Achilles tendon suture. Treatment of Achilles tendon rupture without surgery: partial tears and injuries. Treatment with folk remedies

The triceps muscle of the lower leg has three heads - two superficial and one deep. The gastrocnemius muscle is formed by two superficial heads - internal and external. The soleus muscle forms the third deep head. In the center of the lower leg is the calcaneal, or Achilles, tendon, which is the most powerful in all human body. It is formed by all three heads.

At the bottom of the lower leg, the Achilles tendon narrows and attaches to the convex part of the calcaneus. The triceps muscle helps to bend the foot and lower leg.

The tendons and muscles of the limbs are quite often damaged. The ability to work with such injuries is lost, and often a person becomes disabled. The classification of Achilles tendon ruptures will be considered in this article.

What categories of people most often suffer from this?

There are some people who are at risk. Here are some examples:

• professional athletes;
• people who are engaged in heavy physical labor;
• people who fill their lives with uncontrolled and irregular physical activity. These are mainly games, for example, volleyball, basketball, football, tennis, as well as jogging.

These people need to be careful, and at the slightest suspicion of injury, you need to contact specialists.

AT largest number cases (approximately 60%) with injuries, it is precisely Achilles tendon. This happens due to micro-ruptures and overstretching that preceded the gap. Tendon and muscle tissue undergo structural changes. That is, in fact, it is a kind of traumatic disease of the tendon-muscular apparatus.

Classification of tendon ruptures

Achilles tendon rupture can be:

• open;
• closed;
• complete;
• partial;
• fresh;
• old;
• direct;
• indirect.

Open damage

How can the Achilles tendon be damaged? The gap may be open type.

This kind of damage is produced by piercing and cutting objects. An incision is made at the back of the lower leg. If such an injury occurs, you should immediately consult a doctor. First of all, it is important to stop the bleeding in order to avoid a large loss of blood. In addition, it is necessary not to bring an infection into the wound so that suppuration does not occur.

The specialist should carefully examine the wound and identify a rupture of the Achilles tendon, if any. You also need to check the triceps muscle of the lower leg.

Closed injury to the Achilles tendon

The tendon may rupture under the skin. Such an injury can occur due to a strong contraction of the triceps muscle, and in such a way that the strength of the tendon cannot withstand.

Indirect break

With this type of rupture, the triceps muscle of the lower leg is suddenly, sharply, forcibly stretched. In the process of this stretching, it is excessively reduced, while the force of gravity of the body acts on it. This often happens when a person makes a jump or, conversely, lands on their feet. Professional jumpers, volleyball players, gymnasts, ballet dancers, fencers suffer.

Straight break

Another way to damage the Achilles tendon is to tear it directly.

AT this case a direct blow to the tendon with a blunt object. As a result of such an aggressive impact, the triceps muscle is greatly reduced, the tendon cannot withstand and is torn. This leads him to chronic diseases or the fact that it is in chronic overexertion.

As mentioned above, athletes, dancers, acrobats suffer from this most often. They have degenerative changes tendon tissues are of a professional nature.

We have considered the classification of ruptures of the Achilles tendon.

Location of damage

The tendon may tear in the upper part - where the tendon-muscle border passes. It can also happen in the lower part - where the tubercle of the calcaneus is. In the middle part, the tendon can also be damaged. This often happens. Also, the tendon can come off the tubercle on the heel. This can happen in two ways - with and without bone damage.

Achilles tendon rupture symptoms

This disease is characterized by the following symptoms:

1. The injury is characterized by sharp pain, then pain become constant and aching.

1. Active foot movements are impossible, passive ones are very painful.
2. A positive symptom of Thomson takes place - the calf muscle is strongly pressed, while the flexion of the foot does not occur, although it should be normal.
3. Inability to stand on toes, lameness.
4. With Pirogov's symptom, the following is noted: the patient lies on his stomach, with a contraction of the calf muscles by healthy leg there are contours, this was not revealed on the damaged one.
5. On palpation, there is a failure in the place where the tendon was torn.

Diagnosis of Achilles tendon ruptures

Diagnosing a tear in this tendon is not easy, regardless of acute or remote period injury.

The surgeon may initially suspect partial damage, which implies a conservative solution. The following signs are misleading:

• in the first few days after the injury, there is swelling in the area of ​​​​damage (the lower third of the leg swells);
• plantar flexion of the foot is preserved, because the long plantar tendon is intact.

The patient may be afraid of the operation, so he hopes so much for the operation. conservative therapy. Surgical intervention may also be difficult, as necrosis of the margins is possible. skin wound and many months of rejection of the tendon and suture material. This applies to frequent phenomena and occurs in 15% of cases, even among surgeons with extensive experience.

But specialists should understand that a partial rupture of the Achilles tendon is extremely rare. With a complete rupture, an operation and a stay in a hospital are indicated. You can check the likelihood of complete damage by the signs that it is difficult for the patient to stand on his toes. Indeed, in order to do this, it is necessary to have two healthy tendons on the heels, and since one of them is torn, a person will not be able to do this.

When the diagnosis is confirmed, the patient is hospitalized. He needs to lie down, while the injured leg should be raised. How to do it right? A mesh bandage is put on the leg, then the limb is suspended from it. Place a small flat pillow under your hips. The Beler tire can also help with this. This is necessary for the complete subsidence of puffiness, this happens about 5 days after the injury. Treatment old ruptures the Achilles tendon may be somewhat different.

After that, it will be possible to see the place where the torn tendon sinks. This is clearly seen if the patient kneels.

In addition, the gap is determined by the symptom of the finger (it will be positive). index finger the doctor runs along the calf muscle to the location of the Achilles tendon. Where there is a gap, the finger will fail. Also, if you press your finger on the place of the rupture, the patient will not be able to bend and unbend the foot. When moving the foot, the distal end of the torn tendon will be displaced.

But stale and chronic damage is diagnosed quite difficult. In this case, the subcutaneous muscle atrophies, it is difficult for the patient to stand on the toe. The finger falls through at the site of injury in the same way. This means a rupture of the Achilles tendon.

The operation in this case should be immediate, since the calf muscle will atrophy even more. Other calf muscles can also be affected, causing the person to limp more and more. The quality of life will be increasingly unsatisfactory, because the damaged limb will be functionally limited.

Rupture of the Achilles tendon after the operation will not remind of itself.

How is the operation going?

Surgeons sew the Achilles tendon, but this must be done very delicately. Such operations are carried out by a specialized orthopedic and trauma center. But if necessary, it will also district hospital, but the qualification of the surgeon must be high, otherwise success is not guaranteed. The operation must be performed reliably.

Full anesthesia required local anesthesia won't be enough. Surgery is performed under anesthesia or spinal anesthesia. The operated person is placed on his stomach, his heel should be in a flat position and look towards the ceiling. Wash your feet thoroughly beforehand. warm water using a soapy washcloth, then treated with sterile wipes. Also, the limb should be shaved, but this is done the evening before, since this is prohibited before the operation. Through microdamages on the skin, an infection can enter the wound, after which it fester.

If the gap is chronic, that is, months have passed since the injury, a conventional surgeon may not be able to help. Need to contact specialized center to a plastic surgeon.

Treatment methods

So, there was a rupture of the Achilles tendons.

Treatment is usually standard.

In case of tendon rupture, surgical intervention. It varies depending on the type of damage.

At open injuries the ends of the tendon are sutured, while the suture is nodal and U-shaped. The suture material is chrome-plated catgut or wire, the Bunnel method is used for this. After a month and a half, it is necessary to remove the suture material through the wound. In some cases, it is Plastic surgery. Surgeons choose bridge autoplasty according to Chernavsky, autoplasty according to Nikitin, lavsanoplasty.

With a closed subcutaneous rupture, it is necessary to dissect skin covering, then suture the tendon using the end-to-end method. AT special occasions the tendon is restored plastically with flaps taken from its distal ends. Lavsanoplasty is often used. When the breaks are fresh, a percutaneous dip suture is made.

Consider this method in details.

The patient lies on his stomach, his leg is bent at the knee. The foot is in plantar flexion, it is fixed by a wooden wedge. With the help of palpation and brilliant green, which outlines the contours, the level of damage is revealed.

A surgical cutting needle or chrome-plated catgut penetrates the skin and pierces the tendon. Then, through the injection point, the needle is withdrawn along an oblique line. This forms a legature loop on the skin. If the thread is pulled, the loop sinks under the skin.

This happens on the other side about twice. After that, the loops are stretched and hidden in the distal end of the damage. On the skin, as a result of immersion of the loops, point wounds are formed, which are stitched with a thinner catgut.

After the operation, a plaster cast is applied to the limb. The lower leg and foot remain in a bent position at an angle of 45 degrees.

Rehabilitation after surgery

What is rehabilitation after an Achilles tendon rupture?

Within a couple of days after surgery, the patient is observed by specialists. About 3 weeks later plaster cast reduced to "boot". The foot is slightly unbent, but not completely. With the help of a heel, which is tied to a plaster cast, a person must walk around, giving a load to the leg.

After another 3 weeks, you can remove the plaster.

After that, the following manipulations must be carried out:

• the limb is bandaged with an elastic bandage;
• conduct therapeutic exercises;
• massage;
• swimming;
• taking warm baths;
• do paraffin wax.

All this helps to increase the tone of the calf muscle. But the heel must be worn for another month, preferably one and a half. Its height must be at least 2.5 cm.

You can live in three months full life, work. It takes about 6 months to fully recover, after which you can play sports.

Conclusion

It is important to understand that the more timely the operation was, the faster it will be possible to fully recover. In case of a rupture, it is imperative to contact specialists, and not walk, leaning on a sore leg. After all, this moves the ends of the tendon apart, as a result, the triceps muscle shortens, the calcaneal tubercle descends due to the fact that the triceps muscle loses its function. Rehabilitation of a torn Achilles tendon is also of great importance.

Usually when fast run, jumping, awkwardly pushing off the ground with a toe, a person feels a sharp pain and, as it were, a sharp blow to the tendon from behind (the feeling is so real that some victims, turning around, are looking for the "hooligan" who hit them). Edema develops in the area of ​​injury, lameness. The patient is unable to stand up. A slight retraction appears in the zone of tendon rupture. Some of the victims and the doctor who briefly examined them do not attach any importance to this injury: they say, the usual sprain - "heals before the wedding." You can walk, though with a limp. If the injury occurred in a place where there are no doctors, you can check the integrity of the tendon with the help of a friend in this way: the patient lies on the edge of the couch so that the foot hangs down freely. If, in response to compression by the shin brush, the foot bends at least slightly, the tendon is intact. After a few days, the pain and swelling decrease by themselves. But time runs, and full recovery does not occur: the victim cannot walk quickly, run, climb on his toe. The man is walking to traumatologists, and then it turns out that there was a complete subcutaneous rupture of the Achilles tendon and an operation is necessary. Not all Achilles tendon ruptures are diagnosed quickly and correctly. According to A. F. Krasnov and S. I. Dvoinikov, 46% of patients with tendon rupture are admitted to surgical treatment in late dates(from 1 month to 10 years after injury).

But if you can live with a gap for 10 years, then the operation is optional? Alas, it is not. The tendon does grow together without surgery, but it contracts. The force of flexion (plantar flexion) of the foot falls, a person cannot strongly push off the ground, run, jump, walk on toes, which significantly impairs the quality of life. That is why the operation is obligatory (according to at least for young and middle-aged people).

It is best to do the operation in the first days after the injury. The more time passes, the more difficult it is for the surgeon to tighten and sew the ends of the tendon. In addition, late operations (when more than 1-2 weeks have passed after the injury) give more complications, and the process of functional recovery is coming slower and harder.

Currently, most traumatologists use two main types of operations for suturing a torn Achilles tendon:

— open(arthrotomy), with a wide opening of the damaged area and suturing the ends of the tendon "end to end";

— closed, in which the skin is not cut, the tendon is not opened, and suture threads are injected into the central and peripheral ends of the tendon through the skin and pulled together, bringing together the ends of the tendon until they touch.

Whatever method of operation the surgeon chooses, it is required long time to splice the ends of a torn tendon: 3 weeks use a long plaster cast applied from the back of the foot and mid-thigh. Then this front splint is shortened and turned into a short plaster “boot”, in which the patient walks for another 3 weeks. Only after that, rehabilitation begins.

Taking off the plaster "boot", some surgeons give their patients the following instructions: "For now, walk as much as possible, and in a month I will send you to exercise therapy." This is not true: rehabilitation should be comprehensive and begin immediately after removing the plaster "boot". The main means of rehabilitation are physical exercises performed in the exercise therapy room and the pool, walking training and various types of massage.

Auxiliary means can be some types of physiotherapy and reflexology, which are used only according to indications.

In the first weeks after removing the “boot”, recurrent tendon ruptures quite often occur (the patient accidentally touched the edge of the carpet with his toe, stumbled on the stairs, slipped on a banana peel, tried to do a new exercise that another patient did with him, etc.). Therefore, the patient requires utmost attention, caution when walking and strict discipline when performing the exercises given by the instructor or exercise therapy doctor.

In the first 1-1.5 weeks after the removal of the "boot", edema of the foot and lower leg is often observed, the foot does not bend and unbend well. The patient must walk with crutches. If swelling of the foot and lower leg is pronounced, pneumomassage is performed, which quickly restores lymph and blood circulation. After that, they switch to manual massage. To reduce the tension of the stitched, still fragile tendon, heels are made on the heels of the shoes (the total height of the heels with the heels is 4-5 cm).

Walking is one of the main exercises to restore function. ankle joint. The length of the step in the first 2-3 days should be small (about 1/2 the length of the foot). With each step, the foot of the operated leg makes a soft roll from heel to toe. In this case, the sock should not turn outward. With a different walking technique, it is ineffective. Stepping on the foot, if it does not cause pain, can be almost completely. If after 1-3 days the patient walks confidently enough, you can walk without crutches. The time of continuous walking should be gradually increased from 10 to 20-30 minutes and repeated walking twice a day. If the foot swells after walking, you need to wear an elastic ankle or use elastic bandage. A week after the start of the walking workout, the heels are cut off or sneakers are put on. The stride length increases to a length of 1-1.5 feet. Later restored normal length steps (3-4 feet).

Very useful exercises performed in the water. A person immersed in water up to his neck loses 9/10 of his weight. This allows you to do water exercises in a standing position completely safely 2-3 weeks earlier than with "dry training" (rising on toes, walking on toes, slow running). It is more useful to swim with a breaststroke: in this case, the load on the muscles of the lower leg and the stitched tendon is greater than when swimming with a crawl. Swimming with flippers can also be used 2 weeks after the start of exercises in the water.

All exercises in the exercise therapy room in the first 1-1.5 weeks after the termination of immobilization should be done only in the initial positions, sitting and lying down. First, all movements in the ankle joint and toes are performed without significant muscle tension: flexion, extension, rotation. The emphasis is still on restoring extension (dorsal flexion of the foot).

Self-massage of the foot is used (rolling a stick, ball, movement on a special massager). With self-massage, it is necessary to achieve a feeling of warmth in the foot.

2 weeks after the removal of the "boot", a normal gait is usually restored with medium length step. At this time, exercises in the initial standing position are included in the exercise therapy complex. To reduce the load on the tendon for the first 3-5 days, the patient partially unloads the body weight, leaning his hands on the handrail, rail gymnastic wall, the back of a chair, and then does exercises, only holding on to them for balance.

Such exercises are performed as lifting on toes, half-squats on toes, complicated types of walking (walking with high hips, set steps, back forward, “snake”, etc.), exercises on a stepping machine (stepper).

Only 2.5-3 months after the operation, when the sutured tendon acquires sufficient strength, it is possible to perform toe walking and lifting on the toe on the operated leg. You can start slow running if the patient performs these exercises confidently, but not earlier than 3.5-4 months after the operation.

Rupture of the Achilles tendon is considered an injury that athletes are most susceptible to, but it is possible to get a rupture at home. In 90% of cases full recovery it is possible only with the help of an operation, and without a subsequent course of rehabilitation it is impossible to return to full-fledged activity and life.

Achilles tendon after injury may have:

1. Stretching. This is the easiest type of injury, and the tendon returns to normal after a short fixation of the joint, and a short recovery process;
2. Partial tendon rupture. In this case, the traumatologist, after a series of studies, decides on the need for surgery. If most of the tendon is intact, the patient's ankle is fixed, and after some time a course of restorative procedures is prescribed;
3. Complete rupture of the tendon, recovery from which is possible only operational method. With a complete rupture of the Achilles tendon, recovery occurs in several stages, which include the postoperative period.

In each of the presented cases, a recovery period is necessary, and the intensity of the loads, duration, conditions, are recommended by the attending physician individually to each patient.

Postoperative period

There are two types of Achilles tendon surgery:

• Open surgery to ligate, stitch, or implant a torn tendon;
• A closed operation in which the tendon is tightened without a skin incision. Through special punctures, the surgeon sews the torn parts together and tightens them with suture threads.

In both cases, the postoperative and rehabilitation period are the same.

Immediately after the operation, a splint is applied to the operated leg from the toes to the upper thigh. The leg is fixed with an extended toe in the “away from you” position. Thus, tension is removed from the calf muscle, to which the operated tendon is attached.

2-3 days after surgery on the area postoperative wound assign a magnetic field. Daily, for 10 days, this procedure is aimed at improving blood circulation, as well as reducing the possibility of adhesion formation.

It is very important in the first three weeks not to allow the slightest stretching of the calf muscle and tendon in order to avoid a rupture at the suture site. The longet is removed only for dressing and processing the seam. After removing the sutures on the 5th - 7th day, the splint remains for another two weeks.

At this point, easy rehabilitation after the operation begins. It includes general gymnastics to maintain the tone of the whole body. Exercises are performed sitting and lying down. Exercises for the upper body can be performed using simulators, provided careful attitude to the operated leg.

Within two months after the operation, you will have to use crutches, and this is a significant burden for an untrained body, and overweight patients.

After three weeks, the plaster splint is shortened to the knee, and the patient can bend the leg at the knee. This facilitates movement with crutches, allows you to take a more comfortable sitting and lying position.

Recovery from an Achilles tendon rupture during this period is to increase activity. To the above, you need to add hip exercises. Due to intense workloads:

• Improves blood circulation;
• Several atrophied thigh muscles are restored;
• The general condition improves;
• Preparations are underway for the subsequent, effective period of rehabilitation.

rehabilitation period

6 weeks after the operation, the splint is fixed, the leg is fixed, and removed. And it is important to immediately begin a course of recovery after an Achilles rupture. This is an intensive course of procedures, including:

• Observation of a rehabilitation specialist - orthopedist, analysis of the process, dynamics of recovery;
• Massage;
• Cabinet physiotherapy exercises;
• Water procedures;
• Electrical stimulation of the posterior leg muscles.

After removing the splint, the doctor conducts an examination and gives recommendations on the correct setting and stretching of the ankle. The foot is hard to return to its normal position, and correct setting angle depends on the level of tendon stretch.

The patient continues to use crutches, but he is able to lean slightly on his leg.

Some patients, having specified how long the rehabilitation after a rupture of the Achilles tendon lasts, refuse these procedures in the hope of coping with this task on their own. In the absence of the necessary knowledge in this area, the patient may not calculate his strength. With insufficient stretching and development, contracture is possible, and with excessive load repeated break.

Observation of a rehabilitologist

The whole process must be carried out under the strict supervision of a physician. AT best case– take a course directly under the supervision of the doctor who performed the operation. This practice is common, and has a positive result.

The doctor observes the dynamics of the whole process, and changes the intensity of a particular procedure, notes the changes.

Massage

A light massage of the ankle and calf muscles immediately after removing the splint radically changes both the physical and emotional state. A muscle that has been in a static position for a long time is atrophied, and the purpose of the massage is to increase tone and improve blood circulation.

Already after the first procedure, the patient feels an improvement due to the effect on the part of the body that has been immobilized for a long time.

Massage, with each procedure becomes more intense, and only after a thorough warming up of the muscle, the patient goes to the exercise therapy room.

Physiotherapy room

From the first days of rehabilitation after a rupture of the Achilles tendon, the intensity of the load increases in the physiotherapy room. The first exercises are aimed at stretching the tendon.

To reduce the load, exercises are carried out while sitting, or with the help of an arm rest. By using special simulators exercises are carried out to restore muscle tone.

The rehabilitation doctor monitors the step setting, the presence of foot rolling, and performs procedures that reduce stress. Massage devices for the foot help to quickly and painlessly stretch the tendon, and set the desired angle of the foot.

Standing on the toe is carried out only on two legs, running and jumping cannot be used in the first days of the rehabilitation course, since there is a high chance of a repeated rupture without proper stretching of the tendon and development of the calf muscle.

After 2.5 - 3 months after the operation, provided that the patient performs all the prescribed exercises, you can start putting on the toe, easy running. Jumping is best avoided for the first 6 to 7 months after surgery.

For a full recovery, you must constantly monitor the quality of the step, do the necessary exercises.

Water exercises and electrical stimulation

Rehabilitation after an Achilles rupture is faster when using all possible procedures provided by the clinic. Exercises in the pool, thanks to the support of water, are easier. Swimming quickly restores muscle tone, allows you to perform exercises of any complexity.

Electrical muscle stimulation - forced contraction of the back muscles of the ankle. Atrophy after prolonged immobilization does not allow the full use of the tendon, and the action of the current, aimed at muscle contraction, leads them to tone. Thanks to this procedure, combined with exercise therapy and massage, the recovery process is much easier and painless.

Recovery without surgery

Repair of an Achilles tendon rupture without surgery is only possible if partial break. In this case, the patient's ankle is fixed, as in the case of a complete rupture, depending on the severity of the injury. Rehabilitation after a rupture of the Achilles tendon, even with a partial rupture, proceeds in the same way as with a complete rupture.

In any case, only a traumatologist can correctly assess the severity and prescribe treatment.

Operations of this kind are not carried out on people suffering from diabetes, the elderly, and patients with heart disease.

Rehabilitation after a sports injury

The rehabilitation of athletes after an Achilles rupture is aimed at fast recovery, and enhanced special training is added to the above process.

Thanks to good physical form, full recovery occurs much earlier than in people far from sports.

Even light running is included in the training regimen no earlier than 3-4 months, and a full return to sports is possible only 6 months after the operation.

In case of an injury of any kind, the conclusion of a traumatologist is necessary. The sooner treatment is started, the easier the operation will take place and the recovery process.

The Achilles tendon (Achilles ligament) is the strongest in the human body. It is located on the back of the lower leg and connects the muscles to the calcaneus. Thanks to this connection, a person bends the foot at the ankle joint. So, we stand on our toes, push off with our feet when running and jumping. The Achilles tendon plays a key role in a person's ability to move freely, so damage to it leads to serious consequences up to and including disability.

Shulepin Ivan Vladimirovich, traumatologist-orthopedist, highest qualification category

The total work experience is more than 25 years. In 1994 he graduated from the Moscow Institute of Medical and Social Rehabilitology, in 1997 he completed residency in the specialty "Traumatology and Orthopedics" at the Central Research Institute of Traumatology and Orthopedics named after I.I. N.N. Prifova.

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

Mechanical damage

Its main condition is a strong overvoltage or a blow to a stretched ligament. This happens most often in professional sports or in car accidents. Ordinary mechanical damage preceded by microtraumas that disrupt the structure of tissues. A rupture of a healthy Achilles is very rare with a purposeful strong external influence - injuries at work, car accidents, falls from a height.

Inflammatory process

Acute inflammation of the Achilles tendon - Achillitis (or Achilles tendinitis) is rare. This is usually gradual evolving process, which involves neighboring anatomical formations ( synovial bursa the ligament itself - Achilles bursitis, the tissues surrounding the tendon - peritendinitis, the lesion of the attachment site of the ligament to the calcaneus - enthesopathy). Chronic inflammation is complicated not only by tendon tears, but also by the formation heel spur, bumps on the tendon or its calcification. Predisposing causes of Achilles tendonitis are:

• Age after 40 years when the elasticity of tissues is gradually lost and the slightest awkward movement leads to microdamages and inflammation of the tissues.
• Uncomfortable shoes, especially in combination with overweight body. The constant elevated position of the foot when wearing heels leads to a shortening of the ligament. If a woman abruptly switches to a flat sole, the Achilles tendon is torn and inflamed.
• Diseases with an autoimmune component that affect connective tissue: rheumatoid arthritis, bursitis after bacterial streptococcal infections(tonsillitis, scarlet fever).

for a long time existing inflammation leads to thinning of the fibers connective tissue, a decrease in its elasticity, which can result in injury.

degenerative rupture

The degenerative process is usually the result of chronic inflammation or permanent ligament microtraumas that are observed in professional athletes. Connective tissue degeneration also occurs with insufficient blood circulation in this area in people leading sedentary image life. Cause disruption of the tendon structure age, certain drugs(glucocorticosteroids, antibacterial drugs from the group of fluoroquinolones), especially with their uncontrolled use, bad ecology, bad habits and many other factors. Sometimes a tendon rupture occurs spontaneously for no apparent reason. This is the result of a hereditary violation of the structure of collagen fibers that form the basis of the ligamentous apparatus.

Depending on the type of damage, the following types of Achilles injury are distinguished:

• Open damage- occur when cut or torn with a piercing-cutting object, when all layers of tissues (skin, muscles) are damaged along with the ligament.
• Closed damage characterized by the preservation of the integrity of the skin. The ligament is torn due to excessive contraction of the calf muscle.
• An indirect tear occurs as a result of muscle contraction. On the Achilles tendon, the load is applied through the muscle. Frequent situations leading to this: jumping in basketball or volleyball, when an athlete tries to jump on an extended leg, with a sharp flexion of the foot (sliding off a step), falling on an extended toe of the foot.
• A direct rupture of the ligament is the result of a blow directly to the junction of the muscles of the lower leg with the calcaneus (usually swipe blunt object).

According to the degree of damage, ruptures can be full or partial, according to the time of occurrence - fresh or old.

Causes of complete and incomplete rupture of the Achilles tendon

Trauma symptoms

Regardless of the cause, Achilles tendon injury has common characteristics:

• Pain . With an acute rupture, it occurs suddenly at the back in the lower part of the leg. The intensity is usually sharp. Only in some cases a person experiences slight pain (with a partial tear or reduced pain threshold). With sprain, inflammation or microtrauma, pain increases gradually, first after running and jumping, then after walking and only on last stage at rest.
• characteristic sound. With a sudden complete rupture, you can hear a crack or crunch of torn ligaments.
• Edema. It spreads from the foot to the entire surface of the lower leg, depending on the severity of the injury.
• Hematoma. It is characteristic of external injury when a blow leads to rupture of blood vessels.
• Movement restriction. The degree depends on the type of injury. With a complete break, movement in the ankle joint is impossible, passive flexion causes sharp pain. With a partial rupture or stretching of the Achilles tendon, the leg hurts when walking and especially when running or jumping. Sometimes discomfort during movement can exist for a long time. This indicates the development of a chronic degenerative process that precedes the rupture of the calcaneal tendon.
• Pirogov's symptom positive: the patient lies on his stomach and strains calf muscles. On a healthy leg, the relief on the posterior surface of the lower leg is clearly visible, but this is not the case with a rupture of the Achilles.
• With the development of enthesopathy or tendonitis the tendon above the heel hurts if a person for a long time lies on his back with outstretched legs.

Any type of injury to the Achilles tendon leads to impaired gait, a person limping or being unable to step on the injured leg.

Ligament rupture diagnosis

Any diagnosis begins with a detailed questioning of the patient about the circumstances of the injury. Sometimes this alone is enough to think about damage to the Achilles. On palpation, the doctor detects a characteristic tissue failure at the site of the rupture. But Achilles tendon injuries are insidious, and often lead to misdiagnosis. Consider possible situations when physicians have difficulty identifying correct diagnosis:

• It is believed that with this injury, a person cannot perform plantar flexion of the foot. In fact, this is not always the case.

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

Then the doctor, at best, will suspect a partial rupture of the ligament, which is treated conservatively.

• Next to the Achilles is another thin ligament - plantar, which can remain intact in case of injury. The traumatologist, on palpation, takes it for a part of the Achilles tendon and diagnoses an incomplete rupture.

In order to avoid these errors, there is an algorithm for diagnosing an Achilles tendon rupture with several tests.

Two are usually sufficient for a correct diagnosis. positive tests. AT exceptional cases appoint instrumental research: radiography, ultrasound, MRI.

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

Treatment of Achilles tendon injuries

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

Conservative treatment

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

• Traditional plaster cast.
• Special orthoses or brace.
• Plastic plaster.
• Functional immobilization, which allows you to partially lean on the leg.

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

But conservative treatment is not always successful.

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

Surgery

Achilles tendon plasty surgery is indicated for degenerative tears, upon formation extensive hematoma, which prevents the tight closure of the ends of the ligament, in old age, when the ability of tissues to grow together without outside interference is significantly reduced.

For anesthesia, various anesthesia is used: local, intravenous, spinal anesthesia. Operations are fundamentally different in the type of tendon suture, which is superimposed on the damaged area.

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

The described treatment is carried out only on fresh breaks, from the moment of which no more than 20 days have passed. If this period has passed, the Achilles ligament injury is considered old, sew its ends in a simple way already impossible. Then, Achilloplasty is used with an increase in the area of ​​connective tissue.

Complications after surgery

Surgery is often the preferred treatment for a torn ligament. But, like any method, has its complications:

• Infection. A frequent consequence of ruptures and their subsequent suturing. This is due to the weak blood supply to the damaged area and a small layer of covering tissues. The use of modern self-absorbable suture materials reduces the frequency of infection.
• Tissue necrosis occurs when the flap of the covering tissue is insufficient in size. This happens with extensive lacerations of the posterior surface of the lower leg.
• The formation of rough scars that cause discomfort, up to soreness.
• Re-rupture of the tendon.
• Injury to the sural nerve.
• Violation of the mobility of the limb, which occurs with repeated damage to the tendon.

Prevention of complications postoperative period depends not only on the skill of the surgeon, but also on the patient's compliance with all recommendations for rehabilitation after surgery.

Recovery after injury

The success of treatment depends not only on professional treatment in acute period injuries, but also from rehabilitation at home. Modern approach involves the use of various exercises, physiotherapy procedures and physiotherapy exercises even at the time of immobilization. They are carried out only under medical supervision.

Then, after removing the splint, the patient is recommended to perform various exercises aimed at stretching the muscles of the lower leg and improving the elasticity of the Achilles tendon. Their main task is to strengthen the ligament and muscles in order to avoid re-rupture. Helpful in restoring function various massages(normal, pneumatic and others).

In time, this process can take from 60 to 180 days.

An Achilles tendon injury is always serious and requires a lot of effort on the part of the individual to recover. Successful recovery requires timely appeal per qualified help, the implementation of all recommendations and the exclusion of self-treatment.

What to do if you have an Achilles tendon rupture? How dangerous is this injury?

A torn Achilles tendon is an injury that doesn't just affect professional athletes; each person can "tear the Achilles", we just do not notice the natural work of this tendon so much that the diagnosis of an Achilles rupture seems erroneous. The Achilles tendon (sometimes called the calcaneal tendon) connects the calf muscle to the calcaneus. Together they help lift your heels off the ground (walking, running, jumping) and climbing onto your toes. People use the calf muscle and the Achilles tendon as Everyday life as well as during sports.

What is an Achilles tendon rupture

If your Achilles tendon is pulled too hard, it can be seriously injured (torn, torn).

Achilles tendon rupture symptoms:

• Feeling like you've been hit in the back of the leg
• The sound of the tendon tear itself (sounds like a crunch or pop)
• feeling of tightness, sharp pain at the back of the leg or ankle
• Difficulty walking - especially when walking up stairs
• Lameness, strong pain when walking
• Difficulties with the desire to "stand on your toes" (stand on your toes)
• Bruising or swelling in your leg
• Inability to stretch the foot.
• Swelling or bruising that gradually grows and may move down and reach the fingertips.

How does an Achilles tendon rupture?

The injury most likely happened when you:

• Kick off the ground abruptly (to switch from walking to running or running uphill)
• Tripped and fell or during another "emergency" situation
• Participated in sports related to large quantity stops and starts (like tennis or basketball)
• slipped
• Got a direct hit to the Achilles tendon

Achilles tendon rupture diagnosis

You will probably need an MRI to see what type of Achilles tendon rupture you are. MRI is one of the types of visual diagnostics.
If an MRI is not available, a doctor can diagnose the injury with the following tests:

A partial tear in the Achilles tendon means that at least some of the tendon structures are still intact.

A complete rupture of the Achilles tendon means that your tendon is completely torn, and both sides of the calf and heel are not "attached" to each other.

What to Expect After Treatment for an Achilles Tendon Rupture

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

Gypsum is a traditional and economical method of treating a partial rupture of the Achilles, which has a number of disadvantages - it completely immobilizes the joints, difficulties in rehabilitation period, domestic inconvenience.

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

Help with Achilles tendon rupture symptoms

Important! You can not massage the leg after a rupture of the Achilles tendon

• Use pillows to raise your leg above chest level when you sleep.
• Keep your leg up when you are sitting.
• You can take pain medications such as ibuprofen (such as Nurofen or Mig), naproxen (such as Nalgesin or Naproxen), or acetaminophen (such as Panadol). Do not give aspirin to children!
• If you have heart disease, high blood pressure, kidney disease, stomach ulcers, or bleeding, talk to your doctor before using these medicines. Do not take more than the manufacturer's recommended dose.

Achilles tendon rupture and activity

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

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

When you "stretch" the calf muscles, do it slowly. In addition, during rehabilitation, you should not jump or strain your leg unnecessarily.

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

After healing, you need:

• To be in good shape and before any exertion or exercise do a good workout and stretching.
• Avoid shoes with high heels.
• Check with your doctor if you can play tennis, badminton, basketball, and other sports that require sudden stops and starts.

When to See a Doctor

• See your doctor if you have any of these symptoms:
• Swelling or pain in the legs, ankle, or foot gets worse.
• Your leg turns purple.
• You have a stable temperature

Denial of responsibility : The information provided in this Achilles tendon rupture article is for guidance only. However, it cannot be a substitute for consultation with a health professional.