Achilles tendon tendonitis.

Achilles tendonitis is an inflammation of the Achilles tendon.

There are three forms of this disease:

1. 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.
2. 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 impaired.
3. Enthesopathy is an inflammatory process of the Achilles tendon, which is accompanied by its degeneration, which occurs in the area of the tendon-bone junction. In this case, calcification and the formation of a heel spur are possible.

All three of the above forms of Achilles tendonitis are related and can progress from one to the other. The initial stage of each type of tendonitis requires the same type of initial treatment.

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Causes of Achilles Tendonitis

Causes of Achilles tendonitis include:

1. The main provoking factor of inflammatory processes of the Achilles tendon is considered to be 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 experiences constant tension, without the opportunity to rest. If a person cannot interrupt constant physical exercises or physical work, then this leads to the fact that tendinitis develops in the Achilles tendon.
2. In people aged forty to sixty, Achilles tendonitis occurs as a result of damage to the tendon after prolonged load on the leg, which is not usual. Such a development of events can be caused by long running or walking, which must be done after a permanent hypodynamic lifestyle. A sedentary lifestyle leads to the appearance of tendon rigidity, as well as decreased mobility of the ankle joint. As a result of this complex of conditions, the Achilles tendon is damaged and tendonitis occurs.
3. Professional athletes develop Achilles tendonitis due to poor training habits, prolonged and heavy loads without prior preparation, and overloading of the leg muscles.

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Symptoms of Achilles Tendonitis

Symptoms of Achilles tendonitis include the following:

1. The appearance of painful sensations in the area of the Achilles tendon.
2. The presence of edema located above the attachment of the Achilles tendon by two to six centimeters.
3. The occurrence of pain after exertion on the leg. It should be noted that in the last stages of the disease, pain occurs during exertion on the leg.
4. The appearance of pain upon palpation of the Achilles tendon.
5. The occurrence of pain at the site of attachment of the Achilles tendon when pressing on it
6. The appearance of enthesopathy, that is, pain in the area of the Achilles tendon, if the sick person sleeps in a supine position with legs extended.
7. The appearance of incomplete flexion of the foot from the dorsal side when the Achilles tendon is stretched.

Diagnosis of Achilles tendonitis

Diagnosis of Achilles tendonitis is divided into several stages.

• The diagnostic procedure begins with collecting anamnesis and listening to the patient's complaints. Most often, patients describe in their complaints a constantly increasing pain sensation two to six centimeters above the point of attachment of the Achilles tendon to the bone. At the same time, swelling of the connection area is most often observed along with the pain.

At the initial stage of the disease, pain occurs after exertion on the leg. But as the disease progresses, pain also occurs during exertion.

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

• The next stage of diagnosis is a physical examination of the patient. First of all, the doctor can identify the type of tendonitis by determining the area of pain. With peritendinitis, there is an inflammatory process in the tissues along the entire length of the tendon, and with motor activity in the ankle joint, there is no movement of pain. With tendonitis, the inflammatory process is localized only in a small area and when moving, the area of pain shifts.

It is important for the specialist conducting the examination to rule out the presence of a rupture of the Achilles tendon. Such a diagnosis is confirmed or refuted by conducting the Thompson test, which is carried out as follows. The patient lies on his stomach, and his feet hang off the table. The specialist squeezes the gastrocnemius muscle, while observing the flexion of the sole of the foot. If the foot can bend, then the Thompson test is considered negative and there is no rupture of the tendon. 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 its attachment to the muscle or at some point along its entire length.

• The final step in establishing a diagnosis is radiographic examination or X-ray. Radiographs show areas of calcification along the Achilles tendon, which are visible as an extended shadow of the tendon. Enthesopathy is also characterized by the appearance of calcifications in front of the tendon insertion point.
• At the final stage of diagnostics, instead of (or in parallel with X-ray), 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 the soft tissues that surround it are not enlarged. If such a picture is observed during diagnostics, then this characterizes the acute stage of the disease.

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

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Treatment of Achilles tendonitis

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

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

Achilles tendonitis is treated using conservative and surgical methods.

Conservative treatment of Achilles tendonitis

Conservative therapy begins immediately upon detection of symptoms of the disease. In this case, a tight bandage and cold compresses (ice, etc.) are applied to the entire area of pain. The leg should be at rest and elevated. This therapy is recommended for one to two days, which helps to avoid the appearance of hematomas, and subsequently scars instead.

Further treatment is carried out by administering non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, which provides pain relief, eliminates inflammation and restores 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, since it is important to ensure tissue restoration at the initial stage.

In this case, therapeutic gymnastics is used, which is based on light stretching and strengthening exercises, which helps restore the tendon and develop the functions of the triceps surae muscle.

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

• Physiotherapeutic methods indicated in the rehabilitation period include ultrasound therapy, electrophoresis and electrical stimulation. As a result of using these treatment methods, pain sensations are reduced and the functions of the damaged tendon are restored.
• Massage is also used to treat Achilles tendonitis, which stretches and strengthens the tendon.
• If there is a varus or valgus deformity of the foot of a high degree, it is necessary to use ankle braces.
• In some cases, at night, patients need to use a special corset, which is put on the foot and fixes it in a special position at an angle of ninety degrees in relation to the shin. It happens that this corset must be worn during the daytime, and then the patient can only move with the help of crutches.
• Sometimes, a plaster cast is used to treat Achilles tendonitis. It is not recommended to prescribe painkillers. The exception is cases of constant and severe pain in the tendon area.
• Glucocorticoid drugs should not be injected into the tendon and its attachment area, as they provoke tendon rupture and also prevent its suturing due to the appearance of degenerative processes.

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Surgical treatment of Achilles tendonitis

If conservative treatment methods have been ineffective for six months, surgical intervention should be considered. Surgical treatment is performed as follows: the Achilles tendon is exposed using a midline skin incision, and the altered tissue around the tendon is excised, as are the thickened areas of the tendon itself. When more than half of the Achilles tendon is removed, the excised areas are replaced with the plantar tendon. To avoid strong tension on the tissues around the tendon, when suturing the incisions, the tissues are weakened in front, allowing them to close at the back. In case of enthesopathy, a lateral incision is used, allowing the tendon bursa to be excised.

If the patient has Haglund's deformity, i.e. there is a bone ridge in the form of a spur on the back of the heel bone, then this defect can put pressure on the tendon attachment site. This anomaly is removed using an osteotome.

In the postoperative period, the patient must wear an orthosis or 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 allowed, you can begin rehabilitation therapy, which is carried out for six weeks.

Preventing Achilles tendonitis

Prevention of Achilles tendonitis includes the following:

1. Middle-aged people, from forty to sixty years old, need to lead an active lifestyle with moderate loads. Daily gymnastics is recommended, which should include stretching and strengthening exercises for various muscle groups, including the calf muscles.
2. In case of possible long-term physical activity and loads 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 activities.
3. Professional athletes who are at risk of developing Achilles tendonitis are advised not to disrupt their training regimen. It is necessary to perform constant, feasible loads with a slow increase. Also, runners, for example, need to take care of the correct running technique and the amount of loads. Experts advise all professional athletes to avoid overloads in order to avoid damage to muscles, ligaments and tendons.

Achilles Tendonitis Prognosis

With long-term treatment, Achilles tendonitis can be completely eliminated and leg functions can be restored. It should be remembered that the patient needs to radically change his or her lifestyle, which primarily involves eliminating loads on the leg. Since even normal walking can provoke relapses of the disease.

Patients should avoid any professional or amateur sports activities and limit their movements as much as possible. If these recommendations are not followed, the patient's condition may worsen to such an extent that surgical treatment will be required. But it should be remembered that the surgical intervention is performed in a way that does not allow full use of the operated leg in the future. Throughout the rest of your life, you will need to limit the movement of the affected leg, which is not a guarantee of a full life.

Therefore, it is worth listening to advice and starting conservative treatment at the first signs of Achilles tendonitis. And also to stop sports and other physical activities to avoid progression of the disease and the use of surgical intervention.