The modern popularization of sports and active longevity and, in addition to the obvious positive aspects, contributes to an increase in the number of cases of Achilles tendon ruptures. At risk are people aged 35-55 who lead an active lifestyle, but do not have time to build the correct training process, the necessary frequency of training, and often neglect the warm-up.

Causes of Achilles tendon rupture

During training, the increase in muscle strength of the calf muscle occurs faster than the adaptive restructuring of the Achilles tendon to a new level of load. Thus, with a sharp start, jump or uncoordinated movement, a rupture of the largest tendon organ occurs.

Team sports on weekends are leaders in terms of injury rates and not only in this area. It provokes spontaneous rupture of the Achilles tendon and factors such as: the presence of static deformities of the feet (flat feet, hollow foot), chronic microtraumatization, the introduction of glucocorticosteroid hormones and the use of fluoroquinolone antibiotics.

Achilles tendon rupture symptoms

A rupture of the Achilles tendon is characterized by a “feeling of a blow” on the back of the lower leg, the inability to stand on toes, and later swelling and hematoma appear.

How to treat an Achilles tendon rupture in the first hours after an injury
Optimal first aid in this situation: cold, rest, unloading of the injured limb, elastic bandage, elevated position, taking painkillers. Do not use ointments with a warming effect or containing heparin. They will increase swelling, hematoma and, as a result, lead to increased pain.

Achilles tendon rupture: treatment with conservative therapy

With conservative treatment (without surgery), the injured limb is immobilized in order to keep the foot in the position of maximum plantar flexion (equinus) for a period of 8 weeks and flexion at the knee joint for the first 3-4 weeks. It is this position that reduces the traction of the gastrocnemius muscle and allows you to bring the ends of the torn tendon closer together. Immobilization for 12 weeks is impractical and leads to the formation of a persistent contracture of the ankle joint, a significant lengthening of the treatment period.

Immobilization can be performed with classical gypsum, a polymer bandage based on epoxy resin (“plastic gypsum”) and thermoplastic (Turbocast, Orif and analogues). The difference between these materials is due to the weight of the dressing and the sensations that the patient experiences during the treatment (although the dressing also has a placebo effect). When choosing immobilization, it is important to consider that the use of crutches increases the load on the lumbar spine, especially in patients with pathology in this region. The dressing technique is even more important than the chosen material.

The main disadvantage of conservative treatment is a high probability of re-repair (the probability of re-rupture with conservative treatment is 17.7% versus 2% with surgery), lengthening of the treatment period and a decrease in the strength of the gastrocnemius muscle due to tendon elongation (elongation in the process of fusion).

Conservative treatment is indicated for patients with low motor demands, the presence of general contraindications to surgical treatment and the patient’s conscious desire to refrain from surgery. With this choice of treatment, more time and effort are required from the doctor and the patient during the recovery phase.

In case of rupture of the Achilles tendon in the elderly, when the patient cannot walk on crutches, symptomatic treatment, early activation, learning to walk with additional support, and the formation of a new gait stereotype are indicated.

Benefits of Achilles tendon rupture surgery

As a result of comparative studies of surgical and conservative treatment, a decrease in the strength of the triceps muscle of the lower leg was revealed: with conservative treatment by 38% (with surgery by 12%), a decrease in endurance by 36% (with surgery by 9%). This is due to a decrease in the tension of the fibers of the triceps muscle of the leg.

The goal of surgical treatment for a ruptured Achilles tendon is to restore the physiological tension of the triceps muscle with minimal surgical aggression. In fact, it is necessary to maintain the distance between the insertion of the Achilles tendon to the calcaneus and the transition of the calf muscle to the tendon part for 6 weeks. During this period, the parathenon (sheath of the Achilles tendon) synthesizes a new Achilles tendon. At the stage of rehabilitation, the correct increase in the load allows the collagen fibers to restore the complex internal architecture, of course, not forgetting the rest of the musculoskeletal system.

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