home Diseases Achilles tendon sprain. Achilles tendon rupture - treatment and rehabilitation

Achilles tendon sprain. Achilles tendon rupture - treatment and rehabilitation

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 doctor 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 the plaster cast (first learn to perform a similar movement with the 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 the 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 road, 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 Achilles tendon.

All special exercises during 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. It is recommended to use different positions of the feet: strictly parallel to each other, with the 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 heel to the bottom 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, which develop 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 towards 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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The triceps surae muscle consists of three heads: two superficial and one deep. The superficial heads - internal and external - form the gastrocnemius muscle. The third deep head is formed by the soleus muscle. In the middle of the lower leg, all three heads form the most powerful tendon in the entire human body, the heel, or Achilles.

In the lower part of the leg, the Achilles tendon narrows somewhat and attaches to the tubercle of the heel bone.
The function of the triceps surae muscle is that it is a powerful flexor of the foot and lower leg.
An Achilles tendon rupture can be open or closed (subcutaneous).

Open injuries to the Achilles tendon are the result of exposure to sharp (cutting and piercing) objects on the posterior-inferior surface of the leg.
Remember! All wounds, especially those located near the Achilles tendon, should be carefully examined, and the function of the triceps surae muscle should also be checked.

Closed, subcutaneous rupture of the Achilles tendon. The mechanism of injury is the result of contraction of the triceps surae muscle, the force of which exceeds the strength of the tendon.

Indirect: sudden, sharp, violent stretching of the triceps surae muscle and (as a result of this stretching) its excessive contraction under the simultaneous action of body gravity.
Such damage to the Achilles tendon occurs during a jump or landing after a jump in jumpers, volleyball players, gymnasts, fencers, and ballet dancers.

Direct: blunt force trauma to the Achilles tendon causes sudden, violent contraction of the triceps surae muscle and rupture of the tendon.
Many researchers believe that Achilles tendon rupture occurs due to chronic disease from overvoltage. For athletes, dancers, acrobats degenerative changes Achilles tendons are professional in nature.

Localization of Achilles tendon rupture

1. The upper third of the Achilles tendon at the tendon-muscular border.
2. The middle third is in the Achilles tendon itself (the most common location).
3. The lower third is above the tubercle of the heel bone.
4. Separation of the tendon from the heel tubercle:
- without bone damage;
- with separation of part of the tubercle.

The student and physician should be aware that Achilles tendon ruptures can be complete or incomplete.

Clinical symptoms.

Sharp pain at the site of injury (“as if someone hit the leg with a stick”). The pain is constant, aching.
- Examination reveals retraction over the rupture site, the severity of which depends on the amount of edema and hemorrhage; swelling, hemorrhage, which can spread from the site of the Achilles tendon rupture to the thigh (hemorrhage appears 2-3 days after the rupture).
- Palpation reveals a tendon defect: two thickenings are palpated at the locations of the central and peripheral ends of the torn tendon.
- Active flexion of the foot is impossible with a complete rupture of the Achilles tendon; with a partial rupture, active movements are possible, but weakened.
- Passive movements in the ankle joint are possible, but sharply painful due to stretching of the ends of the torn Achilles tendon.
- Positive Thompson's sign: the calf muscle is compressed with the hand in the upper third, normally the foot assumes a flexion position. When the Achilles tendon ruptures with compression of the calf muscle, the tension of the tendon is not transmitted to the heel tubercle, and there is no movement in the ankle joint (plantar flexion of the foot).
- Complete loss functions of the triceps surae muscle: the patient cannot stand on the toes of the injured leg.
- Lameness when walking due to loss of function of the triceps muscle.
- Positive Pirogov's symptom: the patient lies on the couch on his stomach, his feet hang over the edge. The patient is asked to contract the triceps muscles of both legs, while on the healthy leg the contours of the outer and inner heads of the gastrocnemius muscle appear, on the damaged leg the heads of the gastrocnemius muscle are not contoured.

Treatment.

Surgical treatment of Achilles tendon ruptures is the treatment of choice. Pain relief - local anesthesia, epidural, intraosseous anesthesia, but the best method for pain relief, conduction anesthesia can be considered sciatic nerve 1.5% trimecaine solution or 2% lidocaine solution.

Open damage:

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 its fiber separation, plastic restoration of the tendon is necessary; bridge autoplasty according to Chernavsky, autoplasty according to Nikitin, lavsanoplasty.

Closed (subcutaneous) tears:

dissection 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 the professor of the Department of Traumatology, Orthopedics and military field surgery Russian state medical university S.G. Girshin.

The essence of the method is as follows.

Position the patient on his stomach with a bent position knee joint foot. The foot in the equinus (plantar flexion) position is firmly fixed on a wooden wedge.
- The level of Achilles tendon rupture is determined by palpation; Diamond green marks the contours of the tendon, calf muscle and diastasis between the ends.
- Using a surgical cutting needle and thread (chrome-plated catgut), the skin along with the tendon is pierced in the transverse direction directly at the point of attachment to the heel tubercle.
- The needle is inserted into the same puncture point on the skin and passed back in an oblique direction. A ligature loop will stand above the skin. By pulling the thread, it easily sinks under the skin.
- Similarly, the needle and thread are passed on the other side; after 2-3 times suturing of the tendon and skin, the ligatures are removed to the distal end of the tear. After each stitching, the threads are tightened.
- The belly of the gastrocnemius muscle is stitched in the transverse direction in the lower third of the leg 6-7 cm above the rupture of the Achilles tendon.
- Gradually, after 2-4 times suturing, the ligature is removed to the proximal end of the tendon rupture. After each stitching, the threads are tightened.
- If the ligature loop displaces and retracts the skin during immersion, the latter is released by mobilization with a mosquito-type hemostatic clamp.
- The ligatures are connected on each side by passing the threads through the same holes in the skin into which the ligatures were brought out from the distal end of the torn tendon.
- The ends of both ligatures are tied simultaneously or sequentially on both sides when the tibia is flexed at the knee joint to 50-80° and the foot is maximally flexed. After tying, the knots are easily immersed by a “mosquito” through the same holes from the needle puncture.
- On the pinpoint wounds on the skin formed after immersion of the nodes, one interrupted suture is applied with thin catgut.
- A cut plaster cast is applied to the middle third of the thigh. The lower leg is bent at the knee joint to an angle of 40-50°, the foot is bent to an angle of 45°.

Postoperative period.

After the operation, observation in the hospital is carried out for 1-2 days; The operation can be performed as an “outpatient” operation, i.e. The patient is discharged home after the operation.
- 3 weeks after the intervention, the high plaster cast is changed to a “boot.” The foot is placed in flexion at an angle of 5-10°. The heel is attached to the plaster cast, and the patient puts full weight on the leg.
- After 3 weeks, the plaster cast is removed. The total fixation period is six weeks.
- Bandaging with an elastic bandage, physiotherapy, massage, swimming in the pool, warm baths, paraffin applications to enhance the tone and strength of the calf muscle.
- During the first 4-6 weeks after removing the plaster cast, you must use a heel that is at least 2.5 cm high.

Working capacity is restored 2.5 months after surgery on the Achilles tendon. Sports activities are started six months after the operation.

Remember! Complete restoration of 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 rupture of the Achilles tendon is not diagnosed and the patient continues to walk, loading the sore leg, the ends of the Achilles tendon gradually move away from each other, which is facilitated by the shortening of the triceps muscle due to its elasticity and the lowering of the heel tubercle due to loss of function of the triceps surae muscle.

Vorotnikov Alexander Anatolyevich, candidate medical sciences, Associate Professor, Head of the Department of Traumatology, Orthopedics and Military Surgery of St. State Medical Academy,
Barabash Yuri Anatolyevich, Doctor of Medical Sciences, Professor of the Department,
Apaguni Artur Eduardovich, Candidate of Medical Sciences,
Anisimov Igor Nikolaevich, Candidate of Medical Sciences,
Mosiyants Vachagan Grigorievich, assistant Enikeev Marat Rafaelevich, assistant.

Alexei 12.07.12, 17:09

hello, 6 weeks ago we had surgery, 5 weeks later we stretched the foot to 90 degrees due to a regional injury, but we couldn’t stretch it to about 110 degrees, a cast was applied at the back of the leg, and after this stretching the leg began to darken from the tips of the toes and just above the knee, The doctor prescribed vascular pills and said that this is normal, and my nails on my sore foot are not growing... is this normal?

Anna 26.06.12, 23:53

please answer by mail is possible .

Anna 26.06.12, 23:50

Good evening 3 months ago, surgeons sewed the Achilles, but after 3 weeks they removed the plaster and a month later the ligament was partially torn again, I can’t push off and strained the calf muscle in the area, they said to re-suture the old tear, but take the ligament or donor or from the knee joint of the other leg. I do dancing, please tell me . what is the prognosis for this operation? thank you very much

In most cases the separation Achilles tendon occurs due to strong physical stress on this area. This condition may result from direct or indirect exposure. The main contributing factors are:

A sharp blow to the tendon - possible when active games, as well as professional football.
Increased load on the heel - this condition mainly occurs in sports that involve jumping.
Ankle injury due to sharp drop with toes pointed forward.
Unnatural and sudden flexion of the foot - occurs when the foot falls into a hole or slips down the stairs.

Often, damage to the ligaments and tendons is localized in the area close to the heel. This is explained by the fact that this topical treatment has poor blood circulation and, in case of injury, takes a long time to heal.

The heel tendon is most often injured in runners. The reason may be insufficient warm-up before physical activity.

Injuries to the Achilles tendon are mainly observed with insufficient stretching and warm-up before training in athletes, with a decrease in the strength and elasticity of the lower leg muscles, after previous inflammatory diseases of the tendon (Achilles bursitis, tendonitis), as well as against the background of local injection hormonal drugs to the Achilles area.

Causes of Achilles rupture can also be degenerative changes in the tendon, a decrease in its blood supply, which manifests itself with age, as well as microtrauma.

Microtearing of the fibers (an injury incorrectly known as an Achilles tendon strain) can occur with any careless movement of the leg. As for more serious injuries Achilles tendon, then it provokes specific set risk factors.

careless activity, training without warming up;
injuries as a result of road accidents, household, industrial damage;
inflammatory processes of fibrous tissue, micro-tears – tendenitis;
degenerative processes in body tissues due to disease or age (tendinosis), which are the result of bursitis, tendonitis, arthrosis of the foot;
rapid change of activity - sudden braking or acceleration;
direct blow or fall;
cutting effect.

Active men (30-40 years old), as well as persons undergoing treatment with powerful antibiotics (fluoroquinols) and taking steroid drugs, are most susceptible to this type of damage. Sometimes injuries occur in those who have previously pulled a muscle and thereby weakened the limb.

Depending on the cause, supraspinatus tendon tears can be traumatic or degenerative.

Degenerative ruptures occur due to chronic microtrauma of muscles. People who are most prone to such ruptures professional activity one way or another associated with the frequent position of the shoulder in a state of abduction (teachers, builders, some athletes). This rupture mechanism also occurs in people with a genetic predisposition.

Classification

There are 3 degrees of rupture:

The tendon fibers are partially torn, but the overall integrity is preserved. This stage is called stretching. Treatment for an Achilles tendon strain often takes 2-3 weeks.
Most of the soft tissues are damaged, but partial integrity is preserved. This type of injury requires treatment for up to 6 weeks.
Complete tendon rupture. Accompanied by severe swelling and bruising. Treatment takes more than 2 months.

Injury to the Achilles ligament occurs as a result of strong external influences or serious illnesses, disrupting the structure of the fibers. Injuries are divided into several types.

Mechanical damage

Its main condition is severe overvoltage or a blow to a stretched ligament. This happens most often in professional sports or in car accidents.

Normal mechanical damage is preceded by microtraumas that disrupt tissue structure. Rupture of a healthy Achilles occurs very rarely with targeted strong external influence- workplace injuries, car accidents, falls from heights.

Inflammatory process

Acute inflammation Achilles tendon - achilles (or achillotendinitis) is rare. It's usually gradual evolving process, which involves neighboring anatomical formations ( bursa the ligament itself - achillobursitis, the tissue surrounding the tendon - peritendinitis, damage to the place of attachment of the ligament to the heel bone - enthesopathy).

Chronic inflammation is complicated not only by tendon tears, but also by the formation heel spurs, lumps on the tendon or its calcification. Predisposing causes of Achilles tendinitis are:

Age after 40 years when the elasticity of tissues is gradually lost and the slightest awkward movement leads to microdamage and tissue inflammation.
Uncomfortable shoes, especially in combination with overweight bodies. The constant elevation of the foot when wearing heels leads to shortening of the ligament. If a woman suddenly switches to a flat sole, the Achilles tendon becomes torn and inflamed.
Diseases with an autoimmune component, affecting connective tissue: rheumatoid arthritis, bursitis after bacterial streptococcal infections(angina, scarlet fever).

Long-term inflammation leads to thinning of the connective tissue fibers, a decrease in its elasticity, which can result in injury.

Degenerative gap

Ruptures of the supraspinatus tendon can be complete or incomplete depending on the number of damaged fibers.

With partial ruptures, pronounced pain syndrome and limitation of mobility in shoulder joint, however its function is retained.

With a complete rupture, the entire thickness of the fibers is damaged, and the abduction function upper limb is completely lost.

Symptoms

An Achilles tendon rupture is accompanied by certain symptoms, which, depending on the severity, type and extent of the lesion, can be severe or mild. Often they look like an ordinary sprain, a simple bruise, to which people do not pay due attention and do not seek help from a doctor.

A sprain of the Achilles tendon is always accompanied by pain of varying severity and limitation of joint movement. Pain from an Achilles sprain is localized exactly in the area of injury - between the heel and the calf muscle.

Depending on the depth of the lesion painful sensations can be severe or moderate. Additional symptom Achilles tendon sprain - tumor-like formation in the area of the ligament.

With a complete rupture, a person cannot “stand on his toes.” You may also hear a clicking or cracking noise at the time of injury.

A special type of pathology is chronic sprain of the Achilles tendon. It develops if, after a sprain of the Achilles ligament, qualified medical care was not provided.

Clinical picture chronic illness in addition to the listed symptoms, it includes an increase in the size of the triceps surae muscle. Excessive flexion of the foot may also occur if more than 6 months have passed since the injury.

When the Achilles tendon ruptures, the function of the foot is impaired, flexion in the ankle joint disappears and the heel drops. The patient complains mainly of acute pain in back surface lower leg and ankle. Pain and limited movement in the foot are usually preceded by a clearly audible click on the back of the ankle joint at the time of injury or simply due to unsuccessful movement.

You can often see a defect or retraction in the Achilles tendon area, which can be determined by touch. Injury often occurs while playing sports.

Damage to the Achilles tendon can be recognized based on an assessment of the victim’s condition. There is a set of signs that indicate injury and are considered as typical symptoms rupture of the Achilles tendon.

Depending on how badly the tissue is damaged, symptoms may increase gradually or appear immediately in the first minutes after injury. It is important to notice problems immediately, since delay is a threat of inflammation with subsequent loss of normal leg mobility.

Signs of damage are as follows:

sharp pain cutting in nature, localized around the ankle;
increasing swelling of the Achilles area (about 5 cm above the heel);
gradual manifestation of bruising;
the inability of the victim to stand on tiptoe; any attempts lead to an increase in swelling, as well as cutting pain;
It is especially dangerous if, along with the tendon, a ligament, muscle, or joint also suffers; in this case, clicks are heard when moving the foot.

Regardless of the cause, Achilles tendon injuries have common characteristics:

Pain in the shoulder area. The intensity of the pain is directly proportional to the extent of the rupture. The pain intensifies when the shoulder is abducted at an angle of more than 70 and can radiate to the elbow.
Limitation of mobility in the joint. The degree of limitation of mobility depends on the number of damaged fibers (with a complete rupture, there is a complete inability to move the arm to the side).

Diagnostics

How to detect an ankle injury and ligamentous apparatus? To do this, the doctor conducts instrumental diagnostics, allowing you to accurately make a diagnosis, assess the extent of the lesion, type and possible consequences.

As an examination, the following methods are often used:

Ultrasound - used to determine the classification of avulsion, helps identify complete or partial violation.
MRI - used for a more accurate, thorough study. Using magnetic resonance imaging, the doctor assesses the extent of the damage and determines the reason why the tendon could be torn.
X-ray is also a mandatory diagnostic method, but is used less frequently than ultrasound and MRI.

An Achilles sprain can often be diagnosed based on symptoms and history. Patients report severe pain when walking, after performing physical exercises involving the legs.

To confirm the diagnosis, there are clinical tests that can only be performed by a traumatologist. At positive reaction After the test, a sprain of the Achilles tendon is confirmed.

You may also need additional instrumental methods research. These include:

radiography;
ultrasonography;
Magnetic resonance imaging.

If a sprained Achilles ligament is not diagnosed in a timely manner and left untreated, it becomes chronic.

Differential diagnosis carried out with diseases such as:

rupture of the posterior group of muscles of the leg;
damage to the heel bone;
overtendency;
deep vein thrombosis.

A doctor's examination is usually sufficient to diagnose an Achilles tendon injury. During the examination, the doctor performs a number of clinical tests, such as the Thompson or Matles test. Positive results tests strongly indicate an Achilles tendon rupture.

The diagnosis is also confirmed using ultrasound or MRI. All patients without exception with Achilles tendon injuries undergo x-ray examination ankle and heel bone to avoid fractures.

To clarify the diagnosis, the injured person must be shown to a doctor. It's about about a traumatologist, orthopedist or surgeon. The doctor will talk with the patient, examine him, and also prescribe examinations.

The results of ultrasound, MRI and CT are helpful in clarifying the condition of the tissues. X-ray is not considered diagnostic of Achilles tendon rupture, but is useful in determining the presence of concomitant bone damage.

Clinical tests help determine with high accuracy that the Achilles tendon area is torn.

With strong compression of the calf, the injured leg, unlike the healthy one, does not extend forward (Thompson test).
If the patient, lying on his stomach, bends his knees, then the damaged foot hangs significantly lower than the healthy one.
If, under anesthesia, a needle is inserted into the area of the tendon plate, then any movement of the foot will deflect the needle.
Sometimes an injury is diagnosed by simple palpation.

Any diagnosis begins with a detailed questioning of the patient about the circumstances of the injury. Sometimes this alone is enough to make you think about an Achilles injury.

Upon palpation, the doctor detects a characteristic failure of the tissue at the site of the rupture. But Achilles tendon injuries are insidious and often lead to diagnostic errors.

Let's consider possible situations when doctors have difficulty establishing correct diagnosis:

It is believed that with this injury the person is unable to plantar flex the foot. In fact, this is not always the case.

If the patient has developed flexor muscles, the foot will flex even if the Achilles tendon is completely torn.

Then the doctor in best case scenario suspect a partial ligament rupture, which is treated conservatively.

Next to the Achilles there is another thin ligament - the plantar ligament, which can remain intact if injured. The traumatologist, upon palpation, mistakes it for part of the Achilles tendon and diagnoses an incomplete rupture.

In order to avoid these mistakes, there is an algorithm for diagnosing an Achilles tendon rupture by performing several tests.

Diagnostic test	Description
Calf compression	With the patient lying on his stomach, compress calf muscles, while flexion occurs in the healthy leg at the ankle joint. When the calcaneal tendon is damaged, there is no flexion.
Needle	A medical needle is inserted at the junction of the aponeurosis of the calf muscle and tendon. They ask the patient to move his foot and watch how the needle moves.
Knee flexion	In the supine position, the patient is asked to bend his legs at the knee joint. The foot on the affected side will be more bent.
Test with sphygmomanometer	If you put a pressure gauge cuff on your shin, pump up the pressure to 100 mmHg. Art. and move your foot, the pressure should increase to no less than 140 mmHg. Art. Less pressure indicates ligament damage.

For a correct diagnosis, two are usually sufficient. positive tests. In exceptional cases, prescribe instrumental study: radiography, ultrasound, MRI.

The doctor talks about the diagnosis and treatment of Achilles tendon injuries

After collecting anamnesis and complaints, the doctor will perform the necessary functional tests (the patient is asked to abduct the arm and hold it in the abducted position), based on which an injury can be suspected.

To confirm the preliminary diagnosis, instrumental research methods are used: radiography, magnetic resonance imaging and ultrasound diagnostics.

Treatment methods

Traditional medicine will help reduce pain and inflammation after a rupture. It has been popular in treatment since ancient times various diseases, including effectively combating tendinitis.

Good recipes are:

Ice can relieve inflammation and pain. To use it, you can make it yourself or purchase it at a pharmacy. It is necessary to wipe the ankle area with ice cubes several times daily for 15-20 minutes.
Saline dressings- you will need a glass for this warm water and a little salt. The ingredients are mixed, a napkin is soaked in the solution, then wrung out, wrapped in a bag and placed in the freezer for 5 minutes. The finished bandage is applied to the leg, secured with a bandage and kept until dry.
Wormwood tincture - stimulates the immune system, reduces inflammatory processes. Easy to prepare: 2-3 tbsp. spoons of grass are poured hot water, infuse for 30 minutes. Apply 3-4 times a day, 1 tbsp. spoon.
Clay ointment - suppresses symptoms well, removes swelling and pain. Clay in an amount of 500 g is dissolved with water to thick sour cream, add 4 tbsp. spoons of apple cider vinegar, stir. The finished ointment is applied to a napkin or bandage, applied to the leg, and left for an hour. The general course of therapy is 6 days.
Calendula ointment - used to reduce inflammation. To prepare, you will need plant flowers and baby cream. The components are mixed in equal quantities and used as needed.
Elecampane is an excellent compress. You need to fill the plant with water and boil for 15 minutes. For therapy, a napkin is moistened with a solution and applied to the site of injury. Can be done several times a day.

It is advisable to consult with your doctor before using traditional medicine recipes in order to eliminate undesirable consequences.

There is canning and surgical treatment. The conservative method is considered ineffective and is rarely used. The essence of the method is to apply a plaster cast to the injured leg. Then ointments, physiotherapy and physical therapy.

Since conservative treatment is practically useless, Achilles sprains are often treated surgically. The operation is performed under local or general anesthesia.

During surgery, the doctor mechanically stitches the tissues that have separated from each other. There are two types of access to perform an operation:

through an incision;
through a puncture

When making an incision, the surgeon sees the full picture of the damage and is guaranteed to sew up the torn tissue, but after the operation there will be cosmetic defect. When puncturing a scar, it is possible to avoid a scar, but the likelihood of incomplete comparison of tissues is greater than with the first method.

For chronic Achilles sprain, surgery is prescribed. Its goal is to restore the normal anatomy of the tendon and remove scar and damaged tissue.

Healing takes from 2 weeks to 6 months, depending on the severity of the injury, but periodically the victim will feel nagging pain.

The doctor chooses the method of treatment for an Achilles injury, taking into account clinical picture and the patient's health status.

With minor injuries and timely treatment, the prognosis is favorable, the injury usually resolves without consequences. If the rupture was massive, and it was not possible to get to the doctor immediately, complications are possible, including disability, without the possibility full recovery functions of the affected limb.

The main treatment for Achilles tendon injuries is surgery. Surgical suture Achilles allows you to quickly restore the function of the foot, as well as the strength and durability of the muscles and tendons of the lower leg. The likelihood of recurrent Achilles tendon ruptures after surgery is significantly lower than after conservative (non-surgical) treatment.

Surgeries for Achilles tendon ruptures can be divided into open and percutaneous.

The basis effective elimination injuries - ensuring peace from the very first minutes. This is facilitated by elastic bandage, splint. Equally important is the primary use of cold to relieve pain and reduce swelling. Next, the doctor will inevitably continue to treat the Achilles tendon rupture using heat. The replacement of cooling with warming occurs on the third day after the injury and continues for about three more days.

In addition to the generalized approaches described, the attending physician additionally forms a technique, which can be based on either a conservative (non-surgical) or surgical (surgical) approach.

Conservative treatment

This method of treatment is not 100% effective. Indicated for minor injuries. It is focused on taking special anti-inflammatory drugs internally (Tempalgin, Baralgin), using non-steroidal painkillers in the form of ointments, gels, creams (Fastum-gel, Troxevasin-gel).

The main component is orthotics or the use of a plaster cast. The duration of such immobilization is at least two months.

ethnoscience complements the listed options with a set of additional features. It is best to turn to such remedies after discussing with doctors - in order to avoid unexpected problems.

Repairing an old Achilles tendon tear is difficult because over time the injured tissue shortens, preventing the foot from returning to natural function. Accordingly, doctors have to resort to the use of artificial or donor tissue.

The donor can be either a piece of fibrous tissue taken from the patient himself or similar fibers from another person.

In traumatology, there are two ways to treat tendon rupture: conservative and surgical.

Its essence lies in complete immobilization of the ankle joint in a position with an extended toe. Then the ends of the damaged tendon are located close to each other, which facilitates their fusion. Immobilization methods can be different:

Traditional plaster splint.
Special orthoses or braces.
Plastic plaster.
Functional immobilization, allowing partial weight bearing on the leg.

The duration of such treatment is at least 6-8 weeks.

But conservative treatment is not always successful.

It has been proven that after it repeated ligament ruptures occur much more often.

Surgery

Surgery to repair the Achilles tendon is indicated for degenerative ruptures, the formation of an extensive hematoma that prevents the ends of the ligament from tightly closing, and in old age, when the ability of tissues to grow together without outside intervention is significantly reduced.

For pain relief, various anesthesia is used: local, intravenous, spinal anesthesia. The operations differ fundamentally in the type of tendon suture that is applied to the damaged area.

The tendon is sutured after access to it is ensured. To do this, an incision of up to 7-10 cm is made on the back surface of the shin. This is the most reliable method surgical treatment, but leaving a large scar on the skin.
The percutaneous suture is applied without cutting the layers of tissue, virtually blindly. The disadvantage of this method is the likelihood of twisting the ligament fibers or damaging the sural nerve.

The described treatment is carried out only on fresh ruptures, from which no more than 20 days have passed. If this period has passed, the injury to the Achilles ligament is considered old, sew its ends in a simple way is no longer possible. Then achilloplasty is used to increase the area of connective tissue.

Complications after surgery

Treatment of tendon rupture is carried out conservatively or with the help of surgical intervention.

Conservative treatment used for subtotal ruptures of the supraspinatus tendon. It involves immobilization of the joint, physiotherapeutic procedures, anti-inflammatory therapy, intra-articular injections.

If the supraspinatus tendon is completely ruptured, surgery is the only way to restore the function of the joint. Rotator cuff reconstruction surgery is performed openly or endoscopically.

Conservative therapy

Torn Achilles - what to do? According to age, individual characteristics body, as well as the presence of complications, pronounced signs and the severity of the damage, resort to in various ways therapy.

Treatment of an Achilles tendon rupture is often accompanied by conservative method, which involves the use of medications and the application of a plaster cast to the leg.

The ankle can be fixed using a special orthosis or a plaster cast. Thanks to this, the foot is in the desired position.

But this method has disadvantages; very often after the cast, repeated tears of the ligaments and tendons appear. And recovery lasts a long period.

First aid

To begin with, it is important to provide complete rest to the injured leg; it is worth putting something soft under it to reduce the load to a minimum.

Then you need to apply ice to the affected area, this will reduce swelling and reduce pain. Avoid direct contact with ice and wrap it in a dry cloth.

When mechanical damage First you should stop the bleeding and wash the wound. Stretching is accompanied intense pain, so the victim should take any available analgesic.

If a person has pulled their Achilles tendon, they should be taken to the nearest hospital as soon as possible. medical institution. Before transporting the victim, a splint must be applied to the leg.

Any sprain of the Achilles tendon requires treatment from a specialist; self-medication can lead to chronicity of the process!

Complications

It is believed that once damaged, tissues will no longer be able to return to their original state. The less careful the patient is, the greater the likelihood of complications.

Those who have suffered problems with the Achilles tendon are advised to reduce the level of physical activity and stop carrying heavy objects. Among unpleasant consequences For those who violate the recommendations, the following are noted:

Repeated injury. It happens after conservative treatment or due to poor quality restoration.
Blood clot formation. The result of long-term immobilization. The risk is reduced when correct use massage and exercise therapy.
Infection. Occurs more often after classical surgery. Eliminated by taking a course of antibiotics.

To avoid complications after surgery, you need to be very careful about physical activity. It is necessary to warm up before training, avoid sudden movements, and pay attention to any pain. Refusal will also play a positive role. bad habits, commitment healthy image life, good shoes.

An Achilles tendon strain, or Achilles sprain, is damage to the fiber structures of the ligament due to excessive tensile force. The Achilles tendon is the most powerful and strong ligament in the human body, however, this does not save it from injury. The tendon serves as a connector for the muscles of the leg and foot. Thus, this structure provides the motor ability of the ankle joint. During movement, the tendon takes the entire load of this joint on itself.

Participating in any movement of the foot, the tendon is often subject to injury. In most cases, the stress placed on the Achilles ligament is compensated. However, there are many situations where the pressure on the tendon is excessive and the tendon becomes stretched.

Athletes are susceptible to such injuries - especially those who engage in sports in which movements involve mainly Bottom part bodies. Dancers are also vulnerable to injury. In addition to direct provoking factors, there are indirect causes of ligament sprain:

Pathologies of the calcaneus;
Fairly high arch of the foot;
Poor and difficult stretching of the muscles of the thigh and lower leg;
Crooked legs.

Symptoms

Signs of stretching appear sharply and sharply, letting the person know about the location of the lesion. IN individually the pain may develop gradually and slowly. Trauma manifests itself as follows:

Severe local pain in the tendon area, which may spread higher to the calf muscles;
The appearance of edema;
Limitation active movements: it is difficult for the victim to bend the foot, and when trying to move it, painful sensations are intensifying.

Ignoring these signs may lead to further development inflammatory processes in the damaged area of tissue. In the future, this will most likely lead to a loss of elastic properties of the tendon: the fibers are replaced connective tissue, that is, they are replaced by scar tissue.

First aid

Any first aid should begin with fixation and immobilization of the affected ligament. If this is a workout, stop exercising. Cold must be applied to the ligament site, thereby reducing swelling and pain. Cold ice should be applied to the damaged area for an average of half an hour every two hours.

Don't ignore the sore spot. If symptoms of a sprain appear, you should go to the emergency room. Before this, you should take painkillers and anti-swelling medications, such as ibuprofen.

Treatment

Therapy for sprains involves the use and application of a fixation splint. In some cases they use plaster casts, superimposed on the month. In addition, treatment involves the implementation of the following points:

On the first day, cold is applied;
From the second to the fifth day, warm compresses are used;
If the victim is experiencing severe pain, anesthetics with an anti-inflammatory effect should be prescribed - ibuprofen, analgin, baralgin or ortofen.

For the period of treatment all exercise stress on the affected leg is limited. The patient needs rest. The second stage of treatment involves rehabilitation methods, which include gradual and uniform physical activity not only on the leg, but on the entire body.

The victim needs to choose a special one that is convenient for him. orthopedic shoes. In addition, the complex of rehabilitation procedures includes massage and self-massage, various options for kinesiotherapy. Diligently following the doctor’s prescriptions will prevent consequences and allow the ligament to restore its previous condition faster.

Ointments

Creamy substances are at the forefront of treating Achilles sprains. The action of the ointment is aimed at:

pain relief for a damaged ligament;
removal of swelling;
elimination of inflammation;
rapid recovery of the affected area.

The effect of this group of drugs is determined by the active substance:

Non-steroidal anti-inflammatory drugs. These medications inhibit the development of inflammatory processes;
Steroid hormones. By stimulating the release of adrenal secretions, SGs also eliminate inflammation and relieve swelling.

Folk remedies

Alternative medicine involves the use of the following recipes:

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A torn Achilles tendon is an injury that does not only affect professional athletes; Anyone can “tear an Achilles,” it’s just that we are so oblivious to the natural workings of this tendon that the diagnosis of an Achilles rupture seems erroneous. The Achilles tendon (sometimes called the calcaneal tendon) connects the calf muscle to the calcaneus. Together they help lift your heels off the ground (walking, running, jumping) and rise onto your toes. People use the calf muscle and Achilles tendon both in Everyday life and during sports.

What is an Achilles tendon rupture?

If your Achilles tendon is pulled too much, it can become seriously injured (torn, ruptured).

Symptoms of Achilles tendon rupture:

Feels like you've been hit in the back of your leg
The sound of the tendon itself breaking (like a crunching or crackling sound)
Feeling of stiffness, sharp pain in the back of the leg or ankle
Difficulty walking - especially walking up stairs
Lameness, severe pain when walking
Difficulties when wanting to “stand on your toes” (stand on your toes)
Bruising or swelling in your leg
Inability to extend the foot.
Swelling or bruising that gradually increases and may move down and reach the fingertips.

How does an Achilles tendon rupture occur?

The injury is most likely to occur when you:

Sharply pushed off the ground with your foot (to switch from walking to running or ran uphill)
Tripped and fell or during another "emergency" situation
Engaged in sports related to big amount stops and starts (like tennis or basketball)
Slipped
Received a direct blow to the Achilles tendon

Diagnosis of Achilles tendon rupture

You will likely need an MRI to see what type of Achilles tendon rupture has afflicted you. MRI is one of the types of visual diagnostics.
If an MRI is not available, your doctor may diagnose the injury using the following tests:

A partial rupture of the Achilles tendon means that at least some of the tendon's structures are still intact.

A complete Achilles tendon rupture means that your tendon is torn completely and both sides - the calf muscle and calcaneus not "attached" to each other.

What to Expect After Treatment for a Torn Achilles Tendon

If you have a complete rupture of your Achilles tendon, you will likely need surgery to repair the tendon. The doctor will definitely discuss the pros and cons of the operation with you. For a partial rupture, the probability surgical intervention less and instead of surgery you will need to wear a plaster cast or orthosis for approximately 6 weeks. During this time, your tendons will grow together.

Plaster is a traditional and economical method of treating partial Achilles rupture, which has a number of disadvantages - it completely immobilizes the joints, difficulty in rehabilitation period, household inconveniences.

The use of a special orthosis or brace also successfully immobilizes the leg and prevents further damage to the leg. You can walk as soon as your doctor says it's okay to do so.

Help with Achilles tendon rupture symptoms

Important! You can't massage your leg after an Achilles tendon rupture.

Use pillows to elevate your leg above chest level when you sleep.
Keep your leg elevated when you sit.
You can take pain medications such as Ibuprofen (such as Nurofen or Mig), Naproxen (such as Nalgesin or Naproxen), or Acetaminophen (such as Panadol). Don't give Aspirin to children!
If you have heart disease, high blood pressure, kidney disease, stomach ulcers, or bleeding, talk to your doctor before using these medications. Do not take more dosage than recommended in the manufacturer's instructions.

Achilles tendon rupture and activity

At some point in your recovery, your healthcare provider will ask you to initiate heel movement. This can happen 2 to 3 weeks or 6 weeks after the injury.

With the help of physical therapy, most people who have an Achilles tendon rupture are able to return to normal activities within 4 to 6 months. Physical therapy can help your calf muscles become stronger and your Achilles tendons more flexible.

When you "stretch" your calf muscles, do it slowly. Additionally, you should not jump or put unnecessary strain on your leg during rehabilitation.

Important! Even after a full course of treatment, you will always be at risk of re-injuring your Achilles tendon.

After healing you need:

Be in good shape and before any exercise or exercise do a good warm-up and stretching.
Avoid high-heeled shoes.
Check with your doctor to see if you can play tennis, badminton, basketball, or other sports that require sudden stops and starts.

When to see a doctor

Contact your doctor if you have any of these symptoms:
Swelling or pain in your legs, ankle, or foot gets worse.
Your leg turns purple.
Your temperature is stable

Denial of responsibility : The information presented in this article about Achilles tendon rupture is intended for informational purposes only. However, it cannot be a substitute for consultation with a medical professional.