Achilles tendon originates from the merger of the gastrocnemius and soleus muscle, and fits the level of the calcaneal apophysis in rear. It is used to push the foot. The sport that most 'easily determine the disease, are football, basketball, volleyball, athletics lightly. This lesion unfortunately not only athletes, but is also evident in people no longer' young. It affects males in a piĆ¹i of age 'between 25 and 50.
must be distinguished:
Tendinopathy: tendon pain due to abuse or excessive load of the joint functional
tendinosis: degenerative process that affects the tendon
Tendinitis: acute inflammation that affects the peritenon (membrane that surrounds the tendon).
be emphasized that the tendon rupture usually occurs from a condition of tendinosis past, so it is vital to carefully evaluate the first signs of pain tendine0 to prevent any and painful lesions
can recognize in acute injuries and degenerative lesions. We can then consider:
-Tears from direct trauma (cuts, from the tip ...)
Broken-traumatic reflex (often in sports such as skiing, track and field ...)
-Broken volunteers (degenerative or repeated trauma also characteristics of the athletes). In the elderly, as already indicated that the breakage is almost always degenerative platform.
Symptoms: while in the acute trauma patient shows a traumatic event with a sudden realization hit or bite associated with pain, chronic fractures, may be a history of subtle and discrete tendon pains associated with a traumatic event of minor symptoms with more muted than in acute trauma. The patient often reports a constant discomfort that lasts a long time. Once damaged, in the tendon, there was a sort of depression more or less evident, and a lack of continuity of the tendon profile, the active movement of articulation of the foot is narrow and joint movement originates pain, But sometimes a patient can proceed independently.
Diagnosis: rule is not complicated, in fact right on palpation of the tendon with the foot in dorsiflexion with the patient prone, it shows the depression caused by the rupture. However, edema, ecchymosis, and little participation of the patient, do not always help in the diagnosis that can be completed by a ultrasound scan or an MRI study.
The decline is not always plainly altered because of the persistence of some fibers and the sheath and for the help given by other forms such as the posterior tibial muscle.
profit may be the operation of Thompson's chin clamp and compression of the calf with the patient prone and knee flexed to ninety degrees when the tendon is intact you should show passive dorsiflexion of the foot.
The partial tears in the usual injuries cut into subcutaneous lesions may be missed in those connections (25%) of the course of the medial plantar tendon
rarely approaches an x-ray examination, it should always be made in case of suspected shutdown of the tendon from the calcaneal tuberosity.
Therapy: treatment without drawing as much as possible with a long period of immobilization may result in rirotture, elongation of the tendon, decreased flexion power, functional impotence.
For this reason often suggested surgery and to tight deadlines, if not possible, we recommend an immediate immobilization with plaster and foot placed in plantar flexion. The intervention is tenoraffia, that can be performed using various techniques. In cases of loss of form, can be used as reinforcement, forms autologous tendon. Recently it is located (where possible), a percutaneous suture with minimal surgical input.
post-operative treatment: is characterized by an initial phase with boot rom Walken type cast or brace with the foot in slight plantar flexion for about four weeks, and a second one will begin a physiotherapy treatment of active and passive mobilization reconnected to a water gymnastics. The aim is to give continuity to the tendon is functionally effective, without generating persistent phenomena of reparative fibrosis that may affect proper joint elasticity. The shooting sports discipline depends on the place, but we recommend no earlier than 60 days.
It 'important to emphasize that the degree of flexion of the tibial tarsal joint in fixed assets, should never be imposed, but should be in "equine gravitary", which is the location of relief that the foot assumes when the patient is sitting with his legs hanging.
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