Useful link: you can familiarize yourself with the rehabilitation program and see video exercises on our website (click the mouse to go to the article about rehabilitation).
The Achilles tendon is the largest tendon in humans. It is formed by the fusion of aponeuroses (flat tendons) of the posterior muscles of the leg - the gastrocnemius and soleus muscles, which are sometimes called the triceps surae muscle. Sometimes it is also called the heel tendon. This tendon attaches to the tubercle of the heel bone. When the muscles contract, they pull on the Achilles tendon, and as a result, plantar flexion occurs at the ankle joint - i.e. we can stand on the toes of our feet or jump, pushing off with our feet. There is a mucous bursa between the surface of the heel bone and the tendon, which reduces friction between the bone and tendon. In addition, the tendon itself is located in a special channel, inside which there is also a little fluid that reduces friction. You can learn more about the anatomy of the Achilles tendon and calf muscles on our website (click to go to the article on anatomy).
The developed Achilles tendon is absent in the great macaques, our immediate evolutionary ancestors, and is a hallmark of erect walking. This largest and strongest tendon in the human body gets its name from the mythical hero Achilles, described by the Greek poet Homer in the collection “Iliad” around 750-650. BC. Achilles was a magnificent warrior and, according to myth, was invulnerable in battle due to the fact that his mother, Tatis, having heard a fortune teller's prediction of her son's impending death in battle, dipped him after birth into the River Styx, one of the five rivers of the underworld. However, at the same time she held her son by the heel, and this place remained untouched by the magical waters of the river and did not receive magical protective powers. During the Trojan War, which was started by the Greek people against the Trojans after Paris stole Helen, the wife of Menealus, king of Sparta, Achilles was a fearless and invincible warrior who terrified the enemy. In part, military doctors can consider Achilles their colleague, since he treated the wounded.
Achilles bandages the wounded Petrocles. Pottery, 5th century AD
Under the command of Achilles, Greek troops captured and destroyed Troy, killing the Trojan prince Hector. Hector's brother Paris took revenge on Achilles by shooting a poisoned arrow and hitting Achilles in the heel. Since then, the expression “Achilles' heel” has been understood as a weak, vulnerable, unprotected place. Note that the arrow pierced Achilles' heel directly, not the heel tendon. The location of the wound is identical in many sculptures.
Wounded Achilles (marble, sculptor Carlo Albicini, 1825). The arrow is lost
You can learn more about the history here (click to go to the historical article).
Why does the Achilles tendon rupture?
The Achilles tendon can rupture in three cases:
With a direct blow to the strained Achilles tendon. More often, this mechanism of injury occurs when playing sports, for example, when playing football.
For indirect injury:
As a result of a sharp contraction of the lower leg muscles when the leg is extended - for example, when trying to jump in basketball or volleyball,
with unexpected sharp dorsiflexion of the foot - for example, when slipping down a step of the stairs.
When falling from a height onto a leg with an extended toe.
Most often, the tendon ruptures 4-5 centimeters from the point of attachment to the heel bone. It is a common belief that this is where the tendon has the worst blood supply and therefore this is where the rupture occurs. However, in fact, this opinion is not entirely true - according to many scientific studies, the blood supply in this place is regarded as normal. The fact is that currently the true causes of Achilles tendon rupture are unknown, and there are several theories:
Degenerative theory. For the most part, the tendon consists of a special protein - collagen, which practically does not stretch. This protein forms tendon fibers. In some cases, including due to hereditary reasons, collagen becomes less durable (degenerative changes occur) and rupture may occur. Sometimes the collagen becomes so weak that rupture can occur without any trauma at all - in this case it is called spontaneous (i.e. sudden) rupture. Drugs such as corticosteroids (diprospan, hydrocortisone) and fluoroquinolone antibiotics (ciprofloxacin) can contribute to degeneration. It is important to note that corticosteroids increase the risk of tendon rupture not only when administered locally (for example, with injections for the treatment of tenopathies, inflammation of mucous bursae, etc.), but also when administered orally (in tablet form) or systemically (intravenously, intramuscularly) during treatment various diseases (chronic obstructive pulmonary disease, etc.). Therefore, if a patient being treated with corticosteroids for any medical condition experiences tendon pain other than the Achilles tendon, some medical professional associations recommend stopping the medication as this may lead to tendon rupture. Another cause of degeneration is chronic inflammation of the tendon, so-called tenopathies, tendinitis, etc. In addition, tendon rupture can also occur due to Haglund’s deformity.
Mechanical theory. Rupture can occur without degenerative changes. This theory is based on the idea that any healthy tendon can rupture if a force greater than its strength is applied to it. In particular, a rupture can occur when the triceps surae muscle works uncoordinated (for example, when the outer head of the gastrocnemius muscle begins to pull the tendon, and the inner head lags behind for a fraction of a second). This is possible if a person starts playing sports after a long break or if he puts in too much stress without warming up. Therefore, a gap often occurs in so-called “weekend athletes” aged 30-50 , who play sports irregularly, occasionally, neglect warm-up and overestimate their physical capabilities. In addition, microtraumas can also lead to degeneration, when, as a result of repeated stretching, micro-tears of the tendon occur and it becomes weaker.
Hyperthermic theory. The tendon is not an absolutely inextensible structure; it is characterized by elasticity (due to the special protein elastin). At least about 10% of the energy generated during elastic lengthening of the tendon is transformed into thermal energy. For example, after jogging for 7 minutes, the tendon can heat up to 45 degrees Celsius, and tendon cells called tenocytes can occur. Thus, hyperthermia that occurs during movement may also contribute to degenerative processes. Good blood supply allows the tendon to cool, and if the blood supply is reduced, the tendon overheats.
Scientists believe that 30-50 year olds are at risk of Achilles tendon rupture also because with age, to one degree or another, degenerative changes still accumulate in the tendon, and age still predisposes a person to consider himself absolutely healthy in sports terms, which can lead to an overestimation of one’s capabilities.
As we have already noted, a rupture can occur as a result of a direct blow, jumping, slipping down a step, falling on a leg, and can occur without any injury at all.
Usually, when a rupture occurs, a person feels a sudden pain, as if someone was hitting the leg from behind with a stick. Sometimes, at the moment of rupture, a person can hear the sound of the rupture itself, similar to a dry crack or crunch. After this, the strength of the triceps muscle of the leg decreases sharply - because the gastrocnemius and soleus muscles are no longer connected to the heel through the Achilles tendon and cannot extend the foot. After this, swelling occurs and a bruise may appear, which gradually increases in size over a few days and can go down to the tips of the fingers.
If the person is not overweight, then along the Achilles tendon at the site of its rupture you can see or feel a depression or a hole.
Retraction, depression along the Achilles tendon
As a rule, after an Achilles tendon rupture, a person cannot extend his foot. The gait is disturbed, severe lameness appears, and sometimes due to pain the person cannot step on his foot at all.
First aid. Do not massage the calf muscles or tendons. Apply something cold to the tendon and see a doctor.
Diagnosis of Achilles tendon rupture
The doctor will ask you about the mechanism of the injury and the circumstances under which it occurred. Do not forget to tell your doctor about previous injuries, possible cases of previous tendon pain (tendinitis, tenopathy, bursitis), how you were treated for these diseases.
Tell us why and for how long you took antibiotics (especially ciprofloxacin) or hormonal drugs (glucocorticoids) you took over the past months, if such treatment took place.
It is believed that the diagnosis of a rupture does not cause any difficulties and can be made by a doctor as a result of a simple examination and questioning of the patient. However, in reality, not everything is so simple and even certified traumatologists who are too self-confident about this problem often make mistakes in diagnosis.
Not only the triceps surae muscle is responsible for plantar flexion of the foot. In addition to the triceps surae muscle, which provides 87% of the force of flexion of the foot, 6 other foot flexor muscles are involved in flexion, which can lead to misdiagnosis.
In addition, in many people, next to the Achilles tendon there is another thin tendon - the plantar tendon, which may not rupture and during palpation (i.e. when the doctor feels the rupture site) misleads the doctor - the doctor may regard the rupture as incomplete, although in fact the gap is complete.
In order to eliminate these diagnostic errors, the doctor must perform special diagnostic tests:
Shin compression test (or Simmonds-Thompson test). When the doctor's hand squeezes the leg muscles, the foot is stretched. The test is performed on a healthy and injured leg and the results are compared.
O'Brien test (needle test). A needle from a medical syringe is inserted into the place where the aponeurosis passes into the tendon, move the foot and watch how the needle deflects.
Matles test (knee flexion test). The patient lies on his stomach, both legs are bent at the knees with the feet up. If the Achilles tendon is torn, the toe of the foot will hang lower.
Copeland test (sphingmomanometer test). A sphingmomanometer cuff is placed on the lower leg. It is inflated to a pressure of 100 mmHg and the doctor begins to move the foot. If the pressure increases to 140 mmHg, then the Achilles tendon is not torn.
It is not necessary to perform all these tests together - it is considered that if at least two tests are positive, then the diagnosis of an Achilles tendon rupture is certain.
In addition, in complex cases, additional research methods may be required - radiography, ultrasound, magnetic resonance imaging. Please note that the need for these studies occurs extremely rarely and they should only be performed as prescribed by a doctor. A patient’s independent decision to perform, for example, magnetic resonance imaging is essentially a meaningless waste of money and time.
Treatment of Achilles tendon rupture
Fundamentally, there are two treatment options – operative (surgical) and conservative.
The essence of conservative treatment is that the leg is immobilized with a plaster splint with the toe of the foot extended for 6-8 weeks. In this position, the ends of the torn tendon come together, touch and gradually grow together. A traditional, properly made plaster splint can immobilize the leg well, but, unfortunately, it is not without its drawbacks. Firstly, it is quite heavy and uncomfortable. Secondly, it completely eliminates movements in the joints, and then, after the immobilization stops, difficulties may arise in developing movements. Thirdly, the splint is quite inconvenient in everyday life - it cannot be wetted, and, you see, not washing thoroughly for 6-8 weeks is a real torment. Fourth, the plaster cast can break, and if it is made thick so that it does not break, it will be very heavy. And, lastly, the plaster can crumble, crumbs can get into the space between the skin and the plaster itself, and onto the bed, which, unfortunately, can cause a lot of inconvenience.
Immobilization with a plaster splint with an extended toe (equinus position)
To make immobilization more comfortable, special orthoses or braces can be used. The advantage of orthoses is that they allow you to adjust the angle at which the foot is immobilized, which greatly facilitates rehabilitation.
Immobilization with an orthosis (brace)
In addition, polymeric materials (plastic plaster) can be used for immobilization. They are much lighter than traditional plaster, more reliable, more comfortable for the patient, and are not afraid of water - you can wash in them!
Immobilization with polymer (plastic) gypsum
In addition, in modern surgery there is the possibility of so-called functional immobilization, in which the joint is not completely immobilized. For this purpose, special orthoses are used, or such a functional splint can be made from traditional or polymer plaster. A special heel can be attached to a functional splint, which will allow you to rest on your leg.
The decision about which option is right for your case should only be made together with your doctor. Changing the immobilization option on your own is unacceptable, as this can lead to the collapse of the entire treatment.
What are the disadvantages of conservative treatment?
If conservative treatment always allowed the tendon to heal, then no one would have performed surgeries to suture the Achilles tendon - they simply would not have been necessary! However, not all so simple.
Along with the rupture of the tendon itself, the blood vessels also rupture and blood accumulates at the rupture site (hematoma), which prevents the ends of the ruptured tendon from coming together. As a result, the tendon fuses with elongation and its strength is significantly reduced. In addition, due to this hematoma, the tendon grows together with scar rather than tendon tissue. As a result, it becomes less strong and there is a high risk that it will rupture again in the future. Large scientific studies show that the risk of re-rupture after conservative treatment is three times greater than after surgical treatment (surgical suturing of the torn tendon).
As we have already noted, tendon rupture can occur against the background of degenerative changes in the tendon itself. In this case, when it ruptures, the ends of the tendon are disintegrated, looking like a disheveled washcloth. A surgeon who sees such a gap with his own eyes quite reasonably assumes that with conservative treatment such rags cannot grow together firmly. We could show you a photograph of a torn tendon with degenerative, frayed ends, but we won't do that for ethical reasons - the surgery is very delicate. Believe me, if you yourself saw the torn ends of the tendon, you would also doubt that it could heal on its own.
In general, world science knows of repeated cases where conservative treatment did not lead to success, the tendon did not heal, surgery was performed several weeks after the start of treatment, and the surgeon did not see even a hint of fusion during the operation...
Therefore, to summarize, conservative treatment is possible if it is started within a few hours after the rupture (while the ends of the tendon can still be compared), if the patient does not have functional needs, is not going to not only play sports, but is also in any way active lifestyle (for example, older people who move only around the apartment). In other cases, we consider an operation more justified, which allows you to accurately and firmly suture the torn tendon and obtain a more reliable and faster result.
According to many scientific studies, the earlier the operation is performed, the better the results. The fact is that over time, the soleus and gastrocnemius muscles shorten, and it is often no longer possible to compare the ends of the tendon 18-20 days after the injury.
The operation is performed under anesthesia. For this, spinal (regional) anesthesia, intravenous anesthesia or local anesthesia can be used.
In the classic version of the operation, an 8-10 centimeter long incision is made along the back surface of the leg, access is made to the tendon, its ends are trimmed and stitched with a special strong thread using one of the types of tendon sutures. There are several dozen or even hundreds of types of tendon sutures, so we will show you only the most common and generally accepted suture in the world - the Krackow suture. This suture is used to sew together both ends of the torn tendon, after which the threads are tied together.
Achilles tendon suture options according to Krackow
After the ends of the tendon are sutured, layer-by-layer suturing of the wound is performed. First, the paratenon is sutured, a special sheath within which the tendon slides, and then the skin. The disadvantages of this operation are: a fairly long incision, which can lead to an uncomfortable and unsightly scar, which, for example, interferes with wearing dress shoes. In addition, sometimes, especially if a person has diabetes, the wound does not heal well after surgery.
Therefore, there are other methods, for example, percutaneous suture of the Achilles tendon according to Ma and Griffith, according to Trachuk and other authors. During this operation, the skin is not cut; stitching is performed with a needle through punctures.
Percutaneous suture of the Achilles tendon according to GWC Ma and T.O. Griffith (1977)
The disadvantages of a percutaneous suture are that the surgeon does not see the ends of the tendon, and they may not be aligned accurately, for example, with such a suture they may become twisted, which subsequently impairs the function of the tendon. In addition, the sural nerve runs next to the tendon, and with a percutaneous suture it runs the risk of getting caught in a loop of thread.
Modern technologies do not have these disadvantages of percutaneous suture - for example, the minimally invasive suturing system with the Achillon system, the principle of operation of which is shown in the figure. To perform this operation, a 3-4 centimeter incision is sufficient, but it is enough to accurately match the ends of the torn tendon end-to-end. Achillon system guides eliminate sural nerve suturing.
Tendon suture technique using the Achillon guide. A – appearance of the guide, B-D – stages of suturing the proximal tendon stump. The distal stump is stitched in a similar way, after which the ends of the threads are tied together. A transverse or longitudinal incision is performed in the projection of the rupture
There are other modern technologies that allow the tendon to be sutured with virtually no incision. For example, does the Tenolig system belong to them? Which works on the harpoon principle.
Percutaneous suture with Tenolig system
If no more than 18-20 days have passed since the rupture, then such a rupture is called fresh, and it can be stitched using one of the above methods. However, if more than 20 days have passed since the rupture, then the rupture is called old or chronic, and when stitching, as we have already mentioned, difficulties may arise - in particular, the contracted muscles will not allow the torn ends of the tendon to be compared. In this case, they talk about a tendon defect, and tendon plastic surgery is needed to eliminate it. Such operations are performed, with rare exceptions, only in an open manner, i.e. a long incision is made. The illustration below shows a version of the plastic surgery according to Lindholm and Chernavsky, when the rupture site is covered with a part of the tendon cut from its upper end. There are many other plastic surgery options that may involve transplanting other tendons or using synthetic materials to correct the defect.
Lindholm plastic surgery – two lateral flaps
Plastic surgery with a central rotation flap according to V.A. Chernavsky
In addition, with old or chronic ruptures, degenerative changes in the ends of the tendon intensify - they become loose, loosened, which also dictates the need for traditional, open surgery, even if there is no tendon defect and the ends of the tendon can be compared without tension.
Degeneration of tendon ends due to old rupture
A special variant of Achilles tendon rupture is repeated rupture (rerupture). In this case, only open surgical treatment is preferable.
After the operation, the leg is immobilized in the same way as during conservative treatment, as we have already written about above. In the first weeks after surgery you will have to walk with the help of crutches. In our opinion, the most preferable is immobilization with an orthosis (brace), which allows you to adjust the angle of flexion of the foot at the ankle joint. With this option, our patients are usually immobilized with their toes extended for 3-4 weeks, then we gradually reduce the angle and allow them to walk without crutches. We stop immobilization completely 6 weeks after surgery, but this period is individual and for some it can be stopped earlier, while for others it has to be extended.
It is traditionally believed that development and rehabilitation begins only after the cessation of immobilization. This approach must be recognized as outdated and harmful. We have developed our own rehabilitation program, which can significantly improve treatment results. It is important to understand that independent rehabilitation can be dangerous and all changes in immobilizing devices (orthoses, casts, splints, braces, etc.), transitions from one stage of rehabilitation to the next should be carried out only by the doctor’s decision. You can familiarize yourself with the rehabilitation program and see video exercises on our website (click to go to the article about rehabilitation).
In any case, even with the most correct treatment for a ruptured Achilles tendon, it will never be as strong as before, and therefore there will always be a risk of re-rupture. As we have already noted, after conservative treatment the risk of re-rupture is three times higher than after surgery. Talk to your doctor about what you need to do to minimize the risk of another rupture.
With both conservative and surgical treatment, there is a small risk of thromboembolic complications, for the prevention of which special drugs can be prescribed.
During surgical treatment, there is a risk of problematic healing of the postoperative wound, but this is minimized when using minimally invasive technologies.
We also want to inform you that currently there are no drugs, medications, dietary supplements or other means that could improve the condition of the tendon and make it stronger.
The only exception known to us is that in April 2009, the results of a study by DA Lowes and co-authors were published, who investigated the protective effect of the mitochondria-tropic antioxidant MitoQ when taking fluoroquinolone antibiotics (ciprofloxacin and moxifloxacin). Its cytoprotective effect on Achilles tendon tenocytes turned out to be much more pronounced than that of mitochondria-neutral antioxidants. This drug is not registered in our country.
Questions to discuss with your doctor
What method of treating an Achilles tendon rupture, operative or conservative, is appropriate in my case if I am ... years old, I work ..., I periodically do/do not play sports, and ... days have passed since the injury?
What type of surgery will be best in my case? Is it possible to use modern minimally invasive techniques?
Will tendon repair be required?
What will the immobilization be like? What is better, plaster, polymer cast or orthosis in my case?
How long will the immobilization last?
Who will monitor the postoperative period, regulate the immobilization option and the rehabilitation program?
How soon can I go to work if I work...?
How soon can I return to sports?
What is the risk of complications in my case?
The article is intended exclusively for comprehensive information about the disease and its treatment tactics. Remember that self-medication can harm your health. See your doctor.
Tendons connect muscles to bones. They come in the form of jumpers that divide the muscle into several sections. And also short, long, wide, narrow. There may be cord-like, round, ribbon-like and lamellar tendons. The digastric muscles have intermediate tendons. They pass along the lateral surface of the muscle body and penetrate into its thickness.
Like a muscle, tendons are made up of parallel bundles. First-order bundles are surrounded by layers of loose connective tissue and form a second-order bundle. A group of second-order beams forms a third-order beam. Tendons are composed of dense fibrous connective tissue; they contain more fibrous elements than cellular elements.
Due to this, their distinctive properties are high strength and low elongation. The tendon part of the muscles grows faster from 15 to 25 years than the muscle belly. Until the age of 15, the tendons are poorly developed, their growth has the same intensity as muscle growth. In the body of older people, changes occur in tissues, the elasticity of tendons is impaired, which often leads to injury.
The longitudinal elasticity of the tendon tissue protects the tendons from rupture during sudden movements and overexertion. Therefore, in order to prevent tendon injuries, it is necessary to activate, develop and strengthen them; regular exercise and performing certain, special exercises will restore their elasticity and strength.
There is a great saying that contains great wisdom: “He who exercises his sinews in his youth will receive vigor in his old age.” If physical effort is needed to train muscles, then tendons are trained using static tension. With physical stress, tendons and fascia are enriched with oxygen and become elastic, gaining endurance and strength.
Tendons must be elastic; the loss of this property leads to displacement of internal organs, changes in natural shapes, and the formation of knots and compactions. The strength of the tendons was known to the hero Zass Alexander Ivanovich, who created his own training method.
Commander Grigory Ivanovich Kotovsky, sitting in captivity, practiced static exercises and was famous for his unprecedented strength and endurance.
To identify tendon pathology, methods are used - palpation, thermography, ultrasonography, biopsy.
When tendons inside a joint are damaged, arthroscopy is effective. Anomalies in the development of tendons are a consequence of malformations of the musculoskeletal system, atypical movement or unusual attachment.
There are several types of inflammatory tendon diseases, accompanied by disruption of the musculoskeletal system.
1. Tendinitis is an inflammatory process that occurs quite often. The reasons for its occurrence are always the same and therefore, during diagnosis, identifying this pathology is quite simple. Tendonitis occurs from prolonged chronic overexertion, which causes degenerative changes and tears in the tendon. This type of inflammation helps reduce the strength of the tendon and increases the risk of rupture.
Tendonitis can also be infectious. Athletes mainly suffer from the dystrophic type due to heavy physical stress on muscles, ligaments and tendons. Various rheumatic diseases of the joints also contribute to the development of such inflammation.
2. Paratenonitis - aseptic inflammation of the peritendinous tissue. It occurs when there is repeated trauma in the joint area. In this case, in the connective tissue, between the fascia and the tendon, after pinpoint hemorrhages and the appearance of swelling, fibrous tissue deposits occur. Nodular seals lead to painful sensations, movements are limited, and activity is lost.
The disease damages the Achilles tendon, extensors of the forearm, and the lower third of the leg. Paratenonitis can have an acute and chronic course. Treatment for tendon inflammation is immobilization of the hand or foot. Traditional physiotherapeutic procedures are also effective.
Treatment of acute inflammation of the tendon (tendinitis) involves antibacterial and restorative methods. In the case of aseptic tendonitis, non-steroidal anti-inflammatory drugs are used.
Local treatment consists of fixing the diseased limb. After the acute manifestations of the disease pass, physiotherapeutic procedures can be prescribed. Warming up should be performed after the acute manifestations of the disease have passed.
This set of procedures includes UHF, microwave therapy, ultrasound, ultraviolet rays. Special therapeutic exercise is useful. Soft heat and magnetic fields, improving blood circulation, relieve inflammation, tissue swelling goes away, and damaged parts of the tendons are restored.
Sprains are the most common type of injury and usually occur in the ankle and knee joints from a sudden movement that exceeds their amplitude. Tendons connect muscles to bones, and ligaments connect bones. These two definitions are often confused. A sprain is in fact always a microscopic tear with a small stretch; with a moderate degree of injury, individual collagen fibers may rupture; if the injury is severe, the entire ligament is torn.
Having a high ability to regenerate, ligaments are restored at any degree of injury. The strongest muscles in humans are found in the lower extremities. This also means that the tendons that attach the muscles to the bones in the legs must withstand enormous forces. But, unfortunately, unsuccessful movements and falls occur, causing sprained tendons in the leg.
Stretching of the Achilles tendon occurs when the muscles are not warmed up enough during sports activities, when wearing uncomfortable shoes, or when walking on uneven, rocky surfaces. Tendon sprains can be divided into three degrees of difficulty:
Typically, third degree tendon damage is repaired surgically. Many victims of the first and second degrees do not pay special attention to treatment and in vain, a weakening of muscle strength may occur, the development of inflammation in the tendon and in the “case” - where there are several of them. This phenomenon is mainly observed in the tendons of the foot muscles and is called tenosynovitis.
Chronic inflammation is complicated by the atrophic process, which affects the thinning of tendon fibers; they can be easily torn with small loads. When the tendons on the leg are sprained, first aid consists of immobilization and fixation in an elevated position. Then you need to apply ice for 20-30 minutes (repeat 4-5 times a day), after which each time apply a pressure bandage using an elastic bandage to limit the spread of swelling.
Ice will stop bleeding from damaged vessels. Severe pain is relieved by drugs such as diclofenac, analgin, ketanov. On the second day, after inflammation and swelling have subsided, if there is no development of a hematoma, the next stage of treatment is applied, namely thermal procedures. The effect of heat normalizes blood flow and the damage heals. The use of anti-inflammatory ointments is effective, among which Finalgon, Efkamon, Voltaren have become popular.
The tendon recovers faster at rest, thanks to the consumption of foods rich in animal and plant proteins. After a week, under the supervision of a specialist, a set of exercises is gradually applied to the sore muscle. Mechanical damage occurs as a result of the direct or indirect action of a traumatic agent.
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Direct action - impact with a blunt object. Indirect action - sharp muscle contraction. There are closed injuries, among which there are ruptures and much less often dislocations. Closed injuries include spontaneous ruptures; they usually occur with chronic injury and dystrophic changes in the structure of the tendons. Also, the cause of rupture can be infectious-toxic and metabolic-toxic factors, for example, diabetes, arthritis, infectious diseases.
There are subcutaneous partial or complete ruptures without damaging the skin. Tendon dislocation as a result of ligament rupture ends in hemorrhage, swelling and pain when moving the joint. The displacement can be so strong that the defects are visible upon visual inspection. Especially if it concerns the extensors of the fingers. Treatment of a dislocation is its reduction, immobilization with a plaster cast for a 3-4 week period.
Surgical intervention is indicated for chronic and habitual dislocations, with pain constantly reminding of the damage, and with an obvious change in functional activity. A tendon rupture is usually signaled by a loud cracking sound, unbearable pain and impaired motor function of the ruptured muscle. Open injuries are observed with stab, cut, chopped wounds, and with severe injuries. Damage levels:
Open injuries (puncture, cut, chopped wounds) are observed in severe injuries, for example, after a hand gets caught in working machinery in production. Damage to the tendons of the muscles of the upper limb at the level of the hand and forearm is mainly observed, most often the flexors. Both individual tendon injuries and combinations with damage to nearby vessels and nerves are noted.
When the hand finds itself between the moving parts of the unit, it is crushed, lacerations are obtained, the muscles contract and the ends of the tendons diverge. A puncture wound completely cuts the tendons in a limb. Here, surgical restoration is required; the operation is quite complex and lengthy because it is necessary to sew up all the damaged tendons in order to normalize the function of the hand. The application of an extensor dynamic splint accelerates the healing process of tendon wounds.
When the tendons of the fingers are torn, a lack of active flexion in the distal interphalangeal joints of the hand can be detected. This is evidence that the deep flexor muscle is damaged. If the absence of active movements in the interphalangeal joints is determined, then the superficial and deep flexors of the fingers are damaged. But the function of the lumbrical muscles, which provides active flexion at the metacarpophalangeal joints, may be preserved.
By examining the sensitivity of the fingers, nerve damage is detected. The X-ray method for bruised and crushed wounds will definitely show the degree of damage to bones and joints. Open injuries to the flexor tendons of the fingers are more common. If there is damage in the area of the distal interphalangeal joint, flexion of the nail phalanx by 60° is possible, but extension is impossible.
If the tendon-aponeurotic stretch of the extensor fingers of the hand is affected at the level of the proximal interphalangeal joint, even if the integrity of its central part is damaged, extension of the nail phalanx is possible, sometimes the middle one can be in a flexed position. It is quite common for the nail and middle phalanges to be in a bent position while all three parts are affected. The extensor finger can be damaged in the area of the main phalanx, then active extension in the joints between the phalanges occurs, but there is no activity of extension of the main phalanx.
Damage to the flexors and extensors of the fingers has to be treated surgically. The exception is fresh tears in the area of the distal interphalangeal joint; here, fixing the nail phalanx in a hyperextension position and bending the middle phalanx at a right angle for 1 to 1.5 months effectively helps.
As for open injuries, first aid consists of stopping the bleeding, after which it is advisable to cover the wound with a sterile bandage and apply a transport splint. At the trauma center, the diagnosis will be clarified, the wound will be treated, and a tendon suture will be made, which, by the way, is contraindicated for lacerations, bruised wounds, bone fractures and joint injuries. Modern surgeons recommend plastic surgery for chronic injuries of the flexor and extensor tendons of the fingers.
Degrees of damage to the tendons of the foot:
Rupture and damage to the Achilles or calcaneal tendon (triceps muscle of the leg), which is attached to the heel tubercle and is very thick, appears as a result of severe tension. Usually the gap in this zone is complete. Causes of damage include direct trauma after being hit by a hard object and indirect impact resulting from a sharp contraction of the triceps surae muscle.
The risk group includes athletes; injury can occur, for example, in runners with a sudden load on the tendon when the foot lifts off the surface at the start, in track and field athletes with sharp dorsiflexion of the foot during a fall from a height. Partial damage to the Achilles tendon occurs due to direct trauma with a cutting object. The victim experiences acute pain, a sensation of a blow to the tendon.
Hemorrhage and swelling are observed on the back surface of the lower third of the leg. You can see a dent in the rupture area. The patient cannot stand on the balls of his feet and plantar flexion of the foot is impossible. First aid consists of pain relief with medications and delivery to the trauma department.
Treatment for fresh ruptures (no more than two weeks) is a closed percutaneous suture. A plaster cast is applied to the affected area for 4 weeks, the leg remains in one position all the time. After removing the thread from the suture, the leg is fixed for 4 weeks in a different position.
If the injury is old (more than 2 weeks), usually scar tissue has already formed at the ends of the tendons, it is removed, a skin incision is made over the tendon, and the ends of the tendon are sutured with a special suture according to Dr. Tkachenko’s method. If there is a tissue defect, plastic surgery is performed, followed by the application of a plaster cast for a period of 6 weeks. Full recovery is guaranteed with the use of special exercises and physiotherapy.
The Achilles tendon is the strongest; when the muscles are tense, it stretches and allows you to stand on your toes or perform a jump. For diagnosis, radiography of the ankle joint in a lateral projection, magnetic resonance imaging, and ultrasound equipment are used. Damage can also be determined using traditional palpation.
In the legs, there is a rupture of the quadriceps tendon. The quadriceps femoris tendon attaches to the surface and sides of the patella and tibial tuberosity. This is a very strong connection, but the muscle also has strength, so its sharp contraction causes the tendon to rupture in the transverse direction in the area just below the attachment to the patella. At the moment of rupture, a crack is heard and a sharp pain is felt above the knee.
Retraction occurs, hemorrhage occurs, and tissues swell. The quadriceps muscle loses its tone, its tension leads to a hemispherical protrusion. Attempts to straighten the lower leg become unsuccessful. First aid - splinting and transport to hospital. To treat a rupture of the quadriceps tendon, pain relief is used and the ends of the tendon are sutured with threads made of absorbable material. A plaster cast is applied for 6 weeks. Then physical therapy and physiotherapy are indicated.
Many people experience pain in the tendons of their legs and arms. Doctors state that they have to deal with such complaints in their practice every day.
Pathogenic processes in tendons such as tendonitis, tendinosis and tenosynovitis are not uncommon. Tendinitis develops with incorrect posture, prolonged sitting in an uncomfortable position, and lack of warming up of the muscles during sports. Infectious diseases, arthritis of the joints and diseases of the musculoskeletal system, different lengths of the limbs increase the load on the muscles and tendons.
If there is pain in the tendons, then it is also noticeable in the neighboring tissues. Soreness may occur suddenly or gradually increase. Unbearable pain is characterized by the presence of calcium deposits, impaired mobility and capsulitis of the shoulder. Sharp pain is observed with tendinosis, because it is associated with tendon rupture. Tenosynovitis also causes tendon pain. The cause of pain in the tendons may be excessive force of the organ. With prolonged stress, tissue degeneration develops and metabolism is disrupted.
The Achilles tendon is the largest tendon in humans. It is formed by the fusion of aponeuroses (flat tendons) of the posterior muscles of the leg - the gastrocnemius and soleus muscles, which are sometimes called the triceps surae muscle. Sometimes it is also called the heel tendon. This tendon attaches to the tubercle of the heel bone. When the muscles contract, they pull on the Achilles tendon, and as a result, plantar flexion occurs at the ankle joint - i.e. we can stand on the toes of our feet or jump, pushing off with our feet. There is a mucous bursa between the surface of the heel bone and the tendon, which reduces friction between the bone and tendon. In addition, the tendon itself is located in a special channel, inside which there is also a little fluid that reduces friction. You can learn more about the anatomy of the Achilles tendon and calf muscles on our website (click to go to the article on anatomy).
In medical language, terms ending in -itis mean inflammation. Tendon in Latin means tendon. Accordingly, tendonitis is an inflammation of the Achilles tendon, manifested by pain during exercise and, in advanced cases, even at rest. However, scientific research over the past ten years shows that pain in the Achilles tendon causes changes that are not very characteristic of typical inflammation, in particular, so-called degenerative changes and disruptions of the normal fiber structure of the tendon occur. Therefore, recently the more correct term tenopathy has become increasingly widespread - i.e. tendon disease.
The basis of Achilles tendon tenopathy is its overstrain - a common situation for runners, basketball players, volleyball players and other athletes, dancers, acrobats who jump a lot, and also start and stop abruptly. Tenopathy of the Achilles tendon is very common - according to some data, the frequency of this disease reaches 11% of all diseases of athletes.
Causes of development of Achilles tendon tenopathy
The Achilles tendon consists of special spirally twisted tendon fibers, consisting mainly of collagen protein, which is very strong and practically does not stretch. In addition, tendon fibers contain another protein - elastin, which is able to lengthen and restore its shape. In general, in a healthy person, the Achilles tendon can elongate by about 5% of its length, which allows the tendon to spring back and act as a shock absorber.
Unfortunately, as we age, the tendon's ability to stretch decreases, so overuse can lead to micro-tears. Therefore, after 35 years, you should never engage in fitness or sports without first warming up, during which you need to perform several exercises to stretch the Achilles tendon. This recommendation is especially important for those people who experience any pain in the Achilles tendon area.
Achilles tendon tenopathy can occur not only as a result of sports stress in untrained people, but also as a result of overly aggressive training in professional athletes.
Flat feet, which are accompanied by hyperpronation (i.e., the foot falling inward), can also lead to Achilles tendon tenopathy. In this case, the tendon is forced to overstretch and become injured.
Overpronation (rolling of the foot inward) with flat feet
Another cause of Achilles tendon tenopathy is uncomfortable, incorrect sports shoes, which can also lead to improper movement of the tendon and its micro-tears.
The culprit of Achilles tendon tenopathy is not only overexertion and micro-tears: many women feel pain in the tendon when they wear high-heeled shoes all day and switch to flat-soled shoes in the evening. This happens because the tendon is used to being in a shortened state - the woman did not put her heel on the ground most of the time, and now the tendon “protests” - for the foot, an unusual stretch can be equivalent to running ten kilometers.
A special variant of Achilles tendon tenopathy can occur with Haglund's deformity.
Achilles tendon tenopathy can be acute, meaning the pain has a short history - usually a few days. Tenopathy is inherently a dangerous stress condition of the Achilles tendon. If this “stress” is not treated and the load continues, then the process can become chronic, i.e. the pain will become constant and, in extreme cases, the tendon may give way and rupture.
Symptoms of Achilles tendon tenopathy
Gradual onset of pain over several days
Pain occurs at the beginning of the load on the tendon and then gradually decreases during training.
The pain goes away after rest
Unpleasant sensations when feeling the Achilles tendon.
Gradual onset of pain over weeks or even months.
The pain occurs with any exercise and does not go away.
Pain in the tendons occurs when climbing up an inclined surface or when climbing stairs.
Pain and stiffness in the Achilles tendon occurs in the morning or after resting. The fact is that when we rest, we usually stretch our feet, and this leads to a weakening of the Achilles tendon tension and a decrease in pain. If the rest lasts for a long time (for example, overnight), then the pain from micro-tears goes away and these micro-tears have time to grow together, and in the morning, with the first steps, we again tear apart what has managed to grow together. In this case, the pain can be so severe that it is even difficult to take a step.
2-5 centimeters above the heel on the Achilles tendon there may be a thickening, compaction or nodule, which is a consequence of a chronic pathological process in the tendon tissue.
The skin around the tendon may be inflamed and red.
Swelling over the tendon.
Sometimes you may feel a creaking sensation when you press on the tendon with your fingers and when you move the ankle joint.
Acute tenopathy is relatively easy to treat, but chronic tenopathy is difficult to treat; it is a rather stubborn, capricious disease, so do not let the disease get worse.
Give the sore leg a rest and temporarily eliminate stress on the Achilles tendon.
Apply something cold to the tendon for 10 minutes 3-4 times a day.
Try not to carry heavy objects.
The leg can be bandaged with an elastic bandage, which will limit movement and protect the tendon.
Temporarily wear shoes with slightly higher heels than usual - this will also relieve the tendon.
Make sure you have the right sports shoes, consult your trainer or doctor.
If these measures do not bring relief, then consult a doctor for a more detailed diagnosis (it is possible that you do not have Achilles tendon tenopathy, but, for example, Haglund’s disease) and treatment.
The first priority is to relieve acute pain. To do this, in addition to the measures described above, the doctor may prescribe you anti-inflammatory drugs in the form of tablets or ointments.
In some cases, the disease is so persistent that it is necessary to completely or partially immobilize the ankle joint with a brace or orthosis.
An orthosis that allows you to completely eliminate movement
Sometimes such orthoses, which fix the foot at a right angle to the shin, are worn only at night, and sometimes they have to be worn during the day, and in especially stubborn cases it is necessary to use crutches.
Special medical massage plays an important role in the treatment of Achilles tendon tenopathy.
After the acute pain has been overcome, they begin to strengthen the tendon through special exercises (stretch exercises, or stretching exercises). Your doctor or sports therapist will recommend strengthening exercises for your rehabilitation.
These exercises are based on forcibly stretching the tendon to the point of “pleasant pain.”
In addition to the fact that the tendon needs to be stretched, you also need to train the posterior muscles of the lower leg (gastrocnemius and soleus), for this purpose exercises are performed on a steppe or on a simple step, the load can be gradually increased: they start from lifting on the toes of both legs, then move on to lifting on the toes one leg and, eventually, exercises with weights (for example, with a backpack on your back) are possible.
Step exercises
For persistent pain, there may be a need to administer special drugs - glucocorticosteroids (diprospan, triamcionolone, hydrocortisone). It is important not to inject these drugs into the tendon itself, and perform the injections no more often than once every 2-3 months.
Taping . Taping is a special branch of sports traumatology. The essence of taping comes down to the fact that a special sports tape is glued on - tape, which relieves the load on the tendon. If tape is not available, then a wide adhesive plaster, for example from Hartmann, can be used. There are two options for taping for Achilles tendon tenopathy - simple, when predominantly one strip is glued, and complex, in which a strip and two rings are glued.
In particularly stubborn cases, an operation may be required, the nature of which is clarified during preoperative planning, including with the help of magnetic resonance imaging. Usually in such cases, foci of chronic degeneration are found in the thickness of the tendon, similar to brushes, which are excised during surgery and the tendon itself is sutured.
Prevention of Achilles tendon tenopathy
Do stretching exercises for the muscles and tendons of your legs to keep your muscles strong and flexible.
Pay special attention to stretching the hamstring muscles.
Systematically pump up your calf muscles and increase their strength.
Before any sports training, warm up and stretch your tendons.
Always gradually increase the intensity and duration of your workouts.
Stop training if you feel pain in the tendon.
For jogging, choose comfortable sports shoes with well-fitted arch supports.
Practice balance - balance on one leg. This has a beneficial effect on both the calves and the Achilles tendon.
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