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Achilles Tendon Repair Rehab Protocol

Overview

The Achilles tendon is the largest tendon in the human body. It connects the calf muscle to the heel bone. However, this tendon is also the most common site of rupture or tendonitis, an inflammation of the tendon due to overuse. Achilles tendon rupture is a partial or complete tear of the Achilles tendon. It comes on suddenly, sometimes with a popping sound, and can be debilitating. A full rupture is more severe, but less common, than a partial rupture. A full rupture splits the Achilles tendon so that it no longer connects the calf muscle to the heel: the calf muscle can no longer cause the foot to ?push off?, so normal walking is impossible. If it is a full rupture, then lightly pinching the Achilles tendon with the forefinger and thumb will reveal a gap in the Achilles tendon. Partial and full Achilles tendon ruptures are most likely to occur in sports requiring sudden stretching, such as sprinting and racquet sports. Partial Achilles tendon tears are also common among middle and long distance runners.


Causes
The tendon is susceptible to injury and can rupture during vigorous activities such as running and jumping. Rupture can also occur as a result of gradual wear. After becoming chronically weakened, it can rupture during non-stress activities like walking.


Symptoms
A person with a ruptured Achilles tendon may experience one or more of the following. Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf, often subsiding into a dull ache. A popping or snapping sensation. Swelling on the back of the leg between the heel and the calf. Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes. These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the “R.I.C.E.” method should be used. This involves, rest. Stay off the injured foot and ankle, since walking can cause pain or further damage. Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin. Compression. Wrap the foot and ankle in an elastic bandage to prevent further swelling. Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level.


Diagnosis
A diagnosis can be made clinically, but an MRI or ultrasound scan can confirm it. On examination, the patient will present with reduced plantarflexion strength, a positive Thompson test and potentially, a palpable gap in the Achilles. The whole length of the tendon should be examined to check for injuries that can occur at the insertion and the musculotendinous junction.


Non Surgical Treatment
Treatment of the initial injury is with use of ice, elevation, and immobilization. If suspected you should contact your podiatrist or physician. Further treatment with continued immobilization, pain medication, or anti-inflammatory medications may be advised. If casted the foot is usually placed in a plantarflexed position to decrease the stretch on the tendon. As healing progresses the cast is changed to a more dorsiflexed position at the ankle. The casting processes can be up to 8 weeks or more.


Surgical Treatment
Referral to a surgeon for open or percutaneous repair of the tendon is often necessary, followed by an immobilisation period. Functional bracing and early mobilisation are becoming more widely used postoperatively. There is no definitive protocol for this and it may differ, depending on the surgeon. Operative treatment has a reduced chance of re-rupture compared with conservative treatment (3.5% versus 12.6%) and a higher percentage of patients returning to the same level of sporting activity (57% versus 29%). The patient’s desired functional outcome and comorbidities that affect healing will be factors in the decision to operate.


Prevention
There are things you can do to help prevent an Achilles tendon injury. You should try the following. Cut down on uphill running. Wear shoes with good support that fit well. Always increase the intensity of your physical activity slowly. Stop exercising if you feel pain or tightness in the back of your calf or heel.

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