One of the most common chronic diseases affecting many athletes is Achilles tendon tendonitis. Although this is the strongest tendon in the human body, systemic high loads in sports and untimely treatment of injuries can cause chronic pain and inflammation. Most often, runners, footballers, gymnasts, basketball players and athletes involved in sports with intense loads of the lower extremities suffer from Achilles tendon tendonitis.
What is Achilles tendon tendonitis
The Achilles tendon is the largest, but also the most susceptible to injury, tendon in the human body. It connects the muscles in the lower back of the leg with the bones of the heel, and constant heavy loads or injuries can lead to inflammation - tendonitis of the Achilles tendon. This is due to the relatively low elasticity of the Achilles tendon, which at peak or systemic loads receives microtraumatic lesions that lead to the development of the inflammatory process. Depending on the location of the microtrauma, inflammation occurs either at a specific point in the Achilles tendon or along its entire length. At the beginning, Achilles tendon tendonitis begins as an acute microtraumatic inflammatory process, which, if not adequately treated, can easily become chronic and lead to degenerative-dystrophic changes and spontaneous rupture of the Achilles tendon, so the problem cannot be ignored. Chronic tendonitis of the Achilles tendon is a particularly serious problem in many athletes because of its difficult presentation to treatment and the tendency to constant relapse.
What triggers the disease
What is tendon tendonitis, and as a result of which pathology develops - an urgent issue for many patients with leg pain during movements in the Achilles region.
The main cause of the disease is trauma and improper load. Microtrauma and chronic overload on tendon fibers do not pass without a trace, especially among professional athletes.
In addition, the disease can occur in people after the age of 40 who start jogging without preliminary preparation. The third important factor is the deformation of the foot. Flat feet with hyperpronation causes overstretching of tendon fibers and leads to injury.
The degenerative inflammatory process captures the tissues of the tendon itself. This is manifested by edema, microscopic damage to collagen. With the correct alternation of loads and rest, the tissues have time to recover. Their structure remodels and adapts to more intensive processes. If the occupation and rest regimen is not observed, microtraumas accumulate and turn into a “fatigue” pathology.
Factors that provoke achillotendinitis also include:
- constant tendon overload due to wearing high heels,
- uncomfortable shoes
- improper start of sports without preheating,
- Haglund deformation.
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The severity of clinical symptoms largely depends on the form of the course and stage of the process. In acute tendonitis, the patient complains of pain at the beginning of the load. After rest, the pain goes away. When feeling, discomfort or soreness in the tendon zone can be detected. The chronic form is characterized by a gradual increase in soreness. Even after complete relaxation, the pain attack does not go away. Pain syndrome can be characterized as follows:
- during exercise, soreness increases,
- seizures persist after resting and warming up,
- ascents and descents on the stairs exacerbate discomfort, and can also trigger an attack.
The following typical symptoms are characteristic of a chronic and acute form of achillotendinitis:
- local hyperemia,
- local temperature increase
- decreased mobility in the joint,
- a feeling of tension in the calf region,
- puffiness around the tendon above the calcaneal tuber 3-7 cm,
- difficulty in the following movements: walking on toes, bending the sole up,
- crunch in the ankle zone.
The disease is divided into 3 main forms:
Inflammation spreads to the tissues surrounding the Achilles tendon.
At the same time, degenerative changes are noted in the tendon itself.
The tendon is inflamed exclusively
Tendon tissue unchanged
Calcification sites are formed
A heel spur forms
Significantly expressed inflammatory and degenerative changes
During the examination of the patient, the doctor finds out complaints, collects an anamnesis, and conducts a physical examination. It is important for an orthopedic surgeon to identify the point of maximum pain, since with simultaneous movement of the foot and feeling, pain moves due to stretching of tendon and muscle fibers. This is a characteristic sign for tenosynovitis.
Tendonitis of the tendon is confirmed using the following methods:
An X-ray is informative only if there are calcification sites against a background of degenerative changes. In the absence of calcifications, the method will not show anything.
With the help of ultrasound and MRI, gaps are identified and determined with treatment tactics.
When soreness appears in the area of the calcaneal tendon, first of all, the legs need to provide rest and proper rest. For this, all loads are excluded, the ankle region is fixed with an elastic bandage. A compress with ice gives a good result.
"Dimexide" is an effective tool for relieving inflammation, anesthesia and fighting infection. To prepare a compress for an inflamed tendon, it is diluted in half with water. To enhance the analgesic effect, Novocaine or the Diclofenac ampoule is added to it.
Treatment of Achilles tendon tendonitis is carried out using the following groups of medicines:
Characteristic features of the disease
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Damage to the structural components of the Achilles tendon is the most striking manifestation of rheumatic pathologies of the periarticular soft tissues. This most powerful ligament in the human body is formed by the tendons of the soleus and calf muscles, which explains its resistance to increased loads. Achilles tendon tendonitis in more than 50% of cases is the result of sports injuries, especially in older patients. After 45 years, the rigidity of the terminal structure of striated muscles increases due to a decrease in the production of elastin and collagen. The range of motion in the ankle joints is also gradually decreasing.
Tendonitis can also be a degenerative pathology.. The arising pain in the ankle and redness of the skin are often mistaken for the symptoms of stretching. The use of non-steroidal anti-inflammatory drugs temporarily reduces the severity of clinical manifestations, but does not eliminate their cause. Further development of destructive-degenerative changes accompanies fibrosis, neoangiogenesis, and in some cases, calciumosis. At this stage, the disease can be recognized by the following signs:
- with an increase in motor activity, a distinctive crackle is clearly heard,
- the diseased tendon is slightly thicker than the healthy one, which is noticeable when palpating them.
To conduct adequate therapy, it is important to establish the form of damage to the Achilles tendon. If during the differential examination revealed inflammation of the periarticular soft tissues, then the patient is diagnosed with peritendinitis. Enthesopathy is established when a pathology is found that is localized in the places where the tendons are attached to the calcaneus. With this disease, the formation of calcaneal spurs and calcified foci in muscle fibers sometimes occurs.
With a sedentary lifestyle, the rigidity of the Achilles tendon appears, the mobility of the ankle decreases. In such cases, inflammation begins even with minor loads on the joint.
Pathology is characterized by a gradual development. At the initial stage, uncomfortable sensations arise, quickly disappearing after a few minutes of motor activity. A small load, for example, sports, helps to completely eliminate pain. When feeling affected by inflammation of the tissues, a slight tingling sensation may occur. Lack of medical care is the cause of chronic disease. It is characterized by such clinical manifestations:
- a gradual increase in the severity of pain. Now it doesn’t disappear during training, and the intensity of uncomfortable sensations increases significantly,
- even after a long rest, the pain does not disappear, it occurs in the morning,
- climbing or descending stairs provokes the appearance of pain or its intensification.
When diagnosing Achilles tendonitis of moderate or high severity, the doctor notes local hyperemia. In damaged tissues, the temperature rises locally, the calf muscle is very tense, there is no full flexion of the foot.
Why is it developing?
The defeat of the Achilles on the leg can occur at any age and under different circumstances. The following negative factors are identified that affect the development of Achilles tendon tendonitis:
- Age-related changes. In an elderly person, the ligament becomes less elastic, due to which it can be damaged even with a small load. Therefore, people after 35 years are recommended to do a thorough warm-up before gymnastics.
- Strong loads. Tendonitis is not uncommon among professional athletes who often overexert the Achilles tendon.
- Flat feet with a roll of the foot into the inside. While walking, the Achilles is overloaded and greatly stretched.
- Wearing uncomfortable or tall shoes.
- Calcaneus growth or deformation of the Haglund. A tumor forms at the site of attachment of the Achilles tendon, leading to tendonitis.
- Diseases of an infectious origin.
- Bone and joint disorders, due to which the patient has one leg shorter than the other.
- Thyroid dysfunction.
Tendonitis is a consequence of advanced gout or rheumatoid arthritis.
Types and forms of Achilles tendon tendonitis
Tendonitis in the region of the Achilles tendon is usually classified into several types. The insertion and non-insertion types of deviations are distinguished. In the second case, the disease is diagnosed more easily, due to the fact that pain occurs along the proximal site of the Achilles. With insertional tendonitis, the pain disturbs at the site of attachment of the Achilles tendon to the back of the calcaneus. And they also share the disease in the forms that are presented in the table.
The clinical picture may not manifest itself for a long time, and a person is unaware of the progression of the disease. Achilles tendon pain is the first symptom of tendinitis. Over time, pain becomes permanent and worries the patient, regardless of physical activity. In addition, with the disease, other symptoms worry:
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How is the diagnosis carried out?
Achilles tendon inflammation can be detected by diagnostic procedures. Differential diagnosis is no less important, since the symptoms of tendonitis are sometimes mistaken for tendinosis. And also tendinopathy develops in a similar way. The doctor examines the affected limb and prescribes diagnostic procedures:
- radiography of the ankle
- MRI and CT
- ultrasound diagnosis of the lower leg.
How to treat with medicines?
Acute and chronic tendonitis of the Achilles tendon is eliminated by conservative methods using drugs of different effects. Before using them, it is necessary to minimize the load on the limb, which is possible in such ways:
- application of a tire or plaster cast,
- rewinding the leg with an elastic bandage,
- use of an orthosis with partial or complete restriction of motor function.
After this, drug treatment is carried out with the use of such drugs:
- Nonsteroidal anti-inflammatory drugs:
- Antibiotics in case of an inflammatory reaction.
- "Analgin." It is used before going to bed as a compress. In the same way it is possible to use Novocaine.
- Local funds. Ointments well eliminate pain, swelling and other symptoms of exacerbation of Achilles tendon tendonitis:
- "Dolobene gel",
If the patient is in serious condition, while conservative treatment of tendonitis does not bring a positive result, then surgery is prescribed.
And also surgery is necessary when a Haglund outgrowth occurs. During surgical manipulation, an incision is made and the damaged area of the Achilles tendon is excised, after which it is sutured. The most difficult thing after the operation is the recovery process, which takes 1-2 months. After surgery, the patient wears a special fixing boot for 1.5 months and takes medication. To step on a limb is possible only 1-2 weeks after surgery.
It is possible to supplement the treatment with folk remedies and pharmacy drugs with physiotherapy, which includes such procedures:
- laser treatment
- ultrasound therapy
- shock wave treatment
- applications with mud.
Exercise therapy is prescribed after the acute phase of the Achilles tendon tendonitis or surgical intervention. This measure allows you to quickly restore motor activity. Such tasks are often performed:
Performing half-squats will help restore the tendon.
- Walking in comfortable shoes. It is performed slowly, while rolling the foot from heel to toe is important. Gradually increasing distance and speed.
- Half squats and toe lifts.
- Classes in the water. Due to the relaxation of the body, the load on the legs is reduced, therefore it is recommended to start many exercises not in the gym, but in the pool.
- Stretching the calf muscles and tendons. They stand near the wall and rest with their hands, and the damaged heel is pushed back with an emphasis on the toe. Linger in this position for half a minute.
Treatment with folk remedies
If the Achilles tendon (heel) is damaged, then it is possible to alleviate the condition at home using alternative medicine. In order to avoid complications of tendonitis, consult a doctor before using folk remedies. Common recipes:
Apple cider vinegar is an important component of a therapeutic ointment.
- Massage with ice. Glasses of plastic are filled with water and put in the freezer. When the liquid freezes, massage using the top of the cup. The duration of the procedure is not more than a quarter of an hour, while repeating up to 3 times a day.
- Elecampane. A product is used to apply to a damaged limb. At 3 tbsp. l raw materials use half a liter of boiled water. Put the mixture on the stove for 20-25 minutes. In the finished broth, a cloth is moistened and applied in the affected area.
- Pine. Sprigs of the plant are necessary for the bath, which is prepared based on half a bucket of raw materials per 10 liters of water. Boil the medicine for 30 minutes and leave to stand for 4 hours. Apply for warming the legs.
- Calendula and baby cream. The components are taken in equal amounts, and thoroughly mixed. Homemade ointment is applied to the Achilles tendon before going to bed.
- Pork fat and wormwood. The first product is melted in a water bath and added to a fresh plant. Mix, cool and apply to the affected area for 6 hours.
- Clay and apple cider vinegar. When preparing ointments adhere to a ratio of 500 g to 4 tbsp. l Wet a sterile rag and apply to the joint for an hour. After 6 treatments, the patient with tendonitis becomes easier.
Forecast and Prevention
If in time to carry out the treatment of Achilles tendon tendonitis, the patient manages to completely recover. Otherwise, the patient's condition worsens, and urgent surgery is required. It is possible to prevent tendinitis by choosing high-quality and comfortable shoes. It is recommended to do light gymnastics every day and eat right.
Symptoms of Achilles tendon tendonitis
Symptoms of Achilles tendonitis tendonitis are associated with acute pain during movement, such as jogging and jumping, which increases with increasing load. Very often, pain occurs unexpectedly after a long period of rest or lack of exercise. The pain is most often felt just above the heel. As a result of the inflammatory process, edema and subsequent compaction in the Achilles tendon can also occur.
В начале лечения ортопед рекомендует пациенту ношение тугой повязки и постельный режим на протяжении двух дней с приподнятой ногой. Cold compresses will help stop inflammation and reduce the severity of pain. Constant cooling of the affected area does not allow the formation of extensive hematomas, the dangerous consequences of which are scars. For immobilization of the ankle joint are used:
- special cotton ribbons. They do not contain latex, are similar in elasticity to human skin, reliably fix the tendon and prevent its stretching,
- orthoses restricting movement. Immobilization is carried out at an angle of 90 ° C at night, and in some cases - constantly.
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When diagnosing a strong inflammatory process, the patient is given a splint, a splint or plaster cast. Minimize exacerbations of the disease helps to change the usual way of life. Lifting weights and wearing high-heeled shoes is prohibited.
What are the causes of Achilles tendon tendonitis?
For athletes, the main factors in the development of tendonitis of the Achilles tendon are overstrain, chronic overload and insufficient heating (lack of warm-up). Most often, in runners this happens due to a sharp increase in distance, speed, incline and insufficient rest between workouts.
Incorrect or worn athletic shoes and improper running techniques can also be added to these factors. The sports load itself is not a problem for the tendons, but a problem arises due to the lack of load control or sharp peak loads without prior preparation.
Treatment of Achilles tendon tendonitis
In most cases, Achilles tendon tendonitis is treated conservatively, and treatment methods are selected depending on the stage of the disease.
In the acute period, the treatment method is similar to the treatment of sprain and consists in rest and no load on the leg (at least one week), cold compresses and cryotherapy (compress with crushed ice for 10-15 minutes several times a day) and lifting the limb.
- Of the kinesitherapeutic agents, you can use light exercises to maintain the mobility of the ankle joint - swimming, cycling and relaxing muscle massage of the back surface of the lower leg.
- From physiotherapy, mid-frequency and low-frequency currents with painkillers, ultrasound, and laser therapy can be used.
- It is advisable to use special orthopedic insoles to support the arch of the foot, various orthoses and bandages, as well as sports bandages for the Achilles tendon (taping).
- Nonsteroidal anti-inflammatory and analgesic drugs can be used as medications, and when using corticosteroids, the increasing risk of subsequent rupture of the Achilles tendon should be assessed.
Exercises for tendonitis of the Achilles tendon.
With tendonitis of the Achilles tendon, the means of treatment are aimed at preventing the transition of inflammation to a chronic form, since this leads to degenerative changes in the tendon, which is one of the main factors in its constant rupture during sports.
If conservative treatment does not give a result, then it is necessary to resort to surgical treatment, and it is best to choose the least traumatic technique of surgery.
At the stage of rehabilitation of tendonitis, physiotherapeutic procedures are practiced: electrophoresis, ultrasound therapy, electrical stimulation. These treatment methods allow for 5-10 sessions:
- reduce the intensity of pain
- accelerate tissue healing
- increase the functional activity of a damaged tendon.
During the recovery period, the patient is recommended to practice therapeutic gymnastics and physical education, consisting in the implementation of general strengthening exercises. Regular training accelerates the healing of damaged tissues and activates the functioning of the ankle triceps muscle. It is this element of the musculoskeletal system that ensures the full functioning of the Achilles tendon.
The use of folk remedies (beekeeping products, infusions of medicinal herbs) is possible only at the rehabilitation stage. Achilles tendon tendon in the absence of medical intervention can cause loss of performance. Only a timely diagnosis and an adequately structured therapeutic regimen will avoid the progression of pathology and significantly accelerate recovery.
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