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Achilles tendon restoration technique. Surgeries on the Achilles tendon: indications, performance, rehabilitation

In case of complete damage to the Achilles tendon ligaments, surgical intervention is indicated to stitch together healthy fibers and, if necessary, introduce artificial material. Recovery takes from 8 weeks to six months.

In the case of a complete rupture of the tendon, the patient cannot lean on the foot, bend it and experiences unbearable pain. Therefore, in such cases, immediate surgical intervention is indicated. The operation is quite successful, the prognosis for recovery is favorable, especially if you consult a doctor in a timely manner.

Indications for surgery

Interestingly, it is the Achilles (or heel) tendon that is the strongest in human body. It is estimated that due to the dense structure of the fabric and the abundance of ligaments, it can withstand even the most severe stretches - up to 350 kg and in some cases more. At the same time, it is precisely this that is often subjected to negative impacts(more than 30% of cases). This is mainly explained sports injuries, awkward, sudden movements that can partially tear the fibers of the ligaments.

The Achilles ligament can rupture for various reasons:

  1. Too sudden movements during sports activities, awkward turning of the leg.
  2. Overload calf muscle legs.
  3. Jump from a height, fall with a twisted leg.
  4. Strong mechanical impact, a complication after a blow.
  5. Sudden movements with changes in height (for example, running up and down stairs).
  6. Complications of chronic diseases - gout, osteoarthritis, rheumatoid arthritis, complications of inflammatory processes.
  7. Side effects of certain medications. For example, it is known that injections of corticosteroid substances, which weaken the tissue and destroy tendon cells, can cause complications.

Pay attention! At risk are athletes, as well as people constantly engaged in intense physical labor, including movement on uneven surfaces. Uncomfortable shoes (narrow, upturned toes, too hard heels) also provoke injury.

For athletes and people engaged in hard work, it is recommended to wear special ones.

Middle-aged and elderly people (people over 40 years of age), mostly men, are also at high risk, which is explained by the characteristics of their lifestyle. With age, the blood supply to the ligaments becomes noticeably worse, so the tissue begins to gradually weaken. Unreasonably high load and awkward movements provoke injury.

Achilles tendon rupture symptoms and first aid measures

In practice, there are 2 forms of rupture:

  • partial;
  • full.

In the first case, the disease proceeds practically without pronounced symptoms - the absence of severe pain, swelling and inflammation often misleads patients, while pathological processes gradually begin to develop in the absence of treatment.

In this case, wearing tight bandages will not solve the problem.

Complete rupture of the ligaments occurs due to severe injury, a fall or blow.

It is accompanied by bright severe symptoms, the main of which is strong, unbearable pain. The disease also manifests itself with the following symptoms:

  • severe pain in the heel, radiating to the foot;
  • it is impossible to place your leg on the floor, you cannot lean on it;
  • it is also difficult to raise the foot, make any movement with it (up/down or rotational);
  • during injury, you can hear a characteristic tearing sound, which is similar to a click;
  • Finally, damage can also be detected by palpation (palpation) - the ligaments characteristically protrude compared to their normal location.

First of all, the victim needs to be seated or laid down so as to completely relieve the injured leg. It is unacceptable to move your foot, much less adjust the tendon yourself. An ice cloth or other cold source is placed on the affected area, and the patient is immediately given pain relief. Next steps Only doctors can do this.

Progress of the operation and its advantages

To clarify the diagnosis, the patient is prescribed an ultrasound, computed tomography or magnetic resonance imaging.

If a ligament rupture is confirmed, surgery on the Achilles tendon is prescribed. Its main task is to restore ligaments, stitch together healthy fibers or implant artificial material (for example, high-strength polyester). The main principle of treatment, which is largely associated with the prognosis for a favorable outcome, is timely consultation with a doctor.

The more time the patient waits, the more the damaged ligaments wear out, and the further the fibers diverge from each other. In addition, the tissues begin to wear out mechanically: the fibrous structures loosen, the tendon becomes less dense, which is why intense degenerative processes begin. Therefore, the victim needs to see a doctor as quickly as possible, even with minor injuries (the first 3-4 weeks are critical).

In this regard, the following are highlighted:

  1. Early ruptures (up to 3 weeks).
  2. Late ruptures (from 3 weeks).

In the first case, treatment is carried out by closed minimally invasive surgery. The patient is given an epidural by safely injecting an anesthetic into the spinal cord. The damaged parts are removed and the healthy ligaments are sutured. Since damage due to the intervention is minimal, the risk of complications is also significantly reduced.

Features of the operation can be seen in the video:

The second case involves open intervention with a more complex surgical technique. Damaged fibers are removed and artificial material is introduced.

The reason is that due to the long-standing period, it is no longer possible to connect healthy tendons. This type of surgery is performed mostly without complications, but recovery takes more time.

Contraindications for surgery

Surgery for rupture of the Achilles tendon is not performed in case of partial damage to the ligaments, when it is enough to do with measures conservative therapy(use of medications, massage and physiotherapeutic procedures,).

However, even with difficult situations When a significant rupture has occurred, the surgeon may refuse the intervention procedure. A negative decision is usually made if:

  • the patient has a general feeling unwell associated with chronic diseases;
  • age-related complications, age over 75–80 years;
  • severe disorders of blood clotting processes that can cause heavy bleeding due to interference;
  • poor condition of the soft tissues of the lower leg;
  • skin infections.

In such situations, conservative treatment is prescribed; the load on the leg is completely eliminated for a certain time. For immobilization, plaster splints or are used.

How does recovery occur after intervention?

The full recovery period takes from 2–3 to 6 months. The rehabilitation period can be divided into several stages:

  • Initially, a plaster cast is applied to the injured leg from the bottom of the knee to the shin (replacement is possible). Flexion and extension of the foot is not allowed, ( or ).

  • 4 days after the operation, the patient, under the supervision of a doctor, attempts to flex the calf muscle, and specialists take appropriate measurements of muscle tone. The bending exercise should be repeated several dozen times throughout the day.
  • The next stage begins after 3 weeks - the plaster cast is removed from the patient and a plaster boot is put on (). It is also worn for about 3 weeks. The boot fixes the ankle joint to a lesser extent, so the victim can begin to make more active movements.
  • After 1.5 months from the moment of intervention, the boot is also removed - now the person can gradually lean on the sore foot and make careful movements to flex and extend the lower leg. Walking is still allowed only with support from crutches or.

  • Finally, after 2 months you are allowed to stop using crutches and you can use everyday shoes.
  • Approximately 3 months after the operation, the person returns to normal life.

Pay attention! During the entire rehabilitation period, physical stress on the leg, vigorous walking, and carrying heavy objects is excluded. Running, jumping and other sudden movements are strictly prohibited. Regular execution shown therapeutic exercises, which are developed by a doctor.

Possible complications

Complications after surgery are rare; they are associated with late consultation with a doctor or incorrect technique of performing the operation:

  • wound infection;
  • formation of a strong scar;
  • large scar on the surface (cosmetic complication);
  • sural nerve damage (extremely rare);
  • skin necrosis (partial death of soft tissue in the area of ​​injury);
  • inability to move the foot normally.

The decision to eliminate the consequences in each case is made individually. At the same time, it is extremely important for the patient to monitor his well-being throughout the entire rehabilitation period and be under constant medical supervision.

Clinics and costs

The price of the operation depends on the degree of complication, individual characteristics patient (age, chronic diseases), as well as from a specific clinic.

Table 1. Overview of the cost of operations in various clinics

Injuries do not only occur in athletes, but they can also occur in any person. excessive load, as a result, complete or partial rupture Achilles tendon, treatment and rehabilitation after surgery to restore it takes quite a lot of time. However, if you follow all the doctor’s recommendations, you can fully recover from this condition.

Anatomically Achilles tendon connects the heel bone to the so-called gastrocnemius muscle. It helps a person when walking and running, ensures the functionality of the lower limbs in everyday life, so when this ligamentous apparatus is injured, it becomes simply impossible to walk and perform normal activities.

Tendon rupture leads to acute pain, localized in the back of the leg in the shin area. It is impossible for a person to lean on the sore leg, a feeling of stiffness is added, and swelling at the site of attachment of the tendon will be visually determined. IN similar situation It is necessary to contact the emergency room as quickly as possible, where the patient will receive qualified assistance.

Treatment of Achilles tendon rupture

In a trauma hospital, the victim is given an MRI to determine the extent of damage to the tendon tissue. Based on the data received, the doctor prescribes therapeutic measures. If this tendon connection is completely ruptured, surgery is performed. If the rupture is partial, the patient is given a so-called plaster splint for about one and a half to two months.

Under the influence of a plaster cast, the ankle joint is immobilized, which brings everyday inconvenience; you have to walk on crutches or with a cane, but there is nothing you can do to restore your health.

In addition, the rehabilitation (recovery) period takes quite a long time and requires certain efforts from the patient in order to regain the function of the Achilles tendon lost due to injury.

Achilles tendon rupture - rehabilitation after surgery

Typically, rehabilitation measures for the tendon after surgery begin in the period from one to six weeks after the procedure. surgical intervention. An increase in the load on the leg must be agreed upon with the treating traumatologist.

The rehabilitation program takes into account all four phases of Achilles tendon restoration (inflammation, proliferation, remodeling, and maturation). The weakest ligamentous apparatus in the first six weeks after surgery, and after 12 months its mechanical strength begins to increase.

First phase of rehabilitation

During this period, the tendon is protected from excessive flexion, and its active fusion is observed. This period lasts from 1 week to 6 weeks. The degree of dosed load is selected for the patient, and the the best way immobilization.

For successful recovery, as well as tendon fusion, a load on the so-called muscle-tendon complex is necessary, which will prevent subsequent muscle atrophy, as well as contracture (immobility) of the joints, in addition, deep vein thrombosis and arthritis.

After dosed axial load, it is recommended to add exercises on a special exercise bike to the rehabilitation program.

To properly heal the repaired gap, rehabilitation includes massage of the so-called postoperative scar, which prevents the formation of scar adhesions. To relieve pain, the doctor performs cryotherapy; to relieve swelling, it is recommended to keep the limb in an elevated position.

Second phase of rehabilitation

The second phase of rehabilitation, correcting the tear, after surgery on the Achilles tendon lasts from 6 to 12 weeks. During this period, it is recommended to slightly increase the mobilization of the limb, and it is also recommended physical exercise for stretching. Provided that the postoperative wound is completely epithelialized, the patient is allowed to walk on the so-called underwater treadmill, as a result of which the axial load on the diseased limb is reduced.

Third phase of rehabilitation

During this period, early strengthening of the tendon occurs. This rehabilitation period lasts from 12 to 20 weeks. The amplitude of active movements in the leg is restored. During this period, you can exercise on simulators according to a specially designed program. Once your gait is restored, you can start running on the so-called underwater treadmill.

The intensity of exercises performed by the patient should be regulated by a rehabilitation therapist. The criterion for transition to the fourth phase is the restoration of the patient’s ability to balance on one leg.

Fourth phase of rehabilitation

During this period, increased physical activity begins, close to sports activities. This phase lasts from 20 to 28 weeks. It is usually recommended for people who play sports professionally to get them back into shape.

At the twentieth week after surgery, so-called isokinetic testing is performed, during which the rehabilitation doctor will receive the necessary objective data on the endurance of the lower leg muscles and their strength.

Conclusion

If the tendon has ruptured, treatment begins with urgent appeal to the trauma center. The rehabilitation process should be carried out under the guidance of a specialist.

The Achilles tendon (lat. tendo calcaneus) or heel tendon is the most powerful and strong tendon in the human body. Despite this, it is one of the most commonly injured tendons.

The proximal part originates at the junction of the soleus and gastrocnemius muscles, the zone of its distal fixation on the posterior surface of the tubercle calcaneus.

An Achilles tendon rupture is usually complete. More often, ruptures occur when there is a sudden sharp load on the tendon when starting in sprinters, when the leg lifts off the ground during a jump, or when the foot is sharply dorsiflexed - a fall from a height. In case of direct trauma with a cutting object, partial damage to the tendon may occur. The patient complains of pain in the Achilles tendon area.

At the time of injury, there is a sensation of a blow to the tendon. On the back surface lower third hemorrhage and swelling occurs in the lower leg. Retraction is detected in the area of ​​the rupture. There is no plantar flexion of the foot - the patient cannot stand on his toes

Most often, the tendon ruptures 4-5 centimeters from the point of attachment to the heel bone.

After surgical treatment

From the first days, therapeutic exercises are prescribed, aimed at improving blood circulation in the area of ​​​​the operation, preventing adhesions, preventing stiffness in immobilized joints and muscle atrophy.

The classes include general toning exercises for upper limbs, shoulder girdle and torso (static and dynamic), exercises for the unoperated lower limb. Special exercises include wiggling your toes, ideomotor exercises, and hip movements.

From the 3-4th day, isometric tension of the triceps surae muscle is necessary when attempting plantar flexion of the foot and extension in knee joint. This exercise should be repeated many times throughout the day.

3 weeks after surgery, the plaster cast is replaced with a plaster boot for 3 weeks, and the foot is given a less flexed position.

The main task of therapeutic exercises at this stage are restoration of the range of motion in the knee joint, functional restoration of the thigh muscles and prevention of atrophy of the lower leg muscles.

The exercises are performed in the starting position, lying on your back, on your stomach, on your side, or sitting on a chair. In addition to general tonic exercises, special ones are performed: dynamic exercises with resistance, static efforts for the thigh muscles, isometric tension of the lower leg muscles, ideomotor exercises.

After 6 weeks the plaster cast is removed and therapeutic exercises is aimed at restoring movements in the ankle joint, strengthening the lower leg muscles, and preparing for walking.

In the first days after the immobilization is removed, movements in the ankle joint are performed carefully, in easier conditions: lying down and sitting on a chair (a sliding plane is placed under the foot). The exercises are carried out independently, with self-help and the help of a rehabilitation specialist.

From 6 to 12 weeks postoperative rehabilitation characterized by full axial load, increased mobilization of the limb and the initiation of stretching exercises. Initially, full axial weight bearing is allowed in a brace and with crutches, and then the patient is allowed to use casual shoes and dispense with crutches.

At this stage, it is advisable to place a heel pad in the shoe, which facilitates the transition from the brace (usually at this point it limits dorsiflexion to 20-30 degrees equinus) to regular shoes. The height of the heel pad is gradually reduced in accordance with the progress of the range of motion. Crutches and heel supports should be stopped only after the patient has restored normal gait.

Subject to complete epithelialization postoperative wound Walking on an underwater treadmill is possible. The need for this simulator is due to the fact that it allows you to develop a normal gait. Walking on an underwater treadmill with the torso immersed in water to the level of the trans-mamillary line allows you to reduce the axial load on the limb by 60-75%, and when immersed in water to the level of the waist - by 40-50%.

Active range of motion is continued in all planes without restrictions, and passive motion is limited. Regular walking is sufficient to restore functional range of motion, but stretching exercises should be avoided for this purpose. As a rule, at this stage of rehabilitation, the range of motion is already at an acceptable level. Also at this stage, careful isometric inversion and eversion are started, which gradually progress to the use of elastic bands for resistance. It is advisable to restore the strength of the lower leg muscles and range of motion using a special simulator, in which the patient’s foot is fixed in a special device that allows movements in all planes.

Once an adequate range of motion of the foot has been achieved, they move on to strengthening the two main flexor muscles (mm. gastrocnemius and soleus). At 6 weeks after surgery, active plantar flexion of the foot with resistance is performed in the position of bending the limb at the knee joint at a right angle. From the 8th week, plantar flexion with resistance begins to be performed with the leg extended at the knee joint.

Plantar flexion with resistance Performed from 6 weeks after surgery. The patient sits on the edge of the couch, legs bent at the knees and hanging down. This position of the legs reduces the tension on the Achilles tendon. A loop of elastic tape is placed on the foot of the affected leg and stretched.

At this stage of rehabilitation, they are supplemented with other exercises. Perform plantar flexion with resistance on various strength training machines. Continue training on the exercise bike, gradually increasing the load on the tarsus and shifting the point of application of the pedals on the foot closer to the toes.

Plantar flexion with resistance. Performed from 8 weeks after surgery. This exercise is performed while sitting on a couch, with the leg straightened at the knee joint lying on the couch: in this position the load on the Achilles tendon is higher. A loop of elastic tape is placed on the foot of the leg being trained and stretched.

At this stage of rehabilitation, other exercises are also used. Perform plantar flexion with resistance on various strength training machines. Continue exercise on the exercise bike, gradually increasing the load on the tarsus and shifting the point of application of the pedals on the foot closer to the toes.

Exercises on weight machines

To restore plantar flexion and proprioception, it is necessary to use backward walking on a treadmill.

Walking backwards. The patient stands on the treadmill backwards, i.e., with the back of his head towards the control panel, holding the handrails with his hands. Set the speed of the treadmill to 1-2 kilometers per hour and begin walking backwards, rolling the foot from toes to heel. In this case, the patient must fully straighten the leg at the knee at the moment when the foot is fully on the treadmill.

Step-up exercises with visual guidance. The exercise begins with a low step (10 cm high). The patient stands in front of the step on the floor and takes a slow step with the healthy leg forward, rising onto the step. In this case, the body weight rests on the sore leg, which will also train balance. There should be a mirror in front of the patient, so that the patient can look at himself from the side, controlling the position of the feet and hips - it is very important to ensure that when climbing the step, the affected leg does not fall to the side. Then return to the starting position and repeat the exercise. If the exercise is performed correctly, then the height of the step is gradually increased (15 and 20 centimeters).

It is necessary to restore not only muscle strength and range of motion, but also proprioception, without which effective muscle interaction is impossible. For this purpose, exercises on moving supports such as BAPS are useful - a stand for biomechanical training. ankle joint. The upper surface of the stand is hard and flat, and the lower surface is soft and shaped like part of a sphere.

BAPS exercises begin in a sitting position, then progress to proprioception training while standing on two legs, then standing on one leg, and gradually increase the difficulty of the exercise by throwing a ball against a wall or resistance. Proprioception and balance training on movable stands can be supplemented strength exercises, which also begin to be performed while standing on a platform on two legs, and then gradually increase the resistance and move on to exercises while standing on one leg.

From 12 to 20 weeks after surgery is full recovery active range of motion, flexor muscle strength, and symmetrical balance in both lower extremities. It is believed that the normal strength of plantar flexion corresponds to the patient’s ability to rise on the toes of one leg at least 10 times. However, the patient must first demonstrate the ability to rise on the toes of both feet, and then the conditions for this exercise become more difficult.

Restoring plantar flexion strength: Start with bilateral flexion on a machine in a seated position (to eliminate the need for balancing) and gradually increase the exercises up to a unilateral calf raise at the edge of a step.

Step-down exercises (going down steps) are performed according to a progressive type, gradually increasing the height of the step (10, 15 and 20 cm). Proprioception and balance training is again done in a progressive manner (both legs - one leg). In this case, not only the already described BAPS platforms can be used, but also trampolines, swinging stands, etc.

To further restore the strength and endurance of the lower leg muscles, isokinetic exercises are used, which involve movements with accommodating resistance at a fixed speed. Consequently, thanks to this principle, the maximum possible contraction of the muscle occurs with a simultaneous full range of movements (in in this case active-passive, since in extreme positions movements are carried out due to the simulator).

Isokinetic plantar and dorsiflexion of the foot. The patient sits in a chair of a biomechanical system with an isokinetic operating mode of the HUMAC NORM type and performs dorsiflexion and plantar flexion of the foot. The exercise trains muscle strength, and the indicators allow you to evaluate the effectiveness rehabilitation program. It is based on the principle of adjustable and accommodating resistance to movements at a constant speed.

After gait has been restored, full range of passive movements and normal muscle strength have been achieved, they begin running on an underwater treadmill, immersing the patient in water up to chest level. Exercises on such a machine allow you to reduce the load by reducing body weight.

The volume and intensity of exercises that the patient performs at home are regulated by the rehabilitation therapist in accordance with the success achieved. The criterion for transition to next phase This includes restoring the ability to balance on one leg, which is compared with the contralateral leg. In this case, both IMOOVE and COBS simulators in testing mode, as well as NeuroCom devices can be used.

From 20 to 28 weeks After the strength and function of the triceps surae muscle has normalized, the patient begins the next phase of rehabilitation, the goal of which is to return to higher than daily activity. physical activity. In general everything rehabilitation measures are aimed at preparing a springboard for the resumption of sports.

At the twentieth week after surgery, isokinetic testing is performed in comparison with the contralateral limb of plantar flexion, dorsiflexion, inversion and eversion. Isokinetic strength assessment is preferred because it is much more accurate than manual isometric testing.

Isokinetic assessment allows the rehabilitator to obtain objective data on the strength, efficiency and endurance of the lower leg muscles, which can be used not only as a criterion for transition to the next phase of rehabilitation, but also to monitor the patient’s status. If the isokinetic assessment results are at least 75% of those of the contralateral limb and the patient can rise on his toes injured limb at least 10 times, then you are allowed to start running forward on the treadmill. The running program should also be progressive, starting at slow speeds and short distances. The increase in load intensity is regulated by the patient’s subjective sensations; the running itself should be painless.

Continue with resistance exercises, development of range of motion and freedom of movement, as well as isokinetic exercises that strengthen the strength and endurance of the muscles responsible for plantar flexion, dorsiflexion, inversion and eversion.

In accordance with the requirements of the sport, they begin running, starting with simple straight running on a flat surface and then, according to the patient’s feelings, complicate the exercises by running sideways, running in a zigzag, in a figure 8 figure, with acceleration and braking. These exercises can be supplemented with elastic resistance.

Running with side steps with resistance. The patient places a loop of a long elastic band around his waist, the other end of which is secured to the wall. Run sideways with side steps, stretching the tape. Return to the starting position with the same extended steps.

Balance training while standing on a bolster (proprioceptive training). A loop about 1 meter long made of elastic lena is attached to the wall at a height of 15 centimeters from the floor. The patient stands facing the wall 70 centimeters from it, the loop is put on the healthy leg, and the affected leg is placed on a bolster. In this case, the affected leg is slightly bent at the knee. Start swinging the healthy leg back and to the side, trying to maintain balance on the affected leg. In the starting position, the tape tension is moderate. During exercises, you should keep your back straight and your legs should be straightened at the knees.

Complex proprioceptive training (balance training while standing on a swinging platform). The patient stands on the affected leg on a swinging platform, the healthy leg is bent at the knee. They throw the ball at the wall with their hands and catch it after pushing it off. The exercise trains the coordinated work of muscles and the ability to balance.

Working capacity is restored 2.5 months after surgery.

Sports activities are started six months after the operation.

It is most effective to carry out a recovery course in rehabilitation center, where the entire process is controlled by specialists.

An Achilles tendon rupture occurs either from a direct blow to the tendon itself, which is tense at that moment, or as a result of muscle contraction, for example, when jumping. The most common treatment option for a rupture is surgery. A conservative method of treatment also has a place, but when fixing with a plaster splint it is not always possible to achieve complete fusion of the tendon.

There is no need to be afraid of the operation; it is carried out under general anesthesia. After surgery, the leg is fixed in a cast or orthosis for approximately 6 weeks. On the recommendation of the doctor, the patient begins to gradually load and develop the tendon. The entire rehabilitation program is divided into several phases.

First phase: maximum protection

Depending on each specific case, the doctor determines the degree of load on the operated and immobilized limb. The load, albeit small, as well as the simplest movements not aimed at stretching, must be present to avoid muscle atrophy and further problems with the joints. First, passive exercises, then dosed axial load using an exercise bike and massage of the scar area - all these are measures aimed at the primary rehabilitation of the Achilles tendon.

Second phase: full load

The goal of the second phase is to normalize gait. After six weeks after surgery, full axial load is allowed with increased mobility of the limb and simple stretching exercises. This phase of rehabilitation involves walking on an underwater treadmill. This valuable simulator allows you to develop a normal gait after surgery by reducing the axial load when walking. Exercises such as multi-planar foot movements, walking backwards, plantar flexion with resistance, and light weight training exercises are also added.

Third phase: strengthening

The goal of the third phase is to maximize the range of motion. The rehabilitation process includes exercises such as step-down, that is, going down stairs. As soon as the patient learns to rise on his toes 10 times, go down the steps backwards, and the joint becomes fully mobile, he can move on to sports activities. If the recommendations are followed correctly, athletes can return to sports in about 7-8 months.

The Achilles tendon forms the posterior aponeuroses of the lower leg muscles (soleus and gastrocnemius). It is attached to the heel bone and is located in a special channel. But, despite the fact that this tendon is considered the strongest in the human body, it is often susceptible to injury. Surgery is one of effective methods treatment.

Causes of Achilles tendon injury

The Achilles tendon bears a lot of important functions: movement of the foot while walking or running, flexion of the foot at the sole, lifting at the tips of the toes. If the load is this body musculoskeletal system above physiological norm, this entails a break.

The main causes of Achilles tendon injury are:

  • falling or jumping from great heights;
  • heavy load on the calf muscles during hard work or training;
  • severe blow or injury sharp object along the tendon in a tense state;
  • sudden slipping of the sole when climbing stairs;
  • execution errors sports exercises: abnormal severity, distance; load without warming up;
  • strong inward rotation of the foot;
  • light load on the tendon, which has already been damaged;
  • wearing shoes with a hard back or very narrow toe;
  • excess body weight, which puts a lot of stress on the feet;
  • using injections containing corticosteroids to treat tendon injuries;
  • presence of osteoarthritis, rheumatoid arthritis, gout;
  • deterioration of blood flow, due to which the tendon does not receive nutrients.

Common negative factor is playing sports: basketball, football, tennis, long-distance running. This can include ballroom dancing and ballet, and repetitive actions on a robot.

Types of damage

Depending on the cause of the injury, the force of the load or impact, the initial condition of the tendon, there are different types gap:

  1. Open. When the tendon area is exposed to a piercing or cutting object with mandatory damage to the skin. In order to exclude a partial rupture, you need to carefully inspect.
  2. Closed. It is the result of a strong contraction of the soleus and gastrocnemius muscles. Occurs without damaging the skin.
  3. Indirect. Strong contraction or stretching of the soleus and gastrocnemius muscles under the influence of body weight.
  4. Direct. A sharp contraction of the muscle to which the tendon is attached. Occurs due to direct impact with a blunt object.
  5. Partial rupture of the Achilles tendon. Damage to a small area.
  6. Full. Injury to the entire tendon.
  7. Professional. It implies a degenerative process in the Achilles tendon due to constant stress. Applies to dancers, athletes, acrobats.

Diagnostics

To make a diagnosis of Achilles rupture, first pay attention to the symptoms that arose after the injury. This is a sudden and sharp pain, the person cannot extend the heel. The strength of the triceps surae muscle immediately decreases. Active flexion is not possible. Swelling and possibly bruising appear. You may feel a depression or dimple 5 cm above the heel bone.

Additional evidence of damage is the patient's lameness when walking. It is immediately noticeable as soon as he enters the doctor's office.

When examined by a specialist, palpation is performed: you can feel two thickenings in the center and at the edge of the torn tendon. Next, the doctor himself tries to gently activate the ankle joint, performing passive rotations in a circle and to the sides. In this case, the patient feels severe pain.

Identifying Thompson's symptom is one of the main diagnostic methods. The specialist presses on the upper third of the calf muscle. The foot should bend when in good condition musculoskeletal system. If the Achilles tendon is torn, this will not happen.

TO laboratory tests refers to the use of a sphingmomananometer. The cuff of the device is placed on the lower leg, inflated, and the specialist moves the patient’s foot. If the pressure rises to 140 mm Hg. Art., then a conclusion is made about the integrity of the tendon. Otherwise, it will be damaged.

Treatment

As with any disease, there are two types of treatment:

  • conservative;
  • surgical.

In the first type of therapy, the patient's toe is pulled out and the foot is fixed using a splint. Must be worn continuously for up to 2 months. In this case, the ends of the Achilles tendon come into contact and grow together over time.

But this method of treating an Achilles tendon rupture has many disadvantages:

  1. Longen is uncomfortable and heavy. It may break.
  2. The devices cannot be wetted, so a person cannot take a shower or bath comfortably.
  3. Disruption of blood flow during injury can form a hematoma. If it is fixed in a longen, it prevents the normal healing of the tendon. It becomes thin and unreliable.
  4. Even after completing a course of therapy, there is a chance that the tendon will not heal at all. And then you will have to have surgery.

Therefore, conservative treatment of Achilles tendon rupture is used only in certain cases:

  • if the patient consulted a doctor within a few hours after the injury, and a longen was immediately applied;
  • if a person has not been involved in dancing or sports, then he does not have degenerative disorders;
  • if this old man, then this treatment method will be safer at this age.

Surgery is the most in an efficient way. The result is positive and fast.

Surgery

Surgery on the Achilles tendon is performed under anesthesia: local, spinal or intravenous. It is advisable to do it immediately after an injury, because the muscles shorten over time, and it is difficult to stretch the parts of the tendon to connect.

During surgery, make access: cut the lower leg approximately 10 cm from the back. Clean the ends of the torn tendon and sew them together with a special thread. The Achilles tendon suture can be done in different ways. Among them:

  • by Krackow;
  • according to Tkachuk;
  • by Ma and Griffith.

The most famous is the first one. A suture is placed on the ends of the torn tendon. After this, the threads are sewn together. After the tendon itself has been manipulated, the outer sheath is sutured, and then I put a suture on the skin. But after healing, a long scar forms.

Therefore, there are other techniques in which external punctures are made through the skin. But the negative point is that the surgeon does not see the exact location of the torn ends. Possible uneven stitching.

If more than 20 days have passed since the injury, there may be difficulties in connection. In such a situation, Achilles tendon plasty is performed according to Chernavsky. A piece is cut out from above the tendon, placed at the site of the tear, and stitched. Another technique is to take the missing piece from another ligament. Or they apply synthetic material.

Important! If the gap is in the same place for the second time, you only need to do open access when performing surgery on the Achilles tendon.

Rehabilitation

After the operation, the leg is immobilized, as in conservative treatment. The best option this will involve the use of an orthosis. With its help, you can regulate the amplitude of flexion in the joint between the lower leg and foot. For up to a month, patients walk with their toes extended and on crutches. This reduces pressure on the injured leg. After this, the angle is reduced.

The approximate period of time for such fixation lasts about 1.5 months. After this, the immobilization aids are removed. But if there is a need to continue immobilization, they put it on again.

When the orthosis is removed after an Achilles tendon rupture, primary rehabilitation consists of normalized load and restoration of range of motion. In order to avoid muscle atrophy, the patient needs to develop the joint: pull the toe down and up, bend it to the sides. It is important to do this carefully, before pain! Stretching exercises are prohibited.

All loads are done on the advice of a specialist. If he allows, you can start using the exercise bike. Be sure to set the resistance to low. Massage is also applied to the entire joint to improve blood circulation. They also rub the scar so that it does not become rough and heals normally.

The patient should not sit long time with legs dangling, not reaching the floor. It is worth sometimes lying down and raising your lower limbs. If pain and calving are a concern, cryotherapy is used. When the condition of the joint has stabilized to a large extent, physical therapy in special rooms. Some exercises:

  1. An elastic loop is attached to the wall, which the patient wears around the waist. It's on a ribbon that he has to pull. You need to run with side steps, first in one direction, then in the other.
  2. A man stands on a platform that swings. He must balance on his bad leg.
  3. Starting position, as in the second exercise. Now you need to throw the ball against the wall and catch it.
  4. Walking backwards.

The main idea of ​​such exercises is the physical resistance of the ankle joint. It develops all lower limb, and strengthens it.

Complications

The most common complications in the area of ​​the operation performed are:

  • necrosis;
  • infectious infection.

Therefore, it is important to visit a doctor during the first month of rehabilitation after an Achilles tendon rupture, who can see the first symptoms pathological process. No less important is the patient’s attention to his condition. If he feels severe pain after exercise, he needs to give his leg a rest. And when meeting with a specialist, tell the situation in which unpleasant sensations arose.

If you follow the instructions, do the exercises, correctly distribute the load, and undergo a systematic examination, you can avoid complications and promote normal healing of the tendon.