Tendinit an Achilles tendon – inflammatory process in an Achilles tendon. Can develop because of constant overloads of a gastrocnemius muscle (at the athletes and people doing hard manual work) or owing to excessive single load of an unprepared sinew (people have 40-60 years, it is connected with an age rigidnost of a sinew). It is shown by pains, hypostasis and insignificant restriction of back bending of foot. The diagnosis is exposed on the basis of the symptoms given to MRT and a X-ray analysis. Treatment is conservative.
Tendinit an Achilles tendon
Tendinit an Achilles tendon – an Achilles tendon inflammation. Comes to light at athletes more often, is a consequence of an overload, wrong equipment or violation of the mode of trainings. It can be diagnosed for people of 40-60 years after single intensive loading of an Achilles tendon (for example, in attempt to be engaged in run), the high probability of development of a tendinit in such cases is caused by the rigidnost of an Achilles tendon amplifying with age and some reduction of volume of movements in an ankle joint.
In clinical traumatology distinguish three forms of a tendinit. Peritendinit name an inflammation of the fabrics surrounding an Achilles tendon. Tendinit – the inflammation actually sinews leading to its degeneration. Entezopatiya – the inflammatory process which is localized in the field of an Achilles tendon attachment to a calcaneal bone can be followed by formation of a calcaneal spur and the centers of calcification in sinew tissue. All three forms of a disease can proceed separately, be observed at the same time or pass one into another.
Symptoms of a tendinit of an Achilles tendon
The disease develops gradually. In the beginning the patient feels pain in an Achilles tendon only the first minutes of loading or a training. After warm-up pain decreases, and at rest finally disappears. At a palpation of area of defeat there is some discomfort, but pains, as a rule, are absent. In the absence of treatment the disease passes into a chronic form over time. Within several weeks or months the pain syndrome accrues. Unlike an initial stage, after warm-up pain does not decrease, and amplifies. Relief is not given even by long rest, some patients of pain are disturbed after a night dream.
Many patients note pains during descent or rise on a ladder or an inclined surface. At survey tension of a gastrocnemius muscle, an Achilles tendon thickening, local hyperaemia and local temperature increase of skin in the field of defeat comes to light. The volume of movements in an ankle joint is a little limited. At a peritendinita of pain are usually localized throughout all sinew, at a tendinita – heels, at an entezopatiya – in the field of an attachment of a sinew or slightly above are 2-6 cm higher than it.
Diagnostics of a tendinit of an Achilles tendon
The diagnosis is exposed on the basis of complaints and data of external survey. From additional methods of a research apply a X-ray analysis of a shin and ankle joint, a magnetic and resonant tomography and ultrasonography of an ankle joint. On roentgenograms in some cases the calcification centers are defined. At a tendinita they "are scattered" on all sinew, at an entezopatiya are localized mainly in its lower part. Lack of kaltsifikat is not the basis for confirmation or a denial of the diagnosis tendinit.
Ultrasonography and MRT – more exact techniques allowing to investigate in details soft fabrics, to define the centers of an inflammation and sites of degenerate changes. Besides, MRT of an ankle joint gives the chance to reveal a sharp stage of an inflammation – at this stage in tissue of a sinew a large amount of liquid accumulates, however external hypostasis is a little expressed or is absent that complicates clinical diagnostics.
Treatment of a tendinit of an Achilles tendon
Treatment of a tendinit mainly conservative, is carried out on an outpatient basis in the conditions of emergency station. In a sharp phase rest, sublime position of an extremity and hard bandaging for the period of walking is shown. In the first days of a disease it is necessary to put cold to area of defeat. For elimination of pains, elimination of inflammatory process and restoration of function of a sinew to the patient appoint NPVS for the term of no more than 7-10 days.
After elimination or considerable reduction of a pain syndrome begin occupations with remedial gymnastics. The LFK program at a tendinita includes the easy strengthening and stretching exercises promoting restoration of a sinew and strengthening of a gastrocnemius muscle. In the subsequent gradually enter exercises with a resistance. Along with LFK for restoration of a sinew use physiotherapeutic procedures: electrostimulation, electrophoresis and ultrasonic therapy.
Apply the massage promoting blood circulation improvement, strengthening and stretching of a sinew. At valgusny or varusny deformation of foot to the patient recommend to carry special clamps for an ankle joint. Fixing with use of a plaster bandage is applied very seldom – only at severe constant pains in a sinew. At especially persistent pain syndrome sometimes carry out medical blockade with glucocorticoid medicines. Glucocorticoids enter only into surrounding fabrics, injections in a sinew or the place of its attachment are strictly forbidden as these medicines can stimulate degenerate processes and provoke a rupture of a sinew.
Surgical intervention is shown at inefficiency of conservative therapy within half a year and more. Operation is performed in a planned order in the conditions of traumatologic or orthopedic office. Carry out a median section a skin section on the back surface of a shin, allocate an Achilles tendon, investigate and excise degenerately changed fabrics. If in the course of intervention it was necessary to excise 50% and more from Achilles tendon tissue, remote sites replace with a sinew of a plantar muscle. In the postoperative period carry out an immobilization within 4-6 weeks, using the orthosis or a plaster bandage. Allow to push around in 2-4 weeks, within 6 weeks hold rehabilitation events.