home Audience 12 Methods for treating Achilles rupture. Achilles tendon sprain

Methods for treating Achilles rupture. Achilles tendon sprain

Probably everyone has heard the ancient Greek myth about the invincible hero Achilles, whom his mother, in infancy, dipped into a special source of immortality, holding him by the heel. Ancient anatomists and healers were very fond of all sorts of poetic comparisons, so they named the most powerful tendon human body Achilles. It is about Achilles tendon rupture - one of the most common problems in traumatology - that we will talk today.

The Achilles or heel tendon is the most powerful and strong tendon that connects the muscles of the back of the leg with the heel tubercle. Its middle part can be felt in a small depression at the junction of the calf and the heel. In the experiment, a bundle of connective tissue fibers of the heel tendon withstood more than 300 kg to break, but in life this tendon experiences enormous loads and is damaged quite often.

Achilles tendon

The main task of all tendons in the human body is to transmit muscle force to certain structures. Simply put, they play the role of levers, participating in flexion, extension and rotation of body segments at the joints. The Achilles tendon is responsible for flexion and rotation of the foot and leg. We can safely say that it is one of the main structures responsible for human upright posture, providing foot stability and shock absorption.

Injuries

Numerous studies have revealed the dependence of the frequency of injuries on the type of human activity. The frequency of ruptures is definitely higher in those patients in whom it was initially subjected to various excessive loads.

Athletes, especially runners, jumpers, volleyball players, gymnasts.
Dancers and ballet dancers.
People with congenital features structure - for example, a short tendon. This condition is called “horse foot”.
Patients with initial inflammation of the tendon and synovial bursa in the area of the heel tubercle - synovitis, bursitis, tenosynovitis.

Classification

We provide a detailed classification of injuries indicating the reasons that caused this or that injury.

Tendon sprain - the mechanism of injury here can be any - similar to that of an Achilles rupture. The difference is that the force of the traumatic factor was less than the tensile strength of the connective tissue fibers of the tendon - therefore, only stretching of the fibers and their disintegration occurred without violating the integrity.
Achilles tendon rupture is a violation of the integrity of the connective tissue fibers of the tendon with obvious dysfunction. Achilles rupture can be complete or incomplete.

With an incomplete rupture or tear, partial damage to the tendon occurs; with a complete rupture, its structure is completely damaged. A separate point is taken to separate the tendon from the heel tubercle.

Depending on the nature of the injury, there are:

Achilles rupture

Open Achilles injury or open rupture of the Achilles tendon. In this case, in addition to the structure of the tendon itself, the skin and soft tissues of the lower leg and heel are damaged. That is why, in the presence of cuts and other open wounds in the back of the lower leg, it is necessary to separately check the function Achilles tendon.
Closed injury, in which the skin remains intact.

Depending on the mechanism and action of the traumatic factor, the following are distinguished:

Direct damage. Such injuries occur as a result of blows from blunt or sharp objects directly to the tendon area.
Indirect injury occurs when the calf muscle contracts and tenses excessively. This situation can be observed with an unsuccessful landing from a jump, a fall on your feet from a height, a mechanical stretch of the calf muscle with a fixed foot - this will be a closed rupture of the Achilles tendon.

Symptoms

The symptoms of an Achilles injury will directly depend on the extent of the tear and the type of injury sustained. Let's list the main features:

Help

Before the patient is brought to medical institution you need to be able to provide minimal first aid. I would immediately like to draw the attention of readers that any amateur activity is completely unacceptable. It is only important to leave the patient in a stable condition until doctors arrive. The following recommendations must be strictly adhered to:

The affected limb should remain at rest. If possible, the foot should be brought into the equinus position - the foot, as it were, slightly tends to the “tight toe”, of course, carefully and without external force. In this position, you need to try to fix the ankle joint - using an elastic bandage and transport tire– two flat hard surfaces.
In the presence of open wound its edges must be treated with any alcohol-containing solution or antiseptic and carefully bandaged with a bandage. Large wounds are not recommended to be treated with alcohol, as this may increase painful sensations and cause painful shock.
It is good to apply dry cold to the injury site - this will help reduce swelling and hemorrhage and relieve pain.

This is all you can do before the patient reaches the hands of medical workers, who will begin to provide the victim with professional assistance.

Treatment

Treatment options will depend on the nature of the injury.

In case of incomplete rupture or sprain of the Achilles without breaking the integrity skin Treatment is most often conservative. The patient is given special plaster splints or orthopedic “boots” - orthoses that create the maximum comfortable position for a damaged tendon.

Unfortunately, complete tendon ruptures require surgery. The essence of the surgical intervention is to stitch the ends of the torn tendon using various materials and suture techniques.

After surgical treatment the damaged foot is plastered in a special boot and a fairly long rehabilitation period begins, which takes up to 6-8 weeks.

Rehabilitation

Physiotherapy

Rehabilitation after an Achilles tendon rupture is a very important period in restoring limb function. As we have already said, this period of time begins immediately after the operation and takes about 2 months.

A prerequisite for proper recovery after injury is the wearing of special orthopedic boots - orthoses. These devices hold the foot in a forced position, relieving stress on the Achilles tendon and speeding up its healing process. It is mandatory for such boots to have a small heel - 2.5-3 cm. After about 6 weeks, the orthosis is changed to comfortable orthopedic shoes with an anatomical heel.

Physiotherapeutic treatment is aimed at improving blood flow in the damaged tendon, eliminating swelling and reducing pain. Most effective thermal procedures: UHF, paraffin therapy, ozokerite therapy. Magnetic therapy is also used to improve blood flow. Electrophoresis with novocaine is effective in reducing pain. In order to restore the tone of the calf muscles, they are very useful impulse currents– electrical stimulation.

Physiotherapy exercises are mandatory rehabilitation period. This is necessary for a soft and gradual start of loading on the injured leg. Swimming pool and massage are also very effective. You can gradually return to full-fledged sports activities no earlier than 6 months after recovery.

What to do (video)

Causes of damage

Often enough Achilles tendon may be damaged by a blow to the straightened shin. This injury is not uncommon among athletes, especially football players. Less often in clinical practice domestic injuries occur. Injuries from piercing objects in 70% of cases lead to damage to the Achilles tendon along the posterior line.

A degenerative theory is currently being discussed, according to which one of the provoking factors may be the degradation of a special structural protein, collagen, which is part of the tendon tissue. Taking antibiotics from the ciprofloxacin group and corticosteroids increases the risk of trophic changes. Ultimately, the Achilles tendon becomes less strong and can be damaged under the influence of strong mechanical factors.

Symptoms

Signs of Achilles tendon injury vary depending on where the force is applied. If we're talking about about the so-called deep gap, then pain syndrome may either be absent altogether or appear slightly. However, the patient is unable to stretch the toe on the injured leg. An hour later he joins severe swelling, intermuscular and subcutaneous hematomas. If we are talking about a rupture of the Achilles tendon at the site of its attachment, then the defect is visible visually in the form of a tubercle or fossa. There may be a burning sensation intense pain. Movement is also limited.

Three stages of pathology

Treatment for the Achilles tendon involves restoring its integrity. The treatment methods themselves can be conservative and surgical (operative). Doctor, based on medical indications, the degree of damage makes a decision on the method of treatment. The most important thing when choosing treatment is timeliness and correct positioning diagnosis, because if required surgery— it must be carried out as soon as possible after injury, because after a certain time (about 20 days from the moment of rupture), the ends of the Achilles tendon begin to gradually move away from each other, which is facilitated by shortening of the triceps muscle due to its elasticity and lowering of the heel tubercle due to loss of function of the triceps surae muscle. It is important to understand that treatment for the Achilles tendon may take time depending on the severity of the injury and individual characteristics patient. It is often necessary to resort to intensive drug support, and the complex rehabilitation activities proceeds smoothly from therapy.

First aid

Providing the first emergency assistance consists of giving the victim painkillers and taking him to the hospital. Under no circumstances should you massage the tendon or muscles of the lower leg. It is necessary to apply ice to the damaged area and immediately consult a doctor.

Conservative treatment

On this moment Doctors consider this method of treating Achilles tendon damage to be insufficiently effective for young people, leading active image life and athletes whose tasks are to fully recover in order to participate in future competitions.

Conservative treatment consists of stopping the load, resting, applying ice to the joint, applying a splint or splint for immobilization. Recommendations for this treatment are an elevated position of the leg and immobility in the joint for some time. In general, this non-invasive treatment of Achilles tendon injury is effective in strict adherence Despite all medical prescriptions, patients often ignore them or follow them incorrectly, which only delays recovery. Important and effective means treatment is physiotherapy and physiotherapy(exercises and rehabilitation scheme for rupture of the Achilles tendon are presented in the section “ Rehabilitation"). In addition to everything, they also add medicinal support: pain relief, injections, anti-inflammatory drugs, ointments, gels. The use of rational pharmacological agents increases the speed of healing and quickly returns patients to their previous lifestyle. Treatment of Achilles tendon injuries, despite such an extensive list, does not cause inconvenience to the patient, if we take into account selective purchases and discussions with the doctor.

Surgical treatment

For the best treatment results it is necessary to as soon as possible carry out surgical intervention (if the surgical method is chosen). This is due to the fact that over time the soleus and gastrocnemius muscles shorten, and it is quite difficult to match the ends of the tendon 18-20 days after injury. That is why treatment of an Achilles tendon rupture must begin promptly, as quickly as possible. Moreover, in the presence of severe clinical picture damage, a visit to an ambulance is indicated.

At classic version operations perform an incision 8-10 centimeters long along back surface shins, access the tendon, strip its ends and sew them with a special strong thread using one of the types of tendon sutures.

Also type surgical intervention directly related to the type of rupture.

In case of open damage, the essence of the operation is as follows:

without a defect in the tendon or disintegration of its ends, the tendon is sutured end to end with interrupted and U-shaped lavsan sutures, chrome-plated catgut or wire according to the Bunnell method (after six weeks, the wire suture is removed with a special loop through the upper pole of the wound);
in case of a tendon defect or fiber separation, plastic restoration of the tendon is necessary; bridge autoplasty according to Chernavsky, autoplasty according to Nikitin, lavsanoplasty.

With a closed gap:

cutting the skin and various options end-to-end seam; plastic restoration using flaps from the proximal and distal ends of the tendon, lavsanoplasty;
percutaneous immersion suture for fresh ruptures, proposed by a professor at the Department of Traumatology, Orthopedics and military field surgery Russian state medical university S.G. Girshin.

It is important to note again that full recovery the function of the triceps surae muscle in case of rupture of the Achilles tendon is possible only with timely early surgical intervention. If the Achilles tendon rupture is not diagnosed and the patient continues to walk, putting weight on the sore leg, the ends of the Achilles tendon gradually move away from each other, which is facilitated by shortening of the triceps muscle due to its elasticity and lowering of the heel tubercle due to loss of function of the triceps surae muscle. Treatment of Achilles tendon rupture is currently carried out using low-traumatic incisions and modern instrumentation, which does not leave any scars, which are sometimes so frightening for young people. It is important to follow all doctor’s recommendations and a set of rehabilitation procedures.

Examples of exercises for training

Achilles tendon rupture– serious injury, because connective tissue It is completely restored only after 6 months.

Injury to the Achilles tendon threatens repeated rupture, wound infection, chronic pain syndrome, marginal wound necrosis, damage to the sural nerve, and loss of elasticity due to the overgrowth of dense connective tissue at the rupture site.

Characteristics of Achilles injuries

There are three grades of Achilles tendon injury:

First degree– characterized by rupture of connective tissue at the microscopic level. The overall structure of the tendon and its continuity are preserved.
Second degree (tear)– partial rupture at the macroscopic level. The continuity of the Achilles is preserved, but some of the movements are lost.
Third degree (rupture) – extreme degree injuries. Continuity is lost, damaged general structure Achilles The motor function of the calf muscle is completely lost. Read more about how to distinguish a tendon sprain from a rupture.

The patient often experiences tendon bruise – closed damage tissues without gross structural disturbances. The skin is often damaged along with the connective tissue, subcutaneous tissue and muscles. The bruise recovers quickly and, with proper care, does not cause complications.

Read more about what kinds of Achilles tendon injuries there are and how to diagnose them.

Symptoms of a Heel Tendon Strain

Stretching has the following symptoms:

Tolerable, minor pain that does not hinder the activity of the limb. But the pain may intensify with movement.
Expressed external changes not on the skin. There may be minimal swelling or blue discoloration.

Symptoms of tear (partial, incomplete tear)

Signs of tearing:

Severe pain that limits movement. The victim cannot use the affected leg as a support leg.
Limiting active movements.
The site of injury swells: a blue tint of the skin and swelling appears. Visually, the ankle area increases in size.
Pinpoint subcutaneous hemorrhages.
Passive movements are possible, but due to pain they are limited.

Signs of a rupture

Clinical picture of Achilles tendon rupture:

Signs of bruise

Achilles tendon bruise– the simplest among other injuries, since the integrity of the ligament is not compromised.

Signs of injury:

Pain. Its severity depends on the force of the blow. As a rule, pain increases over several hours.
Subcutaneous hemorrhage is the most characteristic feature bruise.
Physical safety of all movements: stiffness may appear due to pain.
Edema. The impact site turns blue. On palpation, a painful compaction is detected.

Photo of the Achilles ligament

The photographs below depict Achilles tendon sprains and tears.

Operation

Treatment for rupture is surgical. A cast for a ruptured Achilles tendon (Achilles) is applied after surgery. The fact is that the torn Achilles tendon needs to be sutured, and for proper fusion the limb needs to be tightly fixed: unnecessary movements will damage the connective tissue and it may not strengthen properly. More detailed information about whether surgery is necessary for partial rupture Achilles tendon, can only be given by the attending physician.

Without surgery, the connective tissue will not heal. Surgical intervention - the simplest way restore lost functions of the foot and lower leg, restore muscle strength and strength of the Achilles tendon. Besides, surgery reduces the risk of recurrent ruptures.

Classic open access

Technique: The skin is cut along the Achilles tendon. The incision reaches 20 cm. Soft tissues are dissected longitudinally. Two fragments of the Achilles are isolated and prepared for stitching. Before this, they are cleaned of dead particles. The ends of the Achilles tendon are aligned with each other as closely as possible. Then they are stitched and pulled together.

The main seam is complemented by a U-shaped seam, which performs an auxiliary fixation function. Soft fabrics and the skin is also sutured. After the intervention, the leg is fixed with a splint.

Plastic surgery according to Chernavsky

Need for plastic surgery occurs when gross violation fibrous structure of the Achilles tendon - a variant of rupture in which both ends are disintegrated. Also, the Chernavsky operation is performed for old ruptures and dystrophic changes connective tissue.

Technique: a longitudinal seam is made along the length of the Achilles. Having gained access, the surgeon creates a flap, the length of which does not exceed 8 cm. Using threads, the torn ends of the Achilles tendon are brought together, then they are covered with a flap at the site of the rupture.

This method strengthens the tissue twice as much as the classical method. Kirschner wires are used to prevent recurrence of postoperative rupture.

Methods used to strengthen the Achilles tendon during surgery:

Straight stitching. Use after removing dead areas. The Achilles stumps are connected and secured with sutures.
Bunnell seam. The structure of the seam consists of intertwined threads on two needles, which are sewn along the entire length of the Achilles.
Fibrin glue. Indicated for rough defibration of fabrics. The torn and unfibered ends are glued together. The ends of the Achilles are strengthened in 25-30 seconds. Advantages of glue: ensuring blood clotting and reliable strengthening of tissues. This prevents postoperative complications and re-break.

Consequences of surgery

IN postoperative period the following complications may occur:

How to treat damage at home

At home, you can only treat inflammation that occurs as a result of sprains and tears.

After first aid, pain should be relieved using ointments and tablets (see above). After the victim’s pain has passed, cold is applied to the area of injury for the first 2-3 days. Low temperature should be applied for 20-30 minutes 2-3 times a day.

Instead of cold you can cook home recipe – bandage on saline solution . How to do: you need to mix a tablespoon of salt and a glass of water, approximately 250 ml. Soak a towel in the liquid, wrap it in plastic, and place it in the freezer for 1 hour. Then remove the polyethylene and wrap the fabric around your leg with a bandage.

After the 3rd day (not earlier!) on the Achilles tendon heat can be applied.

The use of folk remedies

The following folk remedies can be used to treat Achilles tendon:

Boil 500 ml of milk and add a tablespoon of dry yarrow to it. Leave for 20 minutes, then strain the milk, moisten a cloth in it and apply to the stretch.
Applying slices raw potatoes. To improve the effect, potatoes can be mixed with salted cabbage, an onion and a teaspoon of sugar. The application is done overnight.
Grind one onion and mix the resulting pulp with a tablespoon of sugar. Apply overnight.
Grind 5 aloe leaves to a paste and apply as a compress to the Achilles for 5-6 hours.
Take half a lemon and a head of garlic. Squeeze the juice from the lemon and grind the garlic. Mix. Soak gauze with this paste and apply it to the affected area for 30-40 minutes. If the gauze is dry, replace the compress and apply again.
Decoction of plantain seeds. Take 2 tablespoons of seeds and pour one glass of boiling water over them. Boil for 20 minutes and leave until cool to room temperature. Strain the liquid. Drink two tablespoons 3 times a day.
A few drops lavender oil mix with 2 drops fir oil, add to them a teaspoon of any other vegetable oil. Rub the tendon with this liquid every morning.
Pour two tablespoons of wormwood into a glass of boiling water and leave for 30 minutes. Strain the liquid. Take 3 times a day.

Forecast

The prognosis for rupture is favorable only if all the doctor’s recommendations are followed. Average term healing of Achilles tendon rupture – 3-4 months. Of these, the leg is in a fixed state for 2-3 months. After healing, rehabilitation begins with the restoration of lost functions.

Useful video

In the video, the surgeon clearly shows the main sign of a rupture - the “gap” between the torn ends of the Achilles.

Results

Consequences of rupture: wound infection, chronic pain, necrosis of the wound edges, nerve damage, loss of tendon elasticity and strength of the calf muscle, re-rupture.
Symptoms of an Achilles tendon rupture: pain, swelling, subcutaneous hemorrhages, limitation and stiffness of movements, popping at the time of injury; palpation reveals the two ends of the ruptured Achilles.
The rupture is treated with conservative therapy and surgery.
Postoperative consequences: tissue infection, re-rupture, nerve damage, impaired wound regeneration, tendon thickening and elongation, calcium deposition and thromboembolism.
The average healing time for a rupture is from 2 to 4 months.

The Achilles tendon of the triceps surae muscle can withstand a deadlift of 400 kg. Nevertheless, Achilles tendon rupture is, unfortunately, not a rare injury, especially in sports. Fortunately, today it is completely curable with surgery. And using the technique of the famous rehabilitation physician Mark Gershburg, you can restore the functionality of this important body to the previous level.

Immobilization period ( first 1.5 months after operation)

Immediately after the operation, a plaster cast is applied. In the first three weeks after surgery, exercises are performed in the starting positions lying and sitting: special exercises for the toes, hip joint and - if the cast allows - for the knee joint.

A set of special exercises (4-5 weeks after surgery):

Sitting on the floor, flexion and extension of the toes (from the first week) (1 min.);
lying on your back, imitation of cycling, forward and backward (if the cast allows - from the first week) (1-2 min.);
lying on your stomach, counter bending the legs at the knee joints (if the plaster allows - from the first week) (1 min.);
sitting on a chair, pressing the plantar part of the foot on plaster cast(first learn to perform a similar movement with your healthy leg), the degree of tension is minimal (the time of one tension varies from 1 to 8 seconds, pauses - 3 seconds, total time - up to 3 minutes);
lying on your healthy side, circular movements in hip joint in both directions alternately (5 min.);
sitting, leg extension from 90 to 180″ with additional weights designed for 20-30 movements (2-3 series);
lying on your back, legs straightened. Raising the pelvis with support on the heels and shoulder blades (1 min.).

The period of recovery of ankle joint function ( from 1.5 months up to 3.5 months after operation)

To avoid complications, immediately after removing the plaster “boot,” you must strictly follow the prescribed motor regimen. “Learning to walk” should be done in heels (up to 4-5 cm), since extension of the ankle joint is limited. In the first 2-3 days (and in winter - up to 57 days), you need to walk with crutches and on a flat path, guided by the following rules:

the position of the longitudinal axis of the foot should be strictly parallel to the direction of movement;
a small step length is selected (about half a foot). In this case, a slight tension should be felt in the operation area.

As fuller extension of the foot is restored, the stride length gradually increases to one foot length and then to three foot lengths. As normal stride length is restored, the height of the heels decreases to 3 centimeters. This usually takes 5-7 days. Another 5-7 days are required for the athlete to train in walking in sneakers. In some cases, you can use a lining in the heel area made of felt, felt or dense rubber 1 cm high. The duration of walking training gradually increases from 15-20 minutes. up to 4560 min. by two months after surgery. Walking training is preparation for running. To start slow running, two mandatory conditions are determined:

absence of overload complications;
Meeting the walking standard - 6 km in one hour (by 4 months after surgery).

However, it is too early to start running in the 2nd period. But it’s time to do stretching exercises using the so-called. mini exercise machines. These include:

“rocking chair” - a device resembling a paperweight;
foot pedal - part of a sewing machine;
a footrest with “reins” made of cord or rubber bandage.

These exercises should be dosed in terms of amplitude and effort very carefully so as not to damage the Achilles tendon.

All special exercises for the period from 1.5 to 2 months. after the operation they are combined into a complex:

sitting on the floor, flexion and extension of the fingers and ankle joint (1-2 min.);
lying on the floor, simulating the rotation of bicycle pedals (emphasis on the work of the feet) (2-3 min.);
lying on your stomach, alternate flexion and extension of the feet (1 min.);
sitting on a chair, simultaneously raise and spread your socks, resting on your heels, then lift and spread your heels, resting on your toes (1 min.);
sitting on a chair, lifting onto your toes, overcoming the weight of a weight (5-10 kg) placed on the thigh (until fatigue);
sitting on a chair, static support with the foot against the wall (5-8 sec.) followed by relaxation (2-3 sec.) (1-2 min.).

2 months after surgery, the set of exercises includes holding body weight while standing on your toes. Recommended to use different staging stop: strictly parallel to each other, with toes turned outward and inward.

A set of special classes ( 2.5-3 months. after operation)

Sitting on the floor, legs apart, circular movements of the feet with maximum amplitude, alternately in both directions (1-2 min.);
sitting on a chair, flexion and extension of the feet with heels on the floor (1-2 min.);
standing, raising on toes (10-15 times);
standing, holding onto a support, the operated leg in the rear push position, static support with the leg (5-10 sec.) followed by muscle relaxation for 2-3 sec. (5-10 times);
standing on your toes, holding onto a support, transferring weight from toe to toe (1 min.);
standing at a support, walking on toes with springy swaying on the supporting leg (1 min.); g) raising toes (5-10 times).

A set of exercises in the pool ( about 2 months after operation)

Holding the handrail, simulating cycling with an emphasis on pedaling alternately in both directions (1-2 min.);
standing at the handrail, feet wider than shoulder width, alternating lunges to the sides with maximum extension of the feet (1-2 min.);
slow walking with a roll over the longitudinal arch of the feet (2-3 minutes);
standing on your toes at the handrail, alternately touching the bottom with your heel with full extension of the knee and ankle joints(1-2 min.);
holding the handrail and resting your feet on the side, alternate lunges to the sides with maximum ankle extension (1-2 min.);
walking with a roll over the longitudinal arch of the feet (2-3 min.);
breaststroke swimming;
walking with toes raised;
backstroke.

Training and recovery period ( 3.5 months after operation)

In addition to the exercises of the 2nd period, developing the ankle and knee joints, in the 3rd period (especially from the 4th month) the following exercises are performed:

rise on the toes on a step of 5-7 cm (after 5-7 days - only on the toe of the operated leg, holding onto the support;
walking in a semi-squat - “goose walking”;
jumping rope from foot to foot;
standing in a mixed support with your hands, jumping from a half-squat to a half-squat;
holding onto the squat support without lifting your heels off the floor;
static support with a pushing leg (5-8 sec.) alternating with muscle relaxation (2-3 sec.)

Following this technique on your own, you need to react very sensitively to the slightest problems in the operated joint and, as they say, think with your head. For example, when performing a “calf raise on a step,” the center of gravity first shifts toward the healthy leg. And you need to very clearly control your sensations in order to gradually increase the load and after a week rise on the toe of only the operated leg.

And lastly: the fact that the rehabilitation period is already the third does not mean that you can do whatever you want, since a person who has undergone such an operation must remain under close supervision medical center until complete recovery. In addition: all physical activity and rehabilitation periods must be agreed upon with the attending physician. Don't forget this!

Achilles tendon rupture - injury history

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According to statistics, the most Achilles tendon ruptures are recorded among people involved in active species sports This is an injury in which the tendon that connects the muscles of the back of the leg to the calcaneus.

With this injury, you may feel a clicking or cracking sound, after which a sharp pain appears in the back of the ankle. The injury almost always prevents normal walking, and many doctors recommend surgery as the best option. effective method treatment of rupture. However, more conservative approaches may also be effective.

Symptoms

Although Achilles tendinitis and subsequent rupture may be asymptomatic, most people notice one or more signs of damage:

pain (often severe and accompanied by swelling in the ankle area);
inability to flex the foot downward or push the affected leg off the ground while walking;
inability to stand on the tips of your toes on the injured leg;
a clicking sound or cracking sound when the tendon ruptures.

Even if there is no pain as such, you should seek medical advice immediately after you hear a clicking or cracking sound in your heel, especially if immediately after this sound you lose the ability to walk normally.

Causes

Helps to lower the mobile part of the foot down, rise on tiptoes and push off the ground with the foot when walking. It gets involved in some way every time you move your foot.

The rupture usually occurs in an area six centimeters above the junction of the tendon with the heel bone. This area especially vulnerable, since blood circulation is difficult here. For the same reason, the tendon heals very slowly after injury.

There are very common examples of Achilles tendon ruptures caused by sharp increase load:

increasing the intensity of sports, especially if they involve jumping;
falling from height;
getting your foot into a hole.

Risk factors

Certain circumstances increase the risk of Achilles tendon ruptures:

Age. Most often injuries of this type observed in patients between thirty and forty years of age.
Floor. According to statistics, for every one female patient there are five men with a tendon rupture.
Sports activities. Most often, damage is caused by physical activity, including running, jumping and alternating sudden movements and stops. Examples are football, basketball, tennis.
Steroid injections. Doctors sometimes prescribe steroid injections to reduce pain and relieve inflammatory process. However, these substances can weaken nearby tendons and eventually lead to tears.
Taking some, such as Ciprofloxacin or Levofloxacin, increases the risk of injury in everyday activities.

Before visiting the doctor

Considering that a rupture (or just inflammation) of the Achilles tendon can lead to an inability to walk normally, you should immediately seek medical help. medical care. You may need to additionally visit a doctor who specializes in sports medicine or orthopedic surgery.

To ensure your consultation is as effective as possible, write down the following information on paper immediately before your appointment:

a detailed description of the symptoms and the previous incident that caused the injury;
information about past health problems;
a list of all medications and nutritional supplements taken;
questions you would like to ask your doctor.

What will the doctor say?

The specialist will likely ask you the following questions:

How did the tendon injury occur?
Have you heard (or perhaps not heard, but felt) a clicking or cracking sound when you were injured?
Can you stand on your toes on your injured leg?

Diagnostics

At primary medical examination Your doctor will examine your lower leg for tenderness and swelling. In many cases, a specialist can manually palpate the discrepancy in the tendon if it has completely ruptured.

The doctor may ask you to kneel on a chair or lie on your stomach on the examination table with your feet hanging over the edge of the table. With this diagnostic method, the doctor squeezes calf muscle patient to check the reflex: the foot should automatically flex. If it remains motionless, there is most likely an inflammation of the Achilles tendon. This is what ultimately led to the injury.

If there is a question about the extent of the damage (that is, whether the tendon is completely torn or only partially torn), the doctor will prescribe ultrasonography or magnetic resonance imaging. These painless procedures allow you to take detailed pictures of any tissue or organ in the body.

Treatment

Many people injure their Achilles tendons to some degree. Treatment often depends on age, level physical activity and severity of injury. In general, the patients are young and physically active people surgical intervention is usually chosen, this is the most effective method. Older patients age groups are more often inclined towards conservative treatment. According to latest research, correctly prescribed conservative therapy can be no less effective than surgery.

Treatment without surgery

With this approach, patients usually wear special orthopedic shoes with a platform under the heel - this allows the torn tendon to heal on its own. This method excludes many, such as infection. However, recovery when wearing orthopedic shoes takes much longer than treating the injury with surgery, and there is a high risk of re-rupture. In the latter case, you will still have to resort to surgery, but there is a high probability that it will now be much more difficult for the surgeon to correct the Achilles tendon rupture.

Operation

Typically surgery consists of the following. The doctor makes an incision in the back of the leg and stitches the torn parts of the tendon. Depending on condition damaged tissue It may be necessary to reinforce the sutures with other tendons. Among possible complications Infections and nerve damage have been reported following surgery. The risk of infection is greatly reduced if the surgeon makes small incisions during surgery.

Contraindications

Treatment of Achilles tendon ruptures operative method Contraindicated for those diagnosed with an active infection or skin disease in the area of injury. Conservative therapy is also prescribed to patients with general poor health, diabetes, and smoking addiction. Circumstances such as a sedentary lifestyle, the use of steroids, and the inability to follow the surgeon's postoperative instructions are also contraindications. Any questions about your health should be discussed with your doctor first.

Rehabilitation

To permanently treat a ruptured Achilles tendon (after surgery or conservative therapy- no matter), you will be prescribed a rehabilitation program that includes physical exercise to train the leg muscles and Achilles tendon. Most patients return to their the usual way life four to six months after the end of therapy or surgery.

Exercises

After conservative treatment Rehabilitation exercises can begin immediately after the pain disappears, after surgery - as soon as the surgical wound has healed. Exercise is the key to full recovery from injury (especially if that injury is an Achilles tendon rupture). Rehabilitation begins with massage and increasing the overall mobility of the ankle - the feeling of stiffness should disappear. After two weeks of gentle therapy, active exercises are prescribed, and best results can be achieved if you devote much-needed physical activity from 12 to 16 weeks. The load begins with stretching, then moves on to strength exercises, including bending and straightening the knee.

If the pain syndrome has passed completely, you can add a more sports-oriented load to your training. It is advisable for athletes to go for runs and do more jumps. Recurrent Achilles tendonitis and subsequent re-rupture will be much less likely if the patient carefully adheres to the prescribed rehabilitation measures.