Achilles tendon tendonitis

Tendonitis of the Achilles tendon 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. Tendonitis 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.
3. Enthesopathy is an inflammatory process of the Achilles tendon, which is accompanied by its degeneration, which occurs in the joint zone of the tendon with the bone. In this case, the appearance of calcification and the formation of the calcaneal spur is possible.

All three of the above forms of Achilles tendon tendonitis are related and can flow into each other. The initial stage of each type of tendinitis requires a similar initial treatment.

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Causes of Achilles tendon tendonitis

The causes of tendonitis of the Achilles tendon are as follows:

1. The main triggering factor inflammatory processes of the Achilles tendon is the constant overload of the gastrocnemius muscle. As a result, the muscle develops chronic tension and shortens the muscle. This leads to the fact that the Achilles tendon experiences constant tension, not being able to rest. If a person, while you can not interrupt the constant physical exercise or physical work, it leads to the fact that tendonitis develops in the Achilles tendon.
2. In people from forty to sixty years, tendonitis of the Achilles tendon appears as a result of his injuries after a prolonged load on the leg, which is not usual. Such a development of events can lead to a long run or walking, which must be done after a permanent hypodynamic way of life. Sedentary life leads to the appearance of rigidity of the tendon, 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 tendonitis occurs.
3. Professional athletes earn tendinitis Achilles tendon due to violation of the training regime, the product of long and heavy loads without preliminary training, and also because of the overload of the leg muscles.

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Symptoms of Achilles tendon tendonitis

Symptoms of Achilles tendon tendonitis are as follows:

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 onset of pain after the load on the leg. It should be noted that in the last period of the disease, pain appears during the load on the leg.
4. The appearance of tenderness in the palpation of the Achilles tendon.
5. The appearance of pain at the place of attachment of the Achilles tendon when you press it
6. The appearance of enthesopathy, that is, tenderness in the Achilles tendon area, if the sick person sleeps in a posture lying on his back with elongated legs.
7. Occurrence of incomplete flexion of the foot from the back with the tension of the Achilles tendon.

Diagnosis of Achilles tendon tendonitis

Diagnosis of tendonitis Achilles tendon is divided into several stages.

• The diagnostic procedure begins with the collection of anamnesis and listening to patient complaints. Most often, patients in their complaints describe the constantly increasing pain sensations two to six centimeters above the point of attachment of the Achilles tendon to the bone. In this case, together with the pain, the zone of the connection is most often swollen.

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

Enthesopathy, as a kind of tendonitis, is also characterized by painful sensations at night, which arise if the patient lays on his back with his legs extended.

• The next step in the diagnosis is a physical examination of the patient. First of all, the doctor can distinguish a type of tendinitis by determining the zone of the onset 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 there is no movement of pain. In tendonitis, the inflammatory process is localized only in a small area and during movement the area of pain is displaced.

For a specialist who conducts an examination, it is important to exclude the presence of a rupture of the Achilles tendon. Such a diagnosis is confirmed or refuted by carrying out a Thompson test, which is carried out as follows. The patient is located on his stomach, and his feet are hanging from the table. The specialist squeezes the gastrocnemius muscle, while observing the flexion of the sole of the foot. In the event that the foot can bend, the Thomson trial 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 attachment to the muscle, or at any point throughout the entire length.

• The final stage of diagnosis is radiation examination or X-ray. The radiograph shows calcification zones along the Achilles tendon, which are seen as an enlarged shadow of it. Enteresopathy is also characterized by the appearance of calcifications in front of the attachment point of the tendon.
• At the last stage of the diagnosis, instead of (or in parallel with the x-ray), an MRI (magnetic resonance imaging) can be performed. Using this method helps to distinguish inflammatory processes and degenerative changes in the tendon. If there is inflammation in the Achilles tendon, a lot of fluid is localized, although the soft tissues that surround it are not enlarged. If the diagnosis is observed such a picture, then it characterizes the acute stage of the disease.

In the presence of thickening of the Achilles tendon, which is revealed in the diagnosis, it can be said that his tissues were replaced by a scar. Such changes at times increase the risk of rupture of the Achilles tendon.

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Achilles tendonitis tendonitis treatment

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

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

Tendonitis of the Achilles tendon is treated with the help of conservative and surgical methods.

Conservative treatment of Achilles tendon tendonitis

Conservative therapy begins immediately when the symptoms of the disease are identified. At the same time, a tight bandage and cold compresses (ice and so on) are superimposed on the entire area of painful sensations. The leg should be at rest and elevated position. This therapy is recommended for one or two days, which allows to avoid the appearance of bruises, and later instead of scars. •

Further treatment with the use of non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics is provided, which provides anesthesia, elimination of inflammation and restoration of the tendon function. The use of NSAIDs should not exceed seven to ten days, because with longer treatment these drugs interfere with the restoration of the Achilles tendon. •

The next stage of treatment is rehabilitation. The rehabilitation period begins a few days after the injury of the tendon, because at the initial stage it is important to restore the tissue.

At the same time, therapeutic gymnastics is applied, based on light stretching and strengthening exercises that help to restore the tendon and develop the functions of the triceps muscles of the shins.

First of all, they begin to perform stretching exercises. These include exercises in the sitting position using a towel and an expander. Load in the form of resistance should increase gradually, but do not cause pain.

• From physiotherapeutic methods during the rehabilitation period, ultrasound therapy, electrophoresis and electrostimulation are shown. As a result of the application of these treatments, pain is reduced and the functions of the damaged tendon are restored.
• Also for the treatment of tendonitis Achilles tendon massage is applied, which stretches and strengthens the tendon.
• With the existing varus or valgus deformation of the foot, it is necessary to use the ankle retainers.
• In some cases, at night, patients need to use a special corsage, which is put on the foot and fixes it in a special position at an angle of ninety degrees with respect to the shin. It happens that this corsage should be worn in the daytime, then the patient can move only with the help of crutches.
• Sometimes, a plaster bandage is used to treat tendonitis of the Achilles tendon. It is not recommended to prescribe pain medication. Exceptions are cases of constant and severe pain in the tendon area.
• Preparations of glucocorticoids can not be introduced into the tendon and the attachment zone, as they provoke a rupture of the tendon, as well as prevent its stitching due to the appearance of degenerative processes.

Surgical treatment of Achilles tendon tendonitis

If conservative methods of therapy within half a year have shown the inefficiency, it is necessary to resort to a surgical intervention. The surgical treatment is performed as follows: the Achilles tendon is exposed through the median cutaneous incision, and the modified tissue near the tendon is excised, as are the thickened zones of the tendon itself. When more than half of the Achilles tendon is removed, the excised areas are replaced by the tendon of the plantar muscle. To avoid strong tension of tissues that are located around the tendon, when sewing incisions, the tissues are weakened from the front, which allows them to close behind. With entesopathy a lateral incision is used, which allows you to excise the tendon bag.

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

In the postoperative period, the patient should wear an orthosis or gypsum boot on the continuation of four to six weeks. Attack on the operated leg can be done after two to four weeks (depending on the patient's condition). Then, after resolving the stresses, you can start rehabilitation therapy, which is carried out for six weeks.

Prophylaxis of Achilles tendon tendonitis

Prevention of tendonitis Achilles tendon is as follows:

1. People of middle age, from forty to sixty years of age, need to live a mobile lifestyle with moderate loads. It is recommended daily gymnastics, in which it is necessary to include stretching exercises and strengthening of various muscle groups, including calf muscles.
2. With possible long physical exertion and loads on the calf muscles (for example, running or walking) it is necessary to prepare for them. It is necessary to practice the exercises for the development of endurance of the legs in advance, gradually increasing the load. In the complex of physical activities, stretching exercises should also be included.
3. Professional athletes who have a risk of tendonitis Achilles tendon, it is recommended not to violate the training regime. It is necessary to produce constant, feasible loads with a slow increase. Also, runners, for example, need to take care of the correct running technique and the number of loads. Experts advise all professional athletes to avoid overloading to avoid damage to muscles, ligaments and tendons.

Prognosis of Achilles tendon tendonitis

When treating for a long time tendinitis Achilles tendon can completely eliminate and restore the function of the foot. It should be remembered that the patient needs to radically change his lifestyle, which, first of all, is to exclude the load on his leg. Because, even ordinary walking can trigger a relapse of the disease.

Patients must abandon any sporting activities of a professional or amateur level, and also to limit the movement as much as possible. If you do not listen to these recommendations, then the patient's condition may worsen to the point that you need to apply surgical treatment. But at the same time it must be remembered that surgical intervention is conducted in a way that does not allow full use of the operated leg in the future. During the entire subsequent life, it will be necessary to restrict the movement of the patient with the leg, which is not a guarantee of a full life.

Therefore, it is worth to listen to advice and begin conservative treatment at the first signs of tendonitis Achilles tendon. And also to leave sports and other physical exertion to avoid the progression of the disease and the use of surgical intervention.