of crepitant tendovaginitis of the Achilles tendon. Treatment should be started immediately, since the inflammatory disease is manifested by thickening of the tendon, pain in movements, and tumor formation. Distinguishing Symptom- sensitive characteristic creaking when moving the joints. Tenosynovitis crepitus type affects the synovial membrane surrounding the tendons of the extensor muscles. The aseptic type of crepitating tendovaginitis is not associated with infection of the body, because of this it is an independent inflammatory disease.

Disease of professionals! Occupational inflammatory foot disease in runners short distances, gymnasts and acrobats - paratenonitis of the Achilles tendon.

It is based on adhesive processes with the formation of compaction, scars developing on the tissues of the sliding apparatus of the Achilles zone. It occurs as a result of microcirculation disorders, old injuries, pathologies of the spine. Against this background, develops secondary inflammation connective tissues of collagen properties. Acute period The disease is characterized by a widespread tumor of the Achilles tendon, sensitive pain syndrome, lameness when walking. This is due to a violation of the outflow of lymph, and compaction synovial membranes sliding fabrics. Collagen inflammation of the Achilles tendon is treatable through the use of innovative methods and the latest pharmacological agents in therapy.

Diagnosis of the disease

If the doctor suggests inflammation of the Achilles tendon, treatment begins after a complete examination and clarification of the diagnosis with various highly qualified specialists - a surgeon, an orthopedist. They check the preservation of the tendon reflex, pain on palpation and joint movements. Doctors in the complex undertake to cure a person, on the condition that he seeks medical help in a timely manner.

Diagnostic methods:

examination by a doctor;
radiation examination;
x-ray examination.

The doctor conducts the initial examination, as seen in the photo, with the help of palpation, finds the places of the greatest pain response to touch. This helps to suggest an injury or inflammatory process, after which further examination is prescribed. Radiation diagnostics provides information if there is an accumulation of calcifications on the tendon. Only in this case, the doctor can see the information that provides the basis for clarifying the diagnosis.

MRI is the most informative examination to date. Magnetic resonance imaging of tissues shows the slightest ruptures, the initial form of inflammation, spurs, and the condition of tendon tissues. Ultrasound determines if surgical care in the treatment of the inflammatory process. X-rays accurately show the location of inflammation. After diagnostic confirmation of the presence inflammatory disease, the doctor prescribes a complete and competent treatment.

Symptoms of the disease

Inflammation on the Achilles tendon occurs in two forms - acute and chronic. Depending on the form of the course of the disease, the manifestations of the disease differ.

Acute inflammation manifests itself:

pain during movement;
gradual subsidence of pain during rest;
discomfort when touching the heel and ankle;
general redness around the tendon.

With a long good rest microscopic tears have time to heal, so the person feels significant relief, and can walk a little without limping. However, from new motor loads, a new injury to the tissues of the ligaments also occurs. It is necessary to pay attention to the slightest symptoms in time, since without treatment the inflammation will turn into chronic form. Inflammation of the Achilles tendon gives symptoms that cannot be confused with any other disease.

Chronic inflammation manifests itself:

gradual increase in pain;
feeling severe pain even after a long rest;
increased pain when descending or climbing stairs.

Both forms of inflammation give the following manifestations:

sharply increased pain;
the tendon thickens;
there is tension in the calf muscles;
limited mobility in the ankle area;
there is a creak in the ankle joint with any movement;
Difficulty bending the foot and lifting on toes.

Each person is responsible for their own health. Is it worth it to allow such serious complications, or is it still better to go to the clinic to your doctor and start treatment on time so as not to get sick and not remain immobilized for many years of life. Inflammation of the Achilles tendon is well treated at home, and traditional surgeons medical practice they themselves advise resorting to folk recipes.

Treatment of inflammatory processes on the Achilles tendons

Achilles tendons can become inflamed due to the habit of wearing uncomfortable shoes. Another reason for the development of inflammatory processes is a metabolic disorder, when cholesterol levels rise in the blood. The inflammatory process of Achilles of the ankle joint develops as secondary disease with gout, tonsillitis, with the deposition of urate microcrystals, with frequent formation of corns on outside heels.

The main treatment is:

exclusion of loads;
cold cloth compresses for 10 minutes several times a day;
restriction of movement of the ankle joint;
usage elastic bandage;
taking medications prescribed by a doctor;
wearing shoes without heels.

Even before the appointment of medications, with the fulfillment of the specified requirements of the doctor, patients receive significant relief. The surgeon examines the leg, palpates the inflamed area, prescribes x-ray examination. With enthesopathy of the Achilles tendon, treatment is prescribed after a complete examination, including x-rays.

After receiving images confirming the presence of an inflammatory process on the Achilles tendon, the doctor prescribes:

painkillers in injections;
injection of medication directly into the joint;
nonsteroidal medications against inflammation;
antibiotics.

Anti-inflammatory agents are used in tablet form or in injections. The doctor makes injections in the leg tissue near the tendon in order to pump the medicine directly into the site of inflammation. The use of non-steroidal ointments and gels is effective as a local effect on inflammation.

Comprehensive treatment! Together with medications, a physiotherapeutic effect on the site of inflammation is used. As a rule, these are UVT, magnet, laser, ultrasound, electrophoresis, mud, massage, therapeutic exercises.

Traditional medicine treatment

After consulting a doctor, inflammation can be treated with folk methods. Of the variety of culinary seasonings, a herbal supplement stands out - curcumin, which has an antibiotic property. It is recommended to chew and drink 0.5 g of curcumin daily with water. It works as an excellent antioxidant and helps reduce inflammation.

If the site of inflammation swells, it helps to relieve pain and stop the development of the inflammatory process with ice massage, which is carried out with ice cubes in the tendon area. Remove inflammation, help relax a tense tendon coniferous baths, with the addition of water sea salt. Traditional healers suggest smearing the inflamed area with plantain and nettle juice, freshly squeezed from young plants. This is a laborious method, but it gives good results along with honey, which can be rubbed on the leg and covered with a cotton cloth.

An unconventional way is to be treated by wrapping the inflamed leg with a milk compress. The compress must be heated, when cooled, you can again dip the fabric into hot milk and wrap the leg again. Do this several times, in total in time - up to 30 minutes.

For ingestion, a vodka tincture is prepared from the internal partitions walnuts. You will need a glass of crushed partitions and 0.5 liters of good vodka. It is necessary to pour a full bottle of chopped walnut partitions, pour vodka over them, leave for 20 days in a dark, dry place. The resulting medicine is recommended to drink 2 times a day, 1 tsp.

life forecast

According to the reviews of people who have suffered inflammation of the Achilles tendon, one must be patient in the treatment, as it is long and versatile. Persistent long-term treatment helps to completely get rid of inflammation of the Achilles tendon, restore full movement of the ankle joint. An important condition for achieving complete cure- change your lifestyle, protect your legs from stress as much as possible in order to avoid exacerbations. It is necessary to strictly follow the recommendations of the surgeon in order to exclude deterioration up to disability and surgical intervention.

Achilles tendinitis is an inflammation of the Achilles tendon.

There are three forms of this disease:

Peritendinitis is an inflammatory process that occurs in the tissues surrounding the Achilles tendon, which is combined with degenerative processes in the tendon or occurs without them.
Tendinitis is an inflammatory process in the Achilles tendon, which leads to its degeneration. At the same time, the functioning of the surrounding tissues is not disturbed.
Enthesopathy is an inflammatory process of the Achilles tendon, which is accompanied by its degeneration, which occurs in the area where the tendon connects to the bone. In this case, the appearance of calcification and formation heel spur.

All three of the above forms of Achilles tendonitis are interconnected and can flow into one another. The initial stage of each type of tendonitis requires the same type of initial treatment.

ICD-10 code

M76.6 Calcaneal [Achilles] tendonitis

Causes of Achilles Tendonitis

The causes of Achilles tendonitis are as follows:

The main provoking factor in the inflammatory processes of the Achilles tendon is the constant overload of the calf muscle. As a result, chronic tension develops in the muscle and shortening of the muscle is observed. This leads to the fact that the Achilles tendon is under constant tension, not being able to rest. If a person, at the same time, it is impossible to interrupt the constant physical exercise or physical work, then this leads to the fact that tendinitis develops in the Achilles tendon.
In people from forty to sixty years old, Achilles tendonitis appears as a result of damage to it after a leg exercise. continuous load which is not usual. Long running or walking, which must be done after a constant hypodynamic lifestyle, can lead to such a development of events. A sedentary lifestyle leads to the appearance of tendon stiffness, as well as a decrease in the mobility of the ankle joint. As a result of this set of conditions, the Achilles tendon is damaged and tendinitis occurs.
Professional athletes earn Achilles tendonitis due to a violation of the training regimen, the production of long and heavy loads without prior preparation, and also due to overload of the leg muscles.

Symptoms of Achilles Tendonitis

The symptoms of Achilles tendonitis are as follows:

Appearance pain in the region of the Achilles tendon.
The presence of edema located above the attachment of the Achilles tendon by two to six centimeters.
The occurrence of pain after the load on the leg. It should be noted that on last dates diseases pain appear during load on the leg.
The appearance of pain on palpation of the Achilles tendon.
The occurrence of pain at the site of attachment of the Achilles tendon when pressed
The appearance of enthesopathy, that is, pain in the region of the Achilles tendon, if a sick person sleeps in a supine position with outstretched legs.
The appearance of incomplete flexion of the foot with back side tension on the Achilles tendon.

Diagnosis of Achilles tendinitis

Diagnosis of Achilles tendonitis is divided into several stages.

The diagnostic procedure begins with the collection of an anamnesis and listening to the patient's complaints. Most often, patients in their complaints describe constantly increasing pain sensations two to six centimeters above the point of attachment of the Achilles tendon to the bone. In this case, along with pain, swelling of the junction zone is most often observed.

At the initial stage of the disease, pain occurs after loads on the leg. But with the progression of the disease, pain also occurs during exercise.

Enthesopathy, as a type of tendonitis, is also characterized by pain at night, which occurs if the patient lies on his back for a long time with his legs extended.

The next step in the diagnosis is a physical examination of the patient. First of all, the doctor can identify a type of tendonitis by determining the area of pain. With peritendinitis, an inflammatory process is observed in the tissues along the entire length of the tendon, and in the presence of motor activity in the ankle joint, pain does not move. With tendinitis, the inflammatory process is localized only in a small area, and when moving, the area of pain shifts.

It is important for the examiner to rule out a torn Achilles tendon. Such a diagnosis is confirmed or refuted by the Thompson test, which is carried out in the following way. The patient lies on his stomach, and his feet hang from the table. The specialist squeezes the calf muscle, while observing the flexion of the sole of the foot. If the foot can bend, then the Thomson test is considered negative and there is no tendon rupture. If it is impossible to bend the sole of the foot, the doctor diagnoses the presence of a rupture of the Achilles tendon, either at the point of attachment to the muscle, or at some point along its entire length.

The final stage of diagnosis is a radiation examination or x-ray. The radiograph shows areas of calcification along the Achilles tendon, which are visible as an enlarged shadow of the tendon. Enthesopathy is also characterized by the appearance of calcifications in front of the point of attachment of the tendon.
On last step diagnostics instead of (or in parallel with x-rays) an MRI (magnetic resonance imaging) can be performed. The use of this method helps to distinguish between inflammatory processes and degenerative changes in the tendon. In the presence of inflammation, a lot of fluid is localized in the Achilles tendon, although soft tissues that surround it are not enlarged. If such a picture is observed in the diagnosis, then this characterizes acute stage diseases.

If there is a thickening of the Achilles tendon, which is detected in the diagnosis, we can say that its tissues have been replaced by a scar. Such changes significantly increase the risk of rupture of the Achilles tendon.

Achilles tendinitis treatment

It is very important to correctly diagnose the stage and type of the disease, since the treatment of Achilles tendinitis in certain cases varies.

Acute processes in the tendon and adjacent tissues are successfully eliminated by anti-inflammatory therapy and the use of common funds treatment of soft tissue injuries - rest, cold, the imposition of a tight bandage, fixing the leg in an elevated position.

Achilles tendonitis is treated with conservative and surgical methods.

Conservative treatment of Achilles tendinitis

Conservative therapy begins immediately when symptoms of the disease are detected. At the same time, a tight bandage and cold compresses (ice and so on) are applied to the entire area of pain. The leg should be at rest and in an elevated position. This therapy recommended for one to two days, which avoids the appearance of hematomas, and later scars instead of them.

Further treatment is carried out with the introduction of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, which provides pain relief, elimination of inflammation and restoration of tendon function. The use of NSAIDs should not exceed seven to ten days, since with longer treatment, these drugs prevent the restoration of the Achilles tendon.

The next stage of treatment is rehabilitation. The rehabilitation period begins a few days after the tendon injury, as initial stage important to ensure tissue repair.

At the same time, therapeutic exercises are used, which are based on light stretching and strengthening exercises, which contributes to the restoration of the tendon and the development of the functions of the triceps muscle of the lower leg.

First of all, begin to perform stretching exercises. These include exercises in a sitting position using a towel and expander. The load in the form of resistance should increase gradually, but at the same time not cause pain.

Of the physiotherapeutic methods in the rehabilitation period, ultrasound therapy, electrophoresis and electrical stimulation are indicated. As a result of the application of these methods of treatment, pain is reduced and the functions of the damaged tendon are restored.
Massage is also used to treat Achilles tendonitis, which stretches and strengthens the tendon.
With the presence of varus or hallux valgus feet to a large extent Ankle braces must be used.
In some cases, at night, patients need to use a special corsage that is put on the foot and fixes it in a special position at an angle of ninety degrees relative to the lower leg. It happens that this corsage needs to be worn in daytime, then the movement of the patient can occur only with the help of crutches.
Sometimes a cast is used to treat Achilles tendinitis. In this case, it is not recommended to prescribe painkillers. The exceptions are cases of constant and severe pain in the area of the tendon.
Glucocorticoid preparations should not be injected into the tendon and the area of its attachment, since they provoke a rupture of the tendon, and also prevent its suturing due to the appearance of degenerative processes.

Surgical treatment of Achilles tendinitis

If conservative methods therapy for six months showed their ineffectiveness, one should resort to surgical intervention. Surgical treatment is performed as follows: the Achilles tendon is exposed using a median skin incision, and the altered tissue near the tendon is excised, as are the thickened zones of the tendon itself. If more than half of the Achilles tendon is removed, the excised areas are replaced with the tendon of the plantar muscle. To avoid strong tension on the tissues that are located around the tendon, when suturing the incisions, the tissues are loosened in front, which allows them to close behind. Enthesopathy uses a lateral incision to excise the tendon sac.

If the patient has Haglund's deformity, that is, there is a bony ridge in the form of a spur on the posterior surface of the calcaneus, then this defect can put pressure on the place of attachment of the tendon. This anomaly is removed with an osteotome.

In the postoperative period, the patient must wear an orthosis or a plaster boot for four to six weeks. You can step on the operated leg after two to four weeks (depending on the patient's condition). Then, after the loads are resolved, rehabilitation therapy can begin, which is carried out for six weeks.

Prevention of Achilles tendinitis

Prevention of Achilles tendonitis is as follows:

Middle-aged people, from forty to sixty years old, need to moving image life with moderate loads. Recommended daily gymnastics, which should include stretching and strengthening exercises various groups muscles, including the calves.
With possible prolonged physical exertion and stress on the calf muscles (for example, running or walking), it is necessary to prepare for them. It is necessary to do exercises in advance to develop leg endurance, gradually increasing the load. Stretching exercises should also be included in the complex of physical activity.
Professional athletes who are at risk of developing Achilles tendonitis are advised not to disrupt their training regimen. It is necessary to produce constant, feasible loads with their slow increase. Also, runners, for example, need to take care of correct technique running and the number of loads. Experts advise all professional athletes to avoid overloading to avoid damage to muscles, ligaments and tendons.

Prognosis of Achilles Tendonitis

With long-term treatment, Achilles tendonitis can be completely eliminated and the function of the leg restored. At the same time, it must be remembered that the patient needs to radically change his lifestyle, which, first of all, consists in eliminating stress on the leg. Since, even ordinary walking can provoke relapses of the disease.

Patients need to abandon any sporting events of a professional or amateur level, as well as limit movement as much as possible. If you do not heed these recommendations, then the patient's condition may worsen to such an extent that it is necessary to apply surgical treatment. But at the same time, it must be remembered that surgical intervention is carried out in such a way that does not allow further full use of the operated leg. During the whole subsequent life, it will be necessary to limit the movement of the sore leg, which is not a guarantee of a full life.

Therefore, it is worth heeding the advice and starting conservative treatment at the first sign of Achilles tendinitis. And also leave sports and other physical activities in order to avoid the progression of the disease and the use of surgical intervention.

The Achilles tendon is the largest and strongest tendon in the human body. It was named after the mythical hero Achilles, who was described by Homer in his works. Its formation is associated with the result of the connection of flat-type tendons, which are located in the calf muscles with the soleus muscles. Another name for the Achilles tendon is the calcaneal tendon. It is attached to the tubercles of the heel bones.

As a result of the contraction of the muscles that begin to pull this tendon, a person can bend his lower limbs at the ankle joint. Thus, a person can rise on his toes, bounce in place, pushing off with his feet. But it happens that the Achilles tendon can be injured or inflamed.

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Biomechanical factors of etiology

There are a number of specific biological and mechanical factors that can cause damage to the tendons. It can be affected, for example, by high convergence of the feet, deformity of the heel bones, insufficient stretching of the muscles in the calf region and the muscles located in the back of the thighs.

In most cases, Achilles tendon injury is the result of multiple, severe damage to which a person does not attach special significance and ignores the first symptomatic manifestations illness. And this, in turn, leads to more complex injuries.

The process of inflammation, which appears under the influence of small injuries, already at the beginning of the disease can bring a little discomfort. In such cases, pain may appear sporadically with increased physical exertion. As a result of such a chronic inflammatory process, the strength in the fibers decreases, their elasticity decreases, and the zones of microscopic tears can become scarred.

Characteristic manifestations of the disease

Very often, the symptoms of inflammation of the Achilles tendon are pronounced. Therefore, a person can immediately notice a number of symptoms that characterize this disease:

1. Pain in the place where the heel bone is located, and in the area under the calves. The pains are sharp, burning in nature. A person begins to feel them in the morning, and their increase occurs during physical exertion. It also happens that the pain becomes so strong that it does not even allow the patient to move.
2. There is swelling, swelling in the area of the tendon, it begins to thicken.
3. The skin above the tendon begins to turn red.
4. The temperature rises in the localization zone.
5. A characteristic crunch appears during motor activity in the ankle joints.

In patients, symptomatic manifestations will vary: different intensity, various injuries, individual characteristics of the body. For example, some people will suffer from unbearable pain, and they will not be able to fully move. And others will talk about discomfort and minor pain.

How do inflammatory processes appear?

The causes of inflammation of the Achilles tendon can be various, the most common of them are the following:

excessive, increased loads on the muscles of the calves of the lower extremities, which lead to a state of overstrain of the tendons;
the presence of flat feet and clubfoot;
in case a person wears uncomfortable shoes that do not stabilize the feet while walking;
violation of metabolic functions in the body: an increase in the concentration of cholesterol, urate and uric acid.

It is important to remember that inflammation in the tendons is not life threatening, but if left untreated timely assistance and ignore the disease, then it will torment with its unpleasant symptoms for a long time, and the person will constantly feel severe pain.

In the Achilles tendon, the structure is such that it consists of tendon fibers twisted in the form of spirals, which in turn consist of collagen protein, it is very strong and almost does not undergo stretching. These fibers in their composition have another 1 protein, which is called elastin, it can lengthen and restore itself.

If a person is healthy, then his Achilles tendon is able to lengthen by 5% of its total length, this makes it possible to spring and be a kind of shock absorber. But over time, the ability of the tendon to stretch decreases, so that any increased physical activity can lead to the appearance of microscopic tears.

People over 35 years of age are advised to engage in fitness or any other sport only after a good warm-up. During the warm-up, it is important to perform at least a couple of stretching exercises for the Achilles tendons. Problems can also arise if a person is subjected to aggressive training.

Therapy Methods

Athletes, dancers, and sprinters often get sprained tendons. These categories are the most vulnerable. This is due to the fact that a person can not carefully, at a sharp pace, break away and, for example, start running, as a result, an injury occurs. lower limb.

Treatment of an inflamed tendon begins with the fact that the patient is prescribed a properly organized regimen: you need to rest as much as possible, eliminate physical exertion and muscle strain in the lower limb. In some cases, a plaster splint may be applied, or simply bandaged tightly. The patient must remember that if he continues to be physically active, goes in for sports, then this aggravates the course of the disease and may lead to undesirable complications.

Be sure to use drug therapy against inflammation, the most important place in this process is occupied by painkillers and anti-inflammatory drugs.

Much attention is also paid to physiotherapeutic procedures, in which paraffin, ozocerite, and mud applications are used. The doctor may prescribe a massage to the affected area for the patient. If conservative methods did not help, and the disease began to acquire severe form specialists may prescribe surgery.

The disease is considered very capricious, so it is not recommended to run it. Patients are advised:

give the sick lower limb rest, eliminate all loads;
apply cold to the affected area, for 10 minutes 3-4 times in knocks;
try not to lift weights;
the lower limb can be wrapped with a bandage to limit motor activity;
you can temporarily wear shoes with a slightly larger heel than you wore before, this will help unload the tendon;
it's important to make sure you're using the right athletic shoes, you can check with your doctor and trainer.

If a number of these measures do not help and do not improve the condition, you should seek medical help for an accurate diagnosis of the disease.

There are also situations when the disease stubbornly does not give up. Therefore, brace or orthoses will help to completely or partially immobilize the joint in the ankle.

In some cases, orthoses that fix the feet can only be worn at night. And there are those that need to be worn in the daytime. In the most severe case, the patient is recommended to use crutches.

A huge role is given to a special massage. When the doctor can eliminate the acute pain in the patient, he proceeds to the next stage of treatment. Your doctor will recommend strengthening your tendons with specific strengthening and rehabilitation exercises.

In medicine, the concept of kinesio taping is used - this is an important section in sports traumatology. This method consists in the fact that a specialized sports tape (patch) called teip is glued to the patient, thanks to which the tendons are unloaded. If it is not possible to purchase such a tape, then you can use a wide adhesive plaster.

There are 2 types of kinesio taping: simple (1 strip is glued) and complex (a strip and 2 rings are glued). If the disease stubbornly does not give up, the patient may be prescribed an operation. It is better not to self-medicate, but immediately contact a specialist.

Inflammation of the tendon is dangerous for a person in that it has a greatly reduced blood supply, and this entails a long healing time. Also, in the presence of inflammation, the Achilles tendon can simply rupture. Therefore, in no case should the disease be left to chance, you should immediately seek medical help. It often hurts so much that it is difficult for a person to make any movements, and this limits him in living conditions. Pain increases when moving, while sitting, walking, while running. Therefore, doctors strongly recommend not to make sudden movements, not to rush anywhere, and to think first of all about your health.

There is such a thing as tendinosis - these are inflammatory processes in the Achilles tendon. For treatment, you should contact a therapist who will issue a referral to a surgeon or a sports doctor. Experts should advise drugs and course rehabilitation program.

Helping the sick at home

At home, it is important to give rest to the sick lower limb, to reduce the carrying of heavy objects. To relieve pain, relieve swelling and redness, you can use an ice pack, while a bandage should be applied to the lower limb.

Sometimes you still need to see a doctor, and not self-medicate. Need health care if the walking process is difficult, and the person assumes a rupture of the tendons. Urgently need medical attention if a person feels pain in the heel area, which increases during exercise (feeling as if he had been hit in the back lower limb).

At home, you can use many methods and ingredients for treatment. You can apply colostrum, milk, eggs, herbal infusions, herbal decoctions, ointments, clay. Many use bear bile, wraps, heat. Decoctions can be made from herbs: elecampane, elderberry, psyllium seeds, hay dust, pine twigs.

You can treat inflammation of the tendon with various oils: lavender, fir, sunflower, geranium, cloves. Ointments are prepared from calendula flowers, as well as wormwood and pork fat.

Preventive measures

It is recommended to perform a series of exercises to stretch the muscles and tendons in the lower limbs so that the muscles are strong and elastic. It is important to pay due attention to stretching the muscles under the knee, systematically pump the muscles of the calves of the lower extremities, and increase their strength. Before any sports training pay tribute to warming up and stretching the tendons. If you feel pain, then you should stop training.

If a person is jogging, you need to choose comfortable shoes that are comfortable in which the arch supports are correctly fixed. Do balance training, stand on 1 lower limb alternately. This exercise is very useful for the calves and Achilles tendon.

The duration and intensity of any workout should be increased gradually. Water exercises are considered very useful.