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Achilles Tendon Exercises After Injury

Overview

Achilles tendon rupture is an injury that affects the back of your lower leg. It most commonly occurs in people playing recreational sports. The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture). The tendon can rupture completely or just partially. If you have an Achilles tendon rupture, you might feel a pop or snap, followed by an immediate sharp pain in the back of your ankle and lower leg that usually affects your ability to walk properly. Surgery is often the best treatment option to repair an Achilles tendon rupture. For many people, however, nonsurgical treatment works just as well.


Causes
Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Rupture usually occurs in the section of the tendon located within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section may be predisposed to rupture because it gets less blood flow, which also may impair its ability to heal. Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. Common examples include increasing the intensity of sports participation, especially in sports that involve jumping, falling from a height, stepping into a hole.


Symptoms
A sudden and severe pain may be felt at the back of the ankle or calf, often described as “being hit by a rock or shot” or “like someone stepped onto the back of my ankle.” The sound of a loud pop or snap may be reported. A gap or depression may be felt and seen in the tendon about 2 inches above the heel bone. Initial pain, swelling, and stiffness may be followed by bruising and weakness. The pain may decrease quickly, and smaller tendons may retain the ability to point the toes. Without the Achilles tendon, though, this would be very difficult. Standing on tiptoe and pushing off when walking will be impossible. A complete tear is more common than a partial tear.


Diagnosis
Other less serious causes of pain in the back of the lower leg include Achilles tendonitis or bursitis. To distinguish between these possibilities, your physician will take a thorough history and examine your lower leg to look for signs of a rupture. The presence of a defect in the tendon that can be felt, evidence of weakness with plantarflexion, and a history consistent with Achilles tendon rupture are usually sufficient for diagnosis. Your physician may also perform a ?Thompson test,? which consists of squeezing the calf muscles of the affected leg. With an intact Achilles tendon, the foot will bend downward; however, with a complete rupture of the tendon, the foot will not move. In cases where the diagnosis is equivocal, your physician may order an MRI of the leg to diagnose a rupture of the Achilles tendon.


Non Surgical Treatment
Two treatment options are casting or surgery. If an Achilles tendon rupture is untreated then it may not heal properly and could lead to loss of strength. Decisions about treatment options should be made on an individual basis. Non-surgical management traditionally is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. The goal of casting is to allow the tendon to slowly heal over time. The foot and ankle are positioned to bring the torn ends of the tendon close together. Casting or bracing for up to 12 weeks or more may be necessary. This method can be effective and avoids some risks, such as infection, associated with surgery. However, the likelihood of re-rupture may be higher with a non-surgical approach and recovery can take longer.


Surgical Treatment
Most published reports on surgical treatment fall into 3 different surgical approach categories that include the following: direct open, minimally invasive, and percutaneous. In multiple studies surgical treatment has demonstrated a lower rate of re-rupture compared to nonoperative treatment, but surgical treatment is associated with a higher rate of wound healing problems, infection, postoperative pain, adhesions, and nerve damage. Most commonly the direct open approach involves a 10- to 18-cm posteromedial incision. The minimally invasive approach has a 3- to 10-cm incision, and the percutaneous approach involves repairing the tendon through multiple small incisions. As with nonsurgical treatment there exists wide variation in the reported literature regarding postoperative treatment protocols. Multiple comparative studies have been published comparing different surgical approaches, repair methods, or postoperative treatment protocols.

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