Achilles tendon tendonitis is a pathology that occurs in the Achilles tendon and is accompanied by an inflammatory process. The main cause of the disease is the intense load on the calf muscles – both in experienced athletes and in people without the necessary physical training. The clinical manifestations of tendonitis are swelling, pain in the foot and limitation of mobility. The patient is assigned a number of laboratory and instrumental studies (radiography, magnetic resonance imaging). Their results make it possible to differentiate pathology and conduct adequate conservative treatment.
Characteristic features of the disease
Damage to the structural components of the Achilles tendon is the most striking manifestation of rheumatic pathologies of the periarticular soft tissues. This most powerful ligament in the human body is formed by the tendons of the soleus and calf muscles, which explains its resistance to increased loads. Achilles tendon tendonitis in more than 50% of cases is the result of sports injuries, especially in older patients. After 45 years, the rigidity of the terminal structure of striated muscles increases due to a decrease in the production of elastin and collagen. The range of motion in the ankle joints is also gradually decreasing.
Tendonitis can also be a degenerative pathology. The arising pain in the ankle and redness of the skin are often mistaken for the symptoms of stretching. The use of non-steroidal anti-inflammatory drugs temporarily reduces the severity of clinical manifestations, but does not eliminate their cause. Further development of destructive-degenerative changes accompanies fibrosis, neoangiogenesis, and in some cases, calciumosis. At this stage, the disease can be recognized by the following signs:
- with an increase in motor activity, a characteristic crackle is clearly heard;
- the diseased tendon is somewhat thicker than the healthy one, which is noticeable when palpating them.
To conduct adequate therapy, it is important to establish the form of damage to the Achilles tendon. If during the differential examination revealed inflammation of the periarticular soft tissues, then the patient is diagnosed with peritendinitis. Enthesopathy is established when a pathology is found that is localized in the places where the tendons are attached to the calcaneus. With this disease, the formation of calcaneal spurs and calcified foci in muscle fibers sometimes occurs.
With a sedentary lifestyle, the rigidity of the Achilles tendon appears, the mobility of the ankle decreases. In such cases, inflammation begins even with minor loads on the joint.
Pathology is characterized by a gradual development. At the initial stage, uncomfortable sensations arise, quickly disappearing after a few minutes of motor activity. A small load, for example, sports, contributes to the complete elimination of pain. When feeling affected by inflammation of the tissues, a slight tingling sensation may occur. Lack of medical care is the cause of chronic disease. It is characterized by such clinical manifestations:
- gradual increase in the severity of pain. Now it does not disappear during training, and the intensity of uncomfortable sensations increases significantly;
- even after a long rest, the pain does not disappear, it occurs in the morning;
- climbing or descending stairs provokes the appearance of pain or its intensification.
When diagnosing Achilles tendonitis tendon of moderate or high severity, the doctor notes local hyperemia. In damaged tissues, the temperature rises locally, the calf muscle is very tense, there is no full flexion of the foot.
External examination and patient complaints help the doctor make an initial diagnosis. A number of laboratory tests are prescribed to exclude or confirm damage to the tissues of the Achilles tendon by pathogenic bacteria. Destructive degenerative changes are established according to the results of instrumental studies:
- radiography of the lower leg;
- Ultrasound of the ankle joint;
In radiographic images, calcified lesions localized in different parts of the tendon can be clearly seen. The diagnosis of tendonitis is made regardless of whether calcifications are present or not in the images. Ultrasonography and MRI are more accurate diagnostic techniques for a detailed study of soft tissues. They help identify foci of inflammation and areas with degenerative changes.
Magnetic resonance imaging with high accuracy establishes the acute stage of the inflammatory process. This stage is characterized by the accumulation of a large amount of fluid in the tissues of the Achilles tendon in the absence of external edema.
At the beginning of treatment, the orthopedist recommends that the patient wear a tight bandage and bed rest for two days with a raised leg. Cold compresses will help stop inflammation and reduce the severity of pain. Constant cooling of the affected area does not allow the formation of extensive hematomas, the dangerous consequences of which are scars. For immobilization of the ankle joint are used:
- special cotton ribbons. They do not contain latex, are similar in elasticity to human skin, reliably fix the tendon and prevent its stretching;
- orthoses restricting movement. Immobilization is carried out at an angle of 90 ° C at night, and in some cases – constantly.
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When diagnosing a strong inflammatory process, a patient is given a splint, a splint or plaster cast. Minimize exacerbations of the disease helps to change the usual way of life. Lifting weights and wearing high-heeled shoes is prohibited.
Non-steroidal anti-inflammatory drugs are the first choice in the treatment of Achilles tendon tendonitis. Most often, orthopedists prescribe Ibuprofen, Diclofenac, Movalis, Nimesulide and Ketorolac. Taking drugs quickly stops swelling and inflammation, eliminates pain of any intensity. To enhance the therapeutic effect, ointments and gels for local application are used: Diklak, Voltaren, Fastum, Dolobene, Indomethacin. The duration of the therapeutic course should not exceed 10 days. When prescribing NSAIDs in tablets, proton pump inhibitors (Omez, Omeprazole) are simultaneously used to prevent damage to the gastric mucosa.
If the cause of tendonitis was intense physical activity, then doctors often recommend Indovazin. It includes a non-steroidal anti-inflammatory drug and venoprotector. After applying the gel in the affected tissues, microcirculation improves, contributing to the rapid regeneration of tissues.
To eliminate pain, swelling and inflammation, compresses are used from injection solutions of Novocaine, Analgin and the hormone Dexamethasone mixed in equal volumes. With severe pain, these drugs are used to block. Parenteral administration of glucocorticoids is also practiced:
These synthetic analogues of adrenal hormones stop inflammation and swelling even after a single use. But glucocorticosteroids are used no longer than 3-5 days due to severe side effects. The most dangerous of them is pathological bone resorption. Hormonal drugs are introduced only in the periarticular tissues. When injected into the Achilles tendon, a violation of its integrity may occur. Glucocorticosteroids are subject to gradual withdrawal with a decrease in single dosages. If you sharply stop taking hormonal drugs, then exacerbation of tendonitis will quickly follow.
To prevent further degenerative changes in the Achilles tendon, chondroprotectors – Teraflex, Structum, Glucosamine-Maximum, Chondroitin-Akos are included in the therapeutic regimen. Their intake contributes to the production of elastin and collagen – fibrillar proteins that make up the basis of the connective tissue of the tendon.
|A group of drugs for the treatment of Achilles tendonitis tendonitis||Names of medicines|
|Nonsteroidal anti-inflammatory drugs||Nimesulide, Meloxicam, Ibuprofen, Diclofenac, Indomethacin|
|Glucocorticosteroids||Prednisolone, Methylprednisolone, Hydrocortisone, Dexamethasone, Diprospan|
|Chondroprotectors||Structum, Don, Teraflex, Arthra, Alflutop|
|B vitamins||Milgamma, Combilipen, Pentovit, Neuromultivitis|
|Ointments and gels for local application||Voltaren, Fastum, Ortofen, Diclovit, Dolobene, Arthro-Active, Arthrosilen|
Surgical treatment is indicated to the patient with the failure of conservative therapy several months after its initiation. During the operation, the doctor makes a midline incision and exposes the tendon. The altered tissues surrounding it are excised along with the formed thickenings. With extensive destruction, surgical intervention is highly complex:
- to restore functional activity, the tendons of the plantar muscles are placed in the excised areas;
- Strong tissue tension is prevented by suturing their incisions in the front in a weakened position for better posterior closure.
In patients with enthesopathy, a tendon bag is excised after a lateral incision. With Haglund deformity (the presence of a bone ridge), the heel spur exerts excessive pressure on the site where the tendon is attached to the heel bone. In this case, the patient is shown an orthopedic operation with bone dissection under general anesthesia. Surgical instruments, a laser or ultrasound can be used in the process. After excision of the tissues, the bones are fixed in the desired position by various devices: nails, plates, bone graft, plaster cast. Skeletal traction is widely practiced, which consists in inserting a steel spoke into the bone and suspending the load. The bone is gradually extended and takes anatomically correct position.
Throughout the postoperative period (1-1,5 months), the patient is shown wearing an orthosis or plaster boot. During movement, he should use crutches in order not to burden the operated leg.
At the stage of rehabilitation of tendonitis, physiotherapeutic procedures are practiced: electrophoresis, ultrasound therapy, electrical stimulation. These treatment methods allow for 5-10 sessions:
- reduce the intensity of pain;
- accelerate tissue healing;
- increase the functional activity of a damaged tendon.
During the recovery period, the patient is recommended to practice therapeutic gymnastics and physical education, consisting in the implementation of general strengthening exercises. Regular training speeds up the healing of damaged tissues and activates the functioning of the ankle triceps. It is this element of the musculoskeletal system that ensures the full functioning of the Achilles tendon.
The use of folk remedies (beekeeping products, infusions of medicinal herbs) is possible only at the stage of rehabilitation. Achilles tendon tendon in the absence of medical intervention can cause loss of performance. Only a timely diagnosis and an adequately structured therapeutic regimen will avoid the progression of pathology and significantly accelerate recovery.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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