Tendonitis code. Tenosynovitis: causes, symptoms, diagnosis, treatment. Diagnosis and treatment

Striated muscles have a formation at the end that serves as an attachment for the muscle to the skeletal bones. This structure is based on collagen fibers interspersed with rows of fibrocytes that form tendons.

As a result of traumatic or other impact, this tissue can become inflamed - most often this occurs in the area of ​​​​the transition from tendon to muscle or in the immediate place of attachment of muscle to bone.

Essentially, joint tendonitis is an acute or chronic inflammation of the tendon, which can also affect the tendon bursa or tendon sheath. Inflammation of the entire tendon rarely spreads; as a rule, this indicates an advanced chronic process, when degenerative processes have the greatest impact.

This disease, depending on the etiology and location, may have an ICD 10 code M65, 75, 76, 77.

The causes of tendonitis are excessive physical activity, which can be either one-time or regular. As a result, the tendon fibers receive micro-tears. Most often, professional athletes and people engaged in monotonous physical labor are susceptible to the disease.

Tendinitis can be recognized by painful physical activity, increased temperature in the affected area combined with hyperemia, as well as slight swelling of the soft tissues.

If tendinitis has acquired the character of a chronic disease, then stopping exacerbations will be an important area of ​​treatment. Treatment can include both medication and surgery.

Symptoms of tendinitis

Tendons are attached in close proximity to the joint. Therefore, when the tendon becomes inflamed, pain will be felt near the joint, which often makes a person think that the problem lies in the joint. Regardless of location, all tendinitis will have the following symptoms:

• At rest, the tendon does not bother you, but as soon as you start moving the affected limb, pain will immediately manifest itself. In addition, the affected tendon will respond painfully to palpation.
• When touched, the skin over the affected area may be red and feel warmer to the touch in the localized area.
• If you listen or use a phonendoscope, the tendon will make a characteristic crunching sound when active.

Depending on the location, each type of tendinitis will have its own specific characteristics.

Tendonitis is characterized by a gradual onset of symptoms. This may result in an increase in pain.
Initially, tendon soreness manifests itself exclusively in peak load situations and most patients do not attach any importance to this, maintaining their usual mode of activity.

During development, pain syndromes become more pronounced and the degree of stress gradually weakens to feel them. The patient begins to experience discomfort in everyday activities. A mild swelling of the soft tissue may form at the site of the lesion.

Types of disease

The inflammatory process of the tendon varies depending on the location. In each case, characteristic features of tendonitis can be identified.

Achilles tendonitis

When the heel tendon becomes inflamed, it is called Achilles tendonitis. Occurs due to poor quality metabolism and impaired tissue conductivity.

When the tendon tissue begins to crack and then scar, the preconditions for the formation of tendinitis gradually develop. Ultimately, it is even possible for the tendon to separate from the heel bone. In addition to the tendon itself, the adjacent tissues of the articular apparatus may be involved in the inflammatory process.

There are cases when the cause of the development of the disease lies in an imbalance of substances that cause the deposition of calcium salts in the tendon tissues. Ultimately, there is a chance of developing a heel bump called plantar fasciitis.

Achilles tendinitis can develop over several months. May manifest itself when going up and down stairs or an inclined plane. The pain is felt after sleep and does not go away after warm-up exercises. Soreness appears after sleep. The patient cannot rise to his toes, which clearly indicates a tendon injury.

Shoulder tendinitis

Near the shoulder joint there are tendons that provide attachment for a large number of muscles, because to ensure such freedom of action, good support is needed.

If the loads and operating mode are not observed, the tendon of the rotator cuff, which includes the tendons of the supraspinatus, teres minor, subscapularis and infraspinatus muscles, is the first to suffer. The second most popular is tendinitis of the biceps brachii or biceps muscle. The supraspinatus is most often affected.

This problem is especially troubling for manual workers and athletes, because they have to immobilize the joint during the rehabilitation period. For those who are familiar with chronic tendinitis, it is very important to properly develop the affected tendons and prevent injury.

Men over 40 are also characterized by calcific tendinitis, which is based on metabolic disorders. Calcium salts trigger pathological degenerative processes in tissues. If left untreated, the processes spread to adjacent joint tissues and muscles. The muscles, subacromial bursa, and shoulder joint capsule suffer.

Knee tendonitis

Jumper's knee is also known as patellar tendinitis. It is this tendon that receives the maximum load during the pushing activity of an athlete. The quadriceps muscle experiences enormous load during jumping, which leads to regular microtrauma.

The disease develops slowly and tends to be chronic. If you do not pay attention and continue to load the knee, you end up with a serious inflammatory process.

Knee tendinitis in the initial stages is successfully treated with conservative methods and physiotherapy. However, in advanced cases it is necessary to perform surgical intervention when the inflamed or torn part of the tendon is excised. The operation is performed using small incisions endoscopically. Healing will require time and constant development of the knee joint, otherwise mobility may be limited.

This pathology is also called “pes anserine tendonitis” because of the shape of the tendon. Sometimes it can be found in adolescents and children, who, due to the immaturity of the ligamentous apparatus, are at risk of receiving a similar injury.

Inflammation of the tendons in the ankle area is a real scourge for athletes and women who prefer high heels.

Tendinitis of the ankle joint develops against the background of regular injuries - dislocations, subluxations, bruises.

During treatment, it is very important to fix the joint and give the limb complete rest. This can be problematic, since the ankle is under load from its own body weight. If it is necessary to completely immobilize a limb, not only splints, but also crutches can be used.

Overweight people will also be at risk. Firstly, this is an additional load on the ankle tendons, and secondly, it is often an incorrect metabolism, which provokes an acceleration of the destruction of the collagen fiber of the tendon.

Treatment of the ankle requires the use of all resources to speed up the rehabilitation of the limb. If surgical intervention is necessary, the joint will be developed and the tendons will be adapted.

In addition, we must not forget that in the foot, as in the hands, there is also a large number of tendons responsible for the work of the fingers and the shock-absorbing properties of the foot when walking. The inability to support in case of inflammation will also require prompt intervention from a doctor.

Tendinitis of the elbow joint

When tendonitis occurs, the elbow joint may show signs characteristic of other common diseases - osteoarthritis or polyarthritis. It is very important to correctly diagnose the problem. It is necessary to find out by palpating the tendon area whether there is tunnel syndrome, supination or valgus, varus syndrome. These are also inflammatory processes, but not related to this case.

Elbows are often subject to stress when playing sports, where it is necessary to constantly keep tense arms bent or when carrying heavy objects. In this situation, it is necessary to avoid overloading the tendons, otherwise you can get an unpleasant chronic problem.

Biceps tendinitis

The biceps or biceps muscle provides flexion of the arm at the elbow joint, as well as rotation of the forearm, that is, the movement of turning the arm with the palm up or down.

Tendonitis of the biceps brachii muscle develops due to excessive sports stress or heavy physical work. This pathology is common among those whose job functions require them to hold their arms above their heads - swimmers, throwers, tennis players.

Biceps tendinitis can develop from a fall on the top of the shoulder. When the adjacent ligamentous apparatus is destroyed, the joint may become hypermobile and begin to fall out, causing dislocations and subluxations.

A distinctive feature of the fingers is that there is no muscle tissue inside. There are muscles only in the hand. The tendons are thin and long; due to them, the fingers move freely and can perform various manipulations.

Today, a very common problem is inflammation of the finger flexors. This is due to the fact that the hands and fingers are constantly under tension when it is necessary to hold or type something. Large loads on the use of fine motor skills make this disease very common.

You should not neglect the problem, since the tendon is thin, and the destructive effect of the disease occurs on it much faster. It is necessary to study therapy as early as possible so as not to suffer in the future. This pathology is inherent in those who work a lot with their hands - from musicians to adjusters.

Hip tendinitis

Tendons are attached to the femur at both the knee and hip joints. This is a large bone and a lot of stress falls on its tendons.

If the femoral tendons are torn, the pain, as in most cases, will increase gradually. It is characteristic that if a person begins to perform simple warm-up exercises, the pain disappears, but as soon as an increased load is given, the pain returns in a much more serious form.

A person, subconsciously protecting the injured area, soon begins to limp, his gait frankly changes. Lameness develops gradually, intensifying. When performing hip abduction, flexion, or walking, crunching sounds may be heard.

The quadriceps tendon is often affected, but clicking may simply be an anatomical feature of the tendon when its attachment slips. Such phenomena occasionally occur when the fastener slips to the greater trochanter of the gluteus maximus tendon. Sometimes this feature occurs in young women and does not cause any problems.

Temporal tendinitis

The temporal tendon can become inflamed due to the strain that occurs in the jaw muscles due to an incorrect bite. The second reason is the habit of gnawing hard food - crackers, nuts. The symptoms that accompany this form of the disease often force you to contact a dentist or neurologist.

Tendinitis in the area of ​​the temporal joint causes headaches and toothaches; when talking, the gums may hurt, and the longer the need to speak, the more sensitive the pain. Patients complain of discomfort when eating.

This form of tendinitis is characterized by irradiation of pain to the temporal and occipital region, and neck. If the patient seeks help in a timely manner, then this form of the disease can be perfectly treated with conservative methods. Physiotherapy has a good effect.

Gluteal tendonitis

When the tendons of the gluteal muscles become inflamed, a person may experience difficulty moving and changing body position.

The dystrophic nature of the pathology is expressed in atrophy and severe weakness of the muscles of the buttocks. When moving, clicks are heard and the person is unable to move normally.

Treatment

Considering the nature of the occurrence and course of tendonitis, it is worth warning that treatment with all kinds of folk remedies in this case can be more likely to cause harm. Because a tendon rupture can be much more serious than you might imagine. In cases where avulsion occurs, the surgeon excises the inflamed part and applies sutures.

Ointments for tendinitis play a supporting role when it is necessary to use not only oral NSAIDs, but also to promote local healing of the tendon. You won't be able to heal tendinitis quickly at home. On average, treatment takes 6 weeks, and if an operation was performed to excise part of the tendon, then rehabilitation can take up to six months.

After the diagnosis, the doctor builds a scheme and determines how to treat tendonitis in a particular case. It should be noted that surgery is an extreme case; most often, such a disease responds well to drug treatment.

The scheme resembles the general algorithm for treating joints and connective tissues:

• The joint must be immobilized with a bandage, splint or elastic bandage.
• Analgesics are prescribed for pain relief. This allows the patient to relax and not experience discomfort. For the purpose of relaxation, after the acute phase has passed, massage is prescribed for tendonitis.
• Corticosteroids and non-steroidal anti-inflammatory drugs are used to relieve inflammation. The doctor will select one so that in your case the likelihood of side effects is zero.
• In parallel, physiotherapy with the administration of medicinal drugs can be used.
• Exercise therapy is another method of rehabilitation for tendonitis. Physical education helps strengthen muscles and ligaments, and at the same time activate blood circulation in the tendon area, providing nutrition to the connective tissue.
• If the tendon is inflamed due to infection, antibiotics will be prescribed. You should not be afraid of this; on the contrary, such therapy will protect nearby joints.

Surgery is indicated for severe inflammation, when it is necessary to clean the tendon.

The main task for preventing the disease is careful control of the load and avoidance of injuries. If the last condition fails, then it is necessary to take care of adequate medical care and methodical implementation of all rehabilitation conditions.

To avoid sprains and dislocations that could injure the tendons, athletes use elastic fixing bandages. This allows you to reduce the load and minimize the number of micro-tears in the tendon. Also, a diet to replenish collagen reserves helps restore the elasticity of the tendon body, which also prevents the likelihood of tearing and the development of inflammation.

Considering the length of the recovery period for tendonitis, it is quite normal to be meticulous and play it safe. Compliance with safety precautions will help maintain the health of not only joints, but tendons and ligaments.

The most complete answers to questions on the topic: “tendinitis of the shoulder joint ICD 10.”

First of all, it must be said that the treatment of shoulder tendinitis largely depends on the stage and severity of the disease. If the disease is diagnosed in the early stages of its manifestation, the treatment protocol is quite gentle and includes:

• Maximum limitation of mobility and load on the diseased joint, and, consequently, on the affected tendon.
• Cold is used as an adjuvant therapy.
• To fix the joint and bring it to rest, splints, bandages, and an elastic bandage are used.
• Physical procedures are actively used:
  • Laser therapy.
  • Shock wave therapy
  • Magnetic therapy.
  • Exposure to ultraviolet and ultrasonic rays.
  • In case of chronic manifestation of the disease, mud and paraffin applications and lidase-based electrophoresis are practiced.
• Not least important is drug treatment - antibiotics, painkillers and anti-inflammatory drugs, antimicrobial drugs.
• After stopping the acute form of the disease and the effective course of therapy, the doctor introduces a set of physical therapy exercises to the patient.
• If there is no exacerbation, massages of the affected area are also indicated.

In case of more severe forms of damage, treatment of shoulder tendonitis begins with conservative therapy using anti-inflammatory drugs. If calcific tendinitis is diagnosed, a procedure is performed to remove salt deposits. To do this, two needles with a large hole are inserted into the joint and the salt is washed out using saline. Then cold therapy, massages, physical procedures, and therapeutic exercises are added. If such measures do not lead to a positive result, then surgical treatment methods have to be resorted to. In this case, it would be appropriate to use an arthroscope - a medical device equipped with a video camera. It is introduced into the lumen of the joint and the necessary manipulations are performed. But classic strip surgery can also be performed. The period of postoperative rehabilitation usually reaches two to three months, but you will be able to return to your usual active life no earlier than after three to four months.

Drug therapy may include multidirectional drugs. They are classified as non-steroidal drugs.

This anti-inflammatory and analgesic drug is not prescribed to patients under 12 years of age. The drug is prescribed orally (orally) immediately after meals. The average daily dosage of the drug is 0.2 g, divided into two doses. Nimesil is prepared immediately before administration. To do this, pour the contents of the sachet into a glass of warm water and mix well. The duration of treatment is no more than two weeks.

It is not recommended to take the drug if a person’s medical history has been diagnosed with: ulcerative lesions of the stomach or duodenum, arterial hypertension, internal bleeding, congestive heart failure, severe renal dysfunction, hypersensitivity to the component composition of the drug. The drug nimesil is contraindicated during pregnancy and while breastfeeding.

This medicine is used externally. Before the procedure, the area of ​​skin in the area of ​​inflammation must first be washed and blotted with a towel. Apply a small layer of gel to the skin (track length up to 3 cm). Do not rub too hard. The number of daily procedures is from three to four. It is not recommended to use for more than ten days.

Contraindications for the drug include: acute phase of erosive and ulcerative lesions of the gastrointestinal tract, internal bleeding, dermatoses of various types, a tendency to allergic manifestations, renal and liver failure, bronchospasm. Nise is not prescribed to women during pregnancy and lactation, as well as to children under seven years of age.

It has pronounced analgesic properties, while the active substance (ketorolac tromethamine) is an excellent anti-inflammatory agent with a moderate antipyretic effect. In tablet form, the drug is prescribed as a single dose of 10 mg. In case of severe pathology, the same dosage is allowed, but up to four times a day. The need for repeated administration is determined only by the attending physician.

Tendonitis is a disease of the tendon. Accompanied by inflammation, and subsequently by degeneration of part of the tendon fibers and adjacent tissues. Tendonitis can be acute or subacute, but is more often chronic. Typically, tendonitis affects the tendons located near the elbow, shoulder, knee and hip joints. The tendons in the ankle and wrist joints may also be affected.
  Tendinitis can develop in a person of any gender and age, but is usually observed in athletes and people with monotonous physical labor. The cause of tendonitis is too high loads on the tendon, leading to microtrauma. As you age, your likelihood of developing tendonitis increases due to weakening of ligaments. In this case, calcium salts are often deposited at the site of inflammation, that is, calcific tendinitis develops.

Lateral tendinitis.

  Lateral epicondylitis, also known as lateral tendonitis or tennis elbow, is an inflammation of the tendons that attach to the extensor muscles of the wrist: the extensor carpi brevis and longus muscles, as well as the brachioradialis muscle. Less commonly, lateral tendonitis affects the tendons of other muscles: the extensor carpi ulnaris, extensor radialis longus, and extensor digitorum communis.
  Lateral tendinitis is one of the most common diseases of the elbow joint in traumatology, occurring in athletes. This form of tendonitis affects about 45% of professionals and about 20% of amateurs, who play on average once a week. The likelihood of developing tendinitis increases after age 40.
  A patient with tendonitis complains of pain along the outer surface of the elbow joint, often radiating to the outer part of the forearm and shoulder. Gradually increasing weakness of the hand is noted. Over time, a patient with tendonitis begins to experience difficulties even with simple everyday movements: shaking hands, twisting clothes, lifting a cup.
  Palpation reveals a clearly localized painful area on the outer surface of the elbow and above the lateral part of the epicondyle. The pain intensifies when trying to straighten the bent middle finger against resistance.
  X-rays for tendonitis are not informative, since the changes affect soft tissue structures rather than bones. To clarify the location and nature of tendinitis, magnetic resonance imaging is performed.
  Treatment for tendinitis depends on the severity of the disease. In case of mild pain, you should avoid putting stress on your elbow. After the complete disappearance of pain, it is recommended to resume the exercise, initially in the most gentle mode. In the absence of unpleasant symptoms, the load is subsequently increased very smoothly and gradually.
  For tendinitis with severe pain, short-term immobilization using a light plastic or plaster splint, local non-steroidal anti-inflammatory drugs (ointments and gels), reflexology, physiotherapy (phonophoresis with hydrocortisone, electrophoresis with novocaine solution), and subsequently therapeutic exercises are indicated.
  For tendonitis accompanied by persistent pain and the absence of effect from conservative therapy, blockades with glucocorticosteroid drugs are recommended.
  The indication for surgical treatment of tendonitis is the ineffectiveness of conservative therapy for one year with the reliable exclusion of other possible causes of pain.
  There are 4 methods of surgical treatment of lateral tendonitis: Heumann's laxative operation (partial cutting of the extensor tendons in the area of ​​attachment), excision of the altered tendon tissue with its subsequent fixation to the lateral epicondyle, intra-articular removal of the annular ligament and synovial bursa, as well as tendon lengthening.
  In the postoperative period, short-term immobilization is recommended. Then therapeutic exercises are prescribed to restore range of motion in the elbow joint and strengthen the muscles.

Medial tendonitis.

  Medial epicondylitis, also known as pronator and flexor tendonitis, or golfer's elbow, develops when the tendons of the palmaris longus, flexor carpi ulnaris, flexor carpi radialis, and pronator teres tendons become inflamed. Medial tendonitis is detected 7-10 times less often than lateral tendinitis.
  This disease develops in those who are engaged in light but monotonous physical labor, during which they have to perform repeated rotational movements of the hand. In addition to golfers, medial tendonitis often affects assembly workers, typists and seamstresses. Among athletes, tedninitis is also common in those who play baseball, gymnastics, tennis and table tennis.
  The symptoms are similar to lateral tendonitis, but the painful area is on the inside of the elbow joint. When bending the hand and pressing on the area of ​​injury, pain occurs above the inner part of the epicondyle. To confirm tendinitis and assess the nature of the process, magnetic resonance imaging is performed.
  Conservative treatment is the same as for lateral tendonitis. If conservative therapy is ineffective, a surgical operation is performed - excision of the altered sections of the pronator teres and flexor carpi radialis tendons with their subsequent suturing. After the operation, short-term immobilization is prescribed, and then physical therapy classes.

Patellar tendonitis.

  Patellar tendonitis, or jumper's knee, is an inflammation of the patellar tendon. Usually develops gradually and is primarily chronic. Caused by short-term, but extremely intense loads on the quadriceps muscle.
  In the initial stages of knee tendinitis, pain occurs after exercise. Over time, pain begins to appear not only after, but also during physical activity, and then even at rest. When examining a patient suffering from tendinitis, pain is detected with active extension of the leg and when pressing on the area of ​​damage. In severe cases, local swelling may occur. An MRI is prescribed to confirm tendinitis.
  Conservative therapy for tendonitis includes avoidance of stress, short-term immobilization, local anti-inflammatory drugs, cold and physical therapy (ultrasound). Blockades for this type of tendinitis are contraindicated, since the administration of glucocorticosteroids can cause weakening of the patellar tendon with its subsequent rupture.
  The indication for surgical treatment of patellar tendonitis is the ineffectiveness of conservative therapy for 1.5-3 months or mucous degeneration of the tendon identified on MRI. During the operation, the damaged area is excised and the remaining part of the tendon is reconstructed.
  The choice of surgical procedure (open - through a regular incision or arthroscopic - through a small puncture) depends on the extent and nature of the pathological changes. If the ligament is pinched due to a bone spur on the patella, arthroscopic surgery is possible. For extensive pathological changes in the tendon tissue, a large incision is necessary.
  After surgery, a patient with tendonitis is given a plastic or plaster splint. Subsequently, restorative therapeutic exercises are prescribed.

Excludes: bursitis due to stress, overload and pressure (M70.-)

Tibialis anterior syndrome

Tibialis posterior tendinitis

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Tendinitis of the heel (Achilles) tendon

Definition and general information [edit]

Achilles tendon diseases are classified as the most common pathologies among athletes. Noting their wide prevalence, various authors indicate that they constitute from 6.5 to 18% of the total number of pathological conditions of the musculoskeletal system during sports.

If previously Achilles tendon diseases were relatively rare, over the past decades there has been an increase in the number of patients with this type of pathology. In works devoted to this topic, data are provided indicating that diseases of the Achilles tendon develop mainly in people involved in sports, primarily in athletics (middle and long distance running, long and high jumps).

Etiology and pathogenesis[edit]

The occurrence of pathological changes in the Achilles tendon and adjacent anatomical structures, their gradual progression lead to a sharp limitation of the functional capabilities of the main flexor of the foot - the triceps surae muscle. This is reflected in the inability to fully perform the loads associated with running and jumping, and often becomes the reason for stopping sports activities.

The causes of Achilles tendon diseases in athletes are varied and can be divided into three groups:

The first group of reasons includes anatomical factors that influence the functioning of the Achilles tendon during physical activity.

A special place in the occurrence of pathological conditions of the Achilles tendon in athletes belongs to shortcomings associated with an irrationally organized training process.

An equally important role in the development of this pathology is given to the costs associated with poorly selected shoes and the surface on which classes are conducted.

Among the anatomical factors, first of all, the peculiarities of the blood supply to the Achilles tendon should be highlighted:

The part of the tendon that is subject to the greatest loads (at a distance of 4-6 cm from the insertion site) is especially poorly supplied with blood. This section of the tendon has extravascular trophism, in the implementation of which the main role belongs to the normally functioning paratenon.

High physical loads that accompany sports require certain biomechanical conditions. Compliance with these conditions is possible only with optimal functioning of all elements of the musculoskeletal system adjacent to the Achilles tendon.

The main factor leading to biomechanical disorders is the presence of one or another type of foot deformity. Moreover, these deformations can be static or dynamic in nature.

Clinical manifestations[edit]

The most common pathology of the Achilles tendon during sports is paratenonitis (inflammation of the paratenon). This disease most often develops in track and field athletes (middle and long distance runners). Its clinical manifestations are characteristic of an aseptic inflammatory process. The occurrence of paratenonitis is accompanied by the athlete's complaints of pain in the Achilles tendon, which suddenly appears during physical activity and is most pronounced with maximum flexion and extension of the foot, which accompanies running and pushing off when jumping.

Clinically, in the initial period of the disease, swelling of the peritendinous tissue and pain in the same area appear on both sides of the tendon, which intensifies with tension in the calf muscle and load on the forefoot. Often, upon palpation along the tendon, crepitus and the presence of soft nodules are determined. This phenomenon is associated with the formation of exudate containing fibrinogen around the Achilles tendon and local deposition of fibrin in the paratenon. In case of continued stress or lack of treatment, the acute inflammatory process becomes chronic.

With chronic paratenonitis, the patient usually complains of pain in the Achilles tendon area when performing normal movements and a sharp increase in pain during sports activities. By palpation, the presence of one or several painful muff-like thickenings with a length of 0.5 to 5.0 cm is determined. The excursion of the tendon decreases, which is reflected in the limitation of extension of the foot by an average of 3-5°. This symptom is a consequence of the formation of scar adhesions between the paratenon and the tendon. In cases of a sufficiently long course of the disease, hypotrophy of the triceps surae muscle and a decrease in the strength of flexion of the foot are noted. The presence of this disease sharply reduces functionality and often leads to cessation of sports activities.

In many cases, inflammation of the paratenon is accompanied by involvement of the tendon tissue itself in the pathological process. This causes a condition called tendonitis. According to most authors, both a combination of these diseases and the existence of one of them is possible. The circumstances leading to the development of tendinitis are usually similar to the circumstances leading to the development of paratenonitis. And the main clinical manifestation is pain during movement and palpation in the area of ​​the Achilles tendon. Important signs of tendonitis are an increase in the diameter of the tendon and heterogeneity of its structure, determined by palpation. In addition, sometimes upon palpation it is possible to identify areas of retraction along the Achilles tendon, corresponding to areas of tendon tissue degeneration.

A fairly common disease during sports, first described by Z.S. Mironova et al. (1980) tendoperiosteopathy of the calcaneal tuber, in which inflammatory and degenerative changes are localized in the area of ​​attachment of the Achilles tendon and spread to both the tendon tissue and the cortical layer of the bone. The main clinical manifestations of this pathology are pain at the site of attachment of the Achilles tendon to the calcaneal tubercle, which intensifies with contraction of the triceps muscle and load on the forefoot. At the same time, a gradually increasing swelling of the soft tissues appears in this area. With a long-term disease, it is possible to palpate the deformation of the postero-superior part of the heel tubercle and ossifications in the tendon tissue.

An equally common disease in this area is inflammation of the deep synovial bursa of the Achilles tendon, the so-called Achilles bursitis. As a rule, the inflammatory process begins after prolonged training associated with a large mechanical load on the ankle joint. There is pain at the insertion of the Achilles tendon, which gets worse with walking and running. Clinically, an elastic swelling is detected at the upper edge of the calcaneus, protruding from one or both sides of the tendon and increasing with extension of the foot.

The inflammatory process in the subcutaneous bursa occurs much less frequently and usually develops from friction of the rear contour of the shoe due to its irregular shape. In this case, a painful swelling, sometimes with fluctuation, is determined at the distal part of the tendon. Inflammatory changes in this localization can be both acute and chronic.

Often, the clinical manifestations of Achilles tendon diseases are not so clear and are more complex. This is due to the simultaneous involvement of the paratenon, tendon and its synovial bursa in the pathological process. In this regard, it is sometimes impossible, using only clinical data, to accurately determine the nature of the pathological process and its prevalence. The desire for a more detailed diagnosis of pathology has led to the introduction of additional research methods.

Tendinitis of the calcaneal (Achilles) tendon: Diagnosis [edit]

Laboratory and instrumental studies

When radiography is performed in a “soft” mode, in diseases of the Achilles tendon it is often possible to detect a decrease in the intensity of the shadow of Kager’s triangle and deformation of its contours. Sometimes it is possible to note the presence of signs of ossification of tendon tissue.

Performing radiography in a lateral projection, with chronic inflammation of the Achilles tendon bursa in combination with deformation of the posterosuperior part of the calcaneal tuber, F. Fowler and J. Philip (1945) described the angle for a more objective interpretation of the pathology. It is formed by two lines, one of which connects the most protruding point of the postero-superior angle of the calcaneus (projection of the synovial bursa) with the posterior contour of the calcaneal tubercle, and the other - the lowest points of the calcaneus and cuboid-calcaneal joint.

On average, this angle is 44-69°. An angle equal to or greater than 75° was assessed by the authors as a result of long-standing bursitis and deformity of the posterosuperior calcaneus. Another radiological sign of chronic Achilles bursitis is destruction of the cortical layer of the heel bone in the area of ​​​​the projection of the location of the synovial bursa, often in combination with its ossification.

In case of Achillothalar syndrome, X-ray examination reveals a pathological functional restructuring of the posterior process of the talus, expressed in its enlargement, uneven contours with a linear rarefaction of the bone structure in the base area, which is often combined with ossification of the posterior part of the ankle joint capsule.

In case of an atypical course of Achilles tendon diseases, it is advisable to perform a CT scan to exclude concomitant bone and soft tissue pathology. As a rule, it is possible to detect an increase in the diameter of the tendon, vagueness and blurring of its contours with areas of varying density (on average 68.8 ± 6.6 N). The diagnostic value of MRI is even greater.

Thus, X-ray examination has great diagnostic value and is indicated for all patients with diseases of the Achilles tendon.

Ultrasound diagnostics is the most informative for diseases of the Achilles tendon.

With paratenonitis, the ultrasound picture is characterized by a significant thickening of the paratenon, resulting in an increase in the distance between the skin and the tendon. Typically, the structure of the tendon itself remains homogeneous.

Achilles bursitis is characterized by the presence of a hypoechoic rounded shadow in the area of ​​attachment of the Achilles tendon to the heel bone.

In patients with tendinitis, ultrasound can reveal changes in the form of an increase in the diameter and disruption of the homogeneity of the tendon, the presence of hypoechogenic zones, a decrease in the differentiation of its fibrous structure and thickening of the paratenon.

In general, only a combination of clinical signs and instrumental diagnostic methods makes it possible to judge the nature, prevalence and stage of the pathological process and, at the same time, is of decisive importance in choosing the most optimal treatment tactics.

Differential diagnosis[edit]

In terms of differential diagnosis for diseases of the Achilles tendon, one should exclude pathology from the posterior part of the talus, stenosing tenosynovitis of the long flexor tendon of the first finger, pathological changes from the long and short peroneus muscles, the presence of concomitant specific infectious diseases, systemic pathology of connective tissue and lipid metabolism disorders .

Heel (Achilles) tendinitis: Treatment[edit]

Treatment of Achilles tendon diseases is carried out taking into account the etiology, location and stage of the pathological process. Its main tasks are the elimination of etiological factors leading to the development of pathology, as well as the restoration of the anatomical and functional usefulness of the Achilles tendon. From the first days it is necessary to stop training loads and conduct a thorough clinical and instrumental examination of the athlete.

The indication for conservative treatment is the acute stage of the disease. In case of acute paratenonitis, treatment begins with the application of external immobilization to unload the Achilles tendon for a period of 5-7 days. Sometimes in cases of Achilles bursitis, to prevent continued irritation of the synovial bursa, it is sufficient to give the hindfoot an elevated position by placing special insoles in shoes. At the initial stages of the disease, to stop the processes of fibrinoid exudation, prevent the development of connective tissue proliferation and scar degeneration of the paratenon, it is considered advisable to use local injections of glucocorticoids. In case of acute paratenonitis, it is sufficient to perform 1-2 injections of 1-2 ml of betamethasone into the area of ​​the peritendinous tissue with an interval of 3-4 days. In cases of acute Achilles bursitis, injections are performed after the serous fluid has been evacuated from the cavity of the bursa. Non-steroidal anti-inflammatory drug therapy is used for the same purpose. The most commonly used derivatives are indole (indomethacin) and alkanoic acids (diclofenac), and they are used both orally and topically (in the form of ointments or creams) for 1-2 weeks. No less important for the normalization of trophic processes in the area of ​​the Achilles tendon is the restoration of microcirculation, therefore the use of direct-acting anticoagulants (nadroparin calcium) and pentoxifylline is indicated. Also, the use of various types of physical influence should be recognized as pathogenetically justified at this stage of diseases. Quite good results are noted when performing cryotherapy. After the first sessions, a clear decrease in swelling and pain in the Achilles tendon area is observed. Significant improvement is also noted with ultrasound therapy. Sometimes a similar effect can be obtained by treatment with ultra-high frequency (UHF) electric current.

After acute inflammatory phenomena have subsided, immobilization of the limb is stopped and a repeat clinical and ultrasound examination is performed. If swelling and pain in the tendon area are not clinically noted, and ultrasonography demonstrates a tendency toward regression of pathological changes in the paratenon and synovial bursa, restorative treatment is justified. It should be aimed, on the one hand, at strengthening the triceps surae muscle, and on the other, at increasing the range of motion in the ankle joint and improving tendon gliding. Based on this, therapeutic tactics at this stage primarily include therapeutic exercises. It consists of first performing active dynamic exercises and stretching exercises to restore movement in the ankle joint. Weight and resistance exercises are then added to strengthen the muscles, increase their elasticity, and improve blood circulation. An important supporting role is played by massage, electrical stimulation and hydrokinesitherapy. Conservative treatment is continued for an average of 3-4 weeks, after which, in the absence of clinical manifestations of the disease and complaints, athletes are allowed to begin training sessions. Full restoration of sports performance occurs on average after 2 months.

Over the past decades, there has been a change in the ratio of acute and chronic diseases of the Achilles tendon towards an increase in the latter.

This is due to a significant increase in sports loads in order to achieve high results, as well as late diagnosis and inadequate therapy. These circumstances lead to an increasing increase in the proportion of surgical treatment.

Relative indications for surgical treatment are the lack of effect of conservative therapy and the chronic stage of the disease. Absolute indications for surgery for diseases of the Achilles tendon include the formation of a pathological substrate in the form of a scar-degenerated paratenon and/or the presence of signs of degeneration of tendon tissue.

When determining the scope of surgical intervention, it is necessary to take into account the nature, location and cause of the pathological process. Operations are performed under conditions of exsanguination after applying a tourniquet in the lower third of the thigh or in the upper third of the leg. The choice of anesthesia method is not of fundamental importance. The most rational is the lateral approach.

In case of chronic paratenonitis, surgical intervention consists of tenolysis of the Achilles tendon, blunt and sharp dissection of the fibrous adhesions connecting the paratenon with the intrinsic fascia of the leg. In cases where compression is noted by scars n. suralis, produce its neurolysis. Then the paratenon is dissected along the dorsal surface of the tendon with excision of the scarred membranes, avoiding damage to it in the ventral part, where the vessels that provide trophism to the tendon are mainly located. Pathogenetically justified, in order to prevent postoperative hypoxia of tendon tissue and prevent the formation of adhesions, it is considered to perform a wide fasciotomy. Such surgical intervention has a positive effect on the normalization of microcirculation in the paratenon, thereby having a beneficial effect on the trophism of tendon tissue and the restoration of tendon gliding.

Achilles tendonitis

Achilles tendonitis is inflammation of the Achilles tendon.

There are three forms of this disease:

1. Peritendinitis is an inflammatory process that occurs in the tissues surrounding the Achilles tendon, which is combined with or without degenerative processes in the tendon.
2. Tendonitis is an inflammatory process in the Achilles tendon, which leads to its degeneration. At the same time, the functioning of surrounding tissues is not impaired.
3. Enthesopathy is an inflammatory process of the Achilles tendon, which is accompanied by its degeneration, which occurs in the area where the tendon connects to the bone. In this case, calcification and the formation of heel spurs may occur.

All three of the above forms of Achilles tendonitis are interconnected and can flow into one another. The initial stage of each type of tendinitis requires the same type of initial treatment.

ICD-10 code

Causes of Achilles tendonitis

The causes of Achilles tendinitis are as follows:

1. The main provoking factor in the inflammatory processes of the Achilles tendon is considered to be constant overload of the calf muscle. As a result, chronic tension develops in the muscle and muscle shortening is observed. This causes the Achilles tendon to be under constant tension without being able to rest. If a person cannot interrupt constant exercise or physical work, then this leads to tendinitis developing in the Achilles tendon.
2. In people from forty to sixty years old, Achilles tendonitis appears as a result of its damage after a prolonged load on the leg that is not usual. This development of events can be caused by long running or walking, which must be done after a constant hypodynamic lifestyle. A sedentary lifestyle leads to tendon stiffness and decreased mobility of the ankle joint. As a result of this set of conditions, the Achilles tendon becomes damaged and tendinitis occurs.
3. Professional athletes develop Achilles tendonitis due to violation of the training regimen, prolonged and heavy loads without prior preparation, as well as due to overload of the leg muscles.

Symptoms of Achilles tendonitis

The symptoms of Achilles tendinitis are as follows:

1. The appearance of pain in the Achilles tendon area.
2. The presence of edema located two to six centimeters above the attachment of the Achilles tendon.
3. The occurrence of pain after exerting stress on the leg. It should be noted that in the last stages of the disease, pain appears during the load on the leg.
4. The appearance of pain on palpation of the Achilles tendon.
5. The occurrence of pain at the site of attachment of the Achilles tendon when pressing on it
6. The appearance of enthesopathy, that is, pain in the Achilles tendon area, if a sick person sleeps in a supine position with legs extended.
7. The appearance of incomplete flexion of the foot on the dorsal side when the Achilles tendon is strained.

Where does it hurt?

Diagnosis of Achilles tendonitis

Diagnosis of Achilles tendinitis is divided into several stages.

• The diagnostic procedure begins with collecting anamnesis and listening to the patient’s complaints. Most often, patients in their complaints describe constantly increasing pain sensations two to six centimeters above the point of attachment of the Achilles tendon to the bone. In this case, along with pain, swelling of the junction zone is most often observed.

At the initial stage of the disease, pain occurs after putting stress on the leg. But as the disease progresses, pain also occurs during exercise.

Enthesopathy, as a type of tendinitis, is also characterized by pain at night, which occurs if the patient lies on his back for a long time with his legs extended.

• The next stage of diagnosis is a physical examination of the patient. First of all, the doctor can identify the type of tendinitis by determining the area where the pain occurs. With peritendinitis, an inflammatory process is observed in the tissues along the entire length of the tendon, and in the presence of motor activity in the ankle joint, pain does not move. With tendinitis, the inflammatory process is localized only in a small area and when moving, the area of ​​pain shifts.

It is important for the examiner to rule out the presence of an Achilles tendon rupture. This diagnosis is confirmed or refuted by performing the Thompson test, which is carried out as follows. The patient lies on his stomach, and his feet hang off the table. The specialist squeezes the calf muscle while observing the flexion of the sole of the foot. If the foot can bend, then the Thomson test is considered negative and there is no tendon rupture. If it is impossible to bend the sole of the foot, the doctor will diagnose the presence of a rupture of the Achilles tendon either at the point where it attaches to the muscle, or at any point along its entire length.

• The final stage of diagnosis is radiation examination or x-ray. The x-ray shows areas of calcification along the Achilles tendon, which are visible as an extended shadow. Enthesopathy is also characterized by the appearance of calcifications in front of the tendon insertion point.
• At the last stage of diagnosis, instead of (or in parallel with x-rays), MRI (magnetic resonance imaging) can be performed. The use of this method helps to distinguish between inflammatory processes and degenerative changes in the tendon. In the presence of inflammation, a lot of fluid is localized in the Achilles tendon, although the soft tissues that surround it are not enlarged. If such a picture is observed during diagnosis, then this characterizes the acute stage of the disease.

If there is thickening of the Achilles tendon, which is detected during diagnostics, we can say that its tissue has been replaced by a scar. Such changes significantly increase the risk of Achilles tendon rupture.

How to examine?

Who to contact?

Treatment of Achilles tendonitis

It is very important to correctly diagnose the stage and type of the disease, since the treatment of Achilles tendonitis varies in certain cases.

Acute processes in the tendon and adjacent tissues are successfully eliminated by anti-inflammatory therapy and the use of general means of treating soft tissue injuries - rest, cold, applying a tight bandage, fixing the leg in an elevated position.

Achilles tendonitis is treated using conservative and surgical methods.

Conservative treatment of Achilles tendonitis

Conservative therapy begins immediately when symptoms of the disease are detected. In this case, a tight bandage and cold compresses (ice, etc.) are applied to the entire area of ​​pain. The leg should be at rest and in an elevated position. This therapy is recommended for one to two days, which avoids the appearance of hematomas, and in the future instead of scars.

Subsequently, treatment is carried out using non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics, which provides pain relief, elimination of inflammation and restoration of tendon function. The use of NSAIDs should not exceed seven to ten days, since with longer treatment these drugs interfere with the recovery of the Achilles tendon.

The next stage of treatment is rehabilitation. The rehabilitation period begins a few days after the tendon injury, since at the initial stage it is important to ensure tissue restoration.

In this case, therapeutic exercises are used, which are based on light stretching and strengthening exercises, which helps restore the tendon and develop the functions of the triceps surae muscle.

First of all, start doing stretching exercises. These include exercises in a sitting position using a towel and an expander. The load in the form of resistance should increase gradually, but not cause pain.

• Physiotherapeutic methods during the rehabilitation period include ultrasound therapy, electrophoresis and electrical stimulation. As a result of the use of these treatment methods, pain is reduced and the functions of the damaged tendon are restored.
• Massage is also used to treat Achilles tendonitis, which stretches and strengthens the tendon.
• If there is a severe varus or valgus deformity of the foot, it is necessary to use ankle joint braces.
• In some cases, at night, patients need to use a special corsage that is put on the foot and fixes it in a special position at an angle of ninety degrees relative to the lower leg. It happens that this corsage needs to be worn during the daytime, then the patient can only move with the help of crutches.
• Sometimes a cast is used to treat Achilles tendonitis. It is not recommended to prescribe painkillers. The exception is cases of constant and severe pain in the tendon area.
• Glucocorticoid preparations cannot be injected into the tendon and its attachment zone, since they provoke tendon rupture and also prevent its suturing due to the appearance of degenerative processes.

Surgical treatment of Achilles tendonitis

If conservative methods of therapy have shown ineffectiveness for six months, surgical intervention should be resorted to. Surgical treatment is performed as follows: the Achilles tendon is exposed using a midline skin incision, and the altered tissue around the tendon is excised, as are the thickened areas of the tendon itself. If more than half of the Achilles tendon is removed, the excised portions are replaced with a plantaris tendon. To avoid putting too much tension on the tissue around the tendon, suturing the incisions loosens the tissue at the front, allowing it to close at the back. For enthesopathy, a lateral incision is used to excise the tendon bursa.

If a patient has a Haglund deformity, which is a spur-like bony ridge on the back of the heel bone, this defect can put pressure on the tendon insertion. This anomaly is removed using an osteotome.

During the postoperative period, the patient must wear an orthosis or plaster boot for four to six weeks. You can step on the operated leg after two to four weeks (depending on the patient’s condition). Then, after the load is resolved, you can begin rehabilitation therapy, which is carried out for six weeks.

Prevention of Achilles tendinitis is as follows:

1. Middle-aged people, from forty to sixty years old, need to lead an active lifestyle with moderate exercise. Daily gymnastics is recommended, which should include stretching exercises and strengthening of various muscle groups, including the calves.
2. If prolonged physical activity and stress on the calf muscles (for example, running or walking) are possible, it is necessary to prepare for them. You need to do exercises to develop leg endurance in advance, gradually increasing the load. Stretching exercises should also be included in the complex of physical activity.
3. Professional athletes who are at risk of developing Achilles tendinitis are advised to maintain their training regimen. It is necessary to produce constant, feasible loads with a slow increase. Also, runners, for example, need to take care of the correct running technique and the amount of load. Experts advise all professional athletes to avoid overload to avoid damage to muscles, ligaments and tendons.

Achilles tendonitis

Why does inflammation occur?

Achilles tendon suture

Achilles tendinitis is an inflammation of the tendon that attaches and connects the heel bone and calf muscle. It is this that allows our feet to bend when we raise our legs while walking and when we stand on our toes.

Inflammatory and destructive processes begin here due to overexertion. In the future, all this can lead to a rupture of the Achilles tendon, and it will be impossible to walk.

According to the international classification of diseases, achillotendinitis is assigned code M 76.6. For treatment and diagnosis, you should contact orthopedists, traumatologists and surgeons.

Development mechanism and reasons

The Achilles tendon is a connective tissue cord that is connected at the top to the soleus and gastrocnemius muscles, and at the bottom connects to the heel bone. This tendon can withstand significant loads when a person walks or runs, and has high strength and elasticity (can stretch up to 5% of its original length).

Under the influence of various causative factors, fiber damage occurs and an inflammatory process develops with the participation of cells of the immune system. They produce substances (prostaglandins) that irritate sensitive nerve endings with the development of a feeling of pain, reduce the outflow of blood from the site of inflammation (hyperemia) and cause the development of tissue edema. The main causative factors causing damage to the Achilles tendon fibers include:

• age – in people over 35 years of age, the strength and elasticity of the Achilles tendon decreases, and even with low loads, damage to its fibers can occur;
• loads that exceed the strength of the connective tissue fibers of the ligaments and lead to micro-tears - often in athletes who run (shuttle running), football players, during long and high jumps;
• congenital changes in the shape of the foot (flat feet) cause a gradual increase in stretching of the Achilles tendon;
• tight shoes also lead to overstretching and damage to the ligaments of the foot, which develop gradually over a significant period of time;
• genetic deformity (Haglund syndrome) - a tubercle on the back of the heel, located under the Achilles tendon at the junction with the heel bone and stretches it, leading to the development of tendonitis;
• bacterial infection - microorganisms can enter the substance of the connective tissue cord through the blood (hematogenously), lymph or skin damage; the lack of adequate treatment leads to purulent complications in the form of an abscess or phlegmon.

Causes

The disease often develops in people whose professional activities involve heavy physical or sports activities. The main factors provoking the development of tendinitis are:

• Microtraumas caused by increased physical activity;
• The presence of chronic diseases of the musculoskeletal system (arthritis, gout, arthrosis);
• An abnormally formed or weakened tendon;
• Age-related decrease in the ability of the tendon to stretch;
• The presence of flat feet, which is accompanied by the foot falling inward (overpronation);
• Wearing uncomfortable shoes or abruptly switching from high heels to low-heeled shoes.

Inflammation due to tendon rupture

Various reasons can lead to inflammation, microtears, and later tendon ruptures.

Over the years, we produce less and less elastin and collagen, which make up the Achilles. Because of this, the extensibility (strength too) of our tendons becomes significantly less, and therefore any inadequate physical activity easily provokes microtears, inflammation and damage. To prevent this, in adulthood, when training, you need to pay as much attention as possible to warming up; Achilles tendonitis is an ailment of many dancers, athletes, gymnasts, and simply those who walk a lot and are engaged in heavy physical labor. If the tissues do not have time to rest and “forgot how” to relax, the Achilles shortens and may begin to collapse over time. It is important for such people to pay attention to any pain and give their legs rest;

But not simple, but with the foot falling inward, that is, hyperpronation. Needless to say, the tendon is constantly and greatly stretched;

But not all of it, but the one that was chosen incorrectly. This is especially true for sneakers and trainers, which are not suitable for this type of physical activity.

Also, tendonitis can haunt women who constantly wear stiletto heels and suddenly change them to flat soles in the evening. A tendon that has been shortened all day can stretch so quickly, so it collapses and tears quickly;

There are three types of achilles tendinitis:

• Peritendinitis. It’s just inflammation of the Achilles tendon, in which there may not be destructive processes in the tissues around the tendon (and in itself).
• Tendinitis. Inflammation of the Achilles tendon, which leads to degeneration of the tendon, but does not impair the functioning of surrounding tissues.
• Enthesopathy. Inflammatory process with severe degeneration and calcification. A heel spur appears.

All these types are interconnected and transform into one another.

According to the anatomical location of the damage and the inflammatory process, Achilles tendonitis can occur in the following forms:

• peritendinitis - inflammation of the tissue located around the tendon without involving its substance in the process;
• tendinitis - direct inflammation of the substance of the ligament;
• enthesopathy - an inflammatory process develops at the junction of the tendon with the heel bone.

Depending on the course of the disease and the clinical picture, there are three main types of Achilles tendinitis:

Peritendinitis is a type of disease characterized by inflammation and degenerative process of the soft tissues surrounding the joint;

Tendonitis is an inflammatory lesion of the Achilles tendon itself, without involvement of adjacent tissues;

Enthesopathy is a degenerative process in the Achilles tendon at the junction with the bone (in some cases accompanied by the development of a heel spur).

By what signs can one suspect the development of tendon pathology?

Since Achilles tendinitis can be acute or chronic, the symptoms will be different in both cases. Let's consider the symptoms and signs of the disease occurring in the acute stage:

Symptoms

Typically, patients complain of pain and swelling in the Achilles tendon area. The disease can develop gradually or, on the contrary, quickly, for example, after a change in sports activity regimen.

When examined, the tendon appears thickened, and the skin over it may be reddened. Patients note limited movement in the ankle and foot.

They often complain about limping and the fact that it is difficult for them to walk up stairs.

In Haglund's disease, the bony prominence of the calcaneus can be palpated, as well as the inflamed retrocalcaneal bursa.

Achilles tendinitis can be both acute and chronic.

The first type is characterized by a gradual increase in pain at the very beginning of walking or training, which subside and completely goes away when you rest. The patient may also feel discomfort when touching the heel and Achilles.

Achilles tendonitis photo

When the pain is chronic, it increases much more slowly: about several months and does not subside even with rest.

Both cases are characterized by symptoms such as:

1. Swelling of the tendon, redness and local increase in temperature.
2. Pain closer to the heel.
3. Restricted ankle movement and tight calf muscles.
4. Pain when jumping or standing on your toes.
5. Achilles may be thickened.
6. There may also be swelling in the heel area and creaking of the ankle joint.

Damage and inflammation of the Achilles tendon can be acute or chronic. The main manifestation is pain, which has the following characteristic features:

• a sharp onset of pain at the time of injury is characteristic of acute tendinitis;
• the appearance or intensification of pain at the beginning or end of the load, when trying to flex or extend the ankle joint;
• constant aching pain that spreads to the tendons of the foot characterizes the development of chronic Achilles tendinitis;
• increased pain during palpation (palpation) - happens with any form of tendonitis;
• thickening of the tendon, which can be noticed upon visual inspection or palpation; the severity of the increase in diameter depends on the degree of damage and inflammation;
• swelling and redness of the skin in the area of ​​projection of the inflammatory process;
• crepitus (characteristic creaking) during movements in the ankle joint;
• a feeling of stiffness in the lower limb while walking.

If an infectious process develops, general intoxication and damage to other ligaments of the foot may develop due to the spread of infection.

Diagnostics

Diagnosis of acute and chronic tendonitis of the Achilles tendon consists of a thorough survey and examination of the patient, including determining the nature and location of pain during palpation, determining hyperemia and hyperthermia.

Additionally, the following may be prescribed: radiography, magnetic resonance imaging or ultrasound.

Conservative therapy, which is most often used for uncomplicated cases, consists of the following measures:

1. Partial or complete immobilization of the damaged tendon;
2. Cold compresses;
3. Use of various auxiliary devices for immobilization of orthoses, braces, taping, canes and crutches for walking;
4. Physiotherapy - magnetic, laser, shock wave, ultrasound and ultraviolet therapy, paraffin or mud applications, electrophoresis with lidase;
5. Administration of painkillers and corticosteroids to help relieve pain and inflammation;
6. After relief of pain and inflammation, a complex of physical therapy and massage is prescribed.

Surgical treatment methods are used in advanced cases, in the presence of a purulent process, severe degenerative changes or tendon rupture.

Carrying out diagnostics using the device

Diagnosis consists of a series of tests; if the patient does not undergo them fully, there is a risk of harm. They start by collecting an anamnesis.

Important: professional characteristics, expected loads on the lower extremities, family history (patients can talk about the hereditary nature of heel spurs).

Women are asked how long they have been wearing high-heeled shoes, whether the pain is the same in the area of ​​interest, that is, it is more disturbing to the right or left joint.

The patient may also complain of tightness, a feeling of being squeezed by shoes or socks that were previously in place, which may indirectly indicate swelling.

If there is a spur, a person notices that there is a growth or lump in the heel area, a stabbing pain in this place, which is difficult to describe correctly. (cm.

photo) In the area of ​​interest, the patient may indicate a lump or neoplasm that looks like a hard wart; it cannot be cured at home; bandaging also does not give results.

After interviewing the patient, the doctor begins an objective examination. Palpation is crucial.

If pain and hyperesthesia stretch throughout the tendon, but do not move during movement, then the presence of peritendinitis can be assumed. If the point of pain is strictly localized, but moves with movement, a diagnosis of tendinitis is likely.

You can also make a diagnosis of tenopathy - when the process is not of an inflammatory nature.

An orthopedic traumatologist treats diseases and injuries of the Achilles tendon. During the examination, the doctor carefully ascertains the history of the disease, conducts clinical tests in order to assess the function of the foot and ankle, as well as identify problem areas of the tendon.

X-rays clearly identify areas of calcification of the Achilles tendon, as well as spur-like deformation of the heel bone in Haglund's disease. Magnetic resonance imaging (MRI) clearly visualizes areas of degeneration and inflammation of the Achilles tendon.

Diagnosis begins with collecting information from the patient about the nature of the pain.

1. During the examination, special tests are performed, for example, the Thompson test, in which the patient is placed on his stomach so that his feet hang off the table. Afterwards, the calf muscle is compressed and the doctor observes whether the sole bends. If yes, then there is no tendon rupture.
2. Radiation examinations and x-rays are also performed.
3. The final stage of diagnosis can be magnetic resonance imaging.
4. Ultrasound can also be used.

Tendinitis of the foot and Achilles tendon can be suspected based on the appearance of one or more symptoms of the process. To verify the diagnosis, additional research is carried out, which includes:

• x-ray or tomography of the ankle;
• ultrasound examination;
• blood tests for markers of the presence of an inflammatory process.

Diagnosis of Achilles tendonitis is usually carried out on the basis of medical history and examination of the patient. In some cases, it is possible to use additional diagnostic methods, namely x-ray examination of the lower leg (ankle), ultrasound and magnetic resonance imaging.

X-rays reveal areas of tendon calcification characteristic of tendinitis. Ultrasound and magnetic resonance imaging are more accurate diagnostic tools.

Using these techniques, it is possible to quite accurately determine the location and size of areas of inflammation and degenerative changes in the tendon.

Treatment

Exercise therapy for tendinitis

Achilles tendonitis needs to be treated. You cannot ignore the disease, subjective sensations, endure until the last. Treatment is carried out by orthopedists or traumatologists.

Tactics depend on the stage and type of pathology. Methods – conservative and surgical. The remedy for acute processes is widely known. They are treated with anti-inflammatory drugs (NSAIDs); antibiotics are not always necessary.

The first stage is immobilization. The tendon area is bandaged. You have to bandage tightly, you can also use cold compresses. The limb is kept at strict rest for 2-3 days, preferably in an elevated position. The point is to prevent edema and hemorrhage.

NSAIDs are used for 7-10 days, they help relieve pain. The price for such drugs is reasonable, which is a plus. Long duration slows down reparative processes in tendon tissues and negatively affects the gastrointestinal tract.

The specific drug Diprospan is a glucocorticoid, used for heel spurs, bursitis, joint stiffness, rheumatoid arthritis, etc. Available in ampoules, injections are prescribed by a specialist according to an individual scheme.

Self-administration of the drug is prohibited. Even if you have already been diagnosed, you should not ignore contraindications.

In addition to injections, ointments are used, for example Solcoseryl, Dolobene. To improve absorption, it is advisable to use ultrasonic devices. Antibiotics are needed only in very severe cases, when an autoimmune process occurs, or suppuration has occurred near the tendon tissue.

Nowadays laser, shock wave, and ultrasound therapy are successfully used.

If you are a follower of traditional methods of treatment, a homemade herbal decoction may help. A popular recipe: elecampane herb – pour about ¾ of a spoon into 12 liters of boiling water. Convenient 500 ml jar. Boil in a water bath. Apply a moistened bandage to the sore spot.

With a successfully chosen treatment regimen, after using conservative therapy, improvement occurs and you can move on to rehabilitation measures.

Supraspinatus tendonitis

If there is no effect from drug therapy, in advanced situations it is necessary to resort to surgical treatment. Treatment of the disease is a complex operation with a long rehabilitation period; recovery requires strength.

The absolute indication for surgical intervention is a rupture of the Achilles tendon, as well as when it is torn from the heel bone. During surgery, tissues in which changes have occurred are cut off.

Thickened areas are also removed. Part of the operation is plastic surgery of the plantar muscle tendons, their aponeurosis is dissected, and a section of tissue is transferred.

Enthesopathy involves cutting off the bursa, removing all damaged tissue, followed by stitching together the remaining healthy tissue.

Achilles tendinosis requires routine treatment with surgery.

During the postoperative period (2-3 weeks), the patient wears an immobilization orthosis in the form of a boot. Rehabilitation after each type of operation is carried out for 2-3 months, the patient undergoes a course of exercise therapy, massage, and physiotherapy.

The specialist prescribes an individual set of exercises, while physical activity should be limited.

Tendinitis is a disease that can lead, in addition to pain, to lameness and shortening of the leg. This may also affect the child.

If you notice swelling of the lower extremities, your leg begins to hurt and crunch or squeak when walking, get examined immediately. Do not rely on folk experience for treatment.

Do not attempt to bandage or bandage limbs yourself. Only an experienced physician can help you.

If the attending physician has confirmed the diagnosis of “Achilles tendonitis,” he determines the necessary methods of therapy based on the stage of the disease and its form.

So, if conservative treatment is indicated, tendonitis can be eliminated in a comprehensive way: with physical therapy, the use of special corrective agents, and medication.

All forms of Achilles tendonitis: treatment in the first stages is the same.

Anti-inflammatory therapy is carried out, ice is applied and then a tight bandage is applied, the leg is fixed in an elevated position.

Therapeutic measures are aimed at reducing the severity of inflammation, pain and restoring damaged ligament fibers, including the following approaches:

• the use of anti-inflammatory drugs that block the synthesis of prostaglandins (nimesil, ketanov, rheumoxicam);
• immobilization (immobilization) of the foot using an elastic bandage or splint;
• physiotherapy (electrophoresis, magnetotherapy);
• surgical treatment for severe inflammation - excision of the damaged and inflamed area is performed, followed by its plastic surgery.

After carrying out basic treatment measures, rehabilitation is performed, which includes therapeutic exercises with a gradual increase in load and range of movements. Late or improper treatment of this pathology can lead to walking disorders in the form of lameness.

Treatment of this disease is carried out on an outpatient basis. Conservative treatment includes the use of NSAIDs, immobilization of the injured limb in an elevated position and physiotherapeutic procedures (electrophoresis, electrical stimulation and ultrasound).

If conservative treatment is ineffective (in rare cases) and severe degenerative changes, planned surgical intervention is indicated. At the rehabilitation stage, massage and exercise therapy are effective.

Preventing Achilles tendinitis

To prevent tendinitis, it is recommended to exercise only after thoroughly warming up the muscles. You need to pay special attention to warming up and stretching before running. It is also not recommended to carefully select sports shoes so that they fit exactly and are comfortable.

Foot tendinitis is a common disease characterized by inflammatory and degenerative processes in tendon tissue. As the disease progresses, the pathology spreads to the tibialis and plantaris muscles. ICD 10 code for tendonitis of the foot is M76.6 (tendonitis of the calcaneal tendon).

Causes

With the development of the pathological process, there is a risk of damage to all tendons of the foot and leg or just one. More often, the inflammatory process is localized in the ligament that attaches the triceps muscle to the heel bone.

The main causes of tendonitis:

• Physical activity - the disease develops in athletes who receive injuries during exercise, which lead to ligament deformation and dislocations, damage to the knee joint and ankle;
• Injuries - bruises of the foot can provoke degenerative-dystrophic deformation in cartilage and tendons;
• Disturbance of metabolic processes in the body - lack of nutrients or difficulty in their supply to the muscles and tendons of the foot (bone growths are formed that interfere with normal movement);
• Joint pathologies – gout or rheumatism;
• Flat feet or curvature of the spinal column;
• Genetic predisposition – congenital pathology of the musculoskeletal system (hip dysplasia, short leg syndrome) can provoke tendonitis.

In older people, tendonitis develops for physiological reasons. With age, degenerative processes in organs, tissues and joints are inevitable, so disease prevention is carried out (vitamin complexes, chondroprotectors as recommended by a doctor).

Classification of tindinitis

Based on the type of localization of inflammation, the disease is divided into the following types:

• Achilles tendonitis (the source of inflammation is located in the ankle area);
• Tendinitis of the posterior tibial muscle (pathology is localized in the area of ​​the lower leg and ankle).

The disease occurs in two forms - acute and chronic. The first is characterized by a sudden onset with acute symptoms, and the second is characterized by a blurred clinical picture, alternating remission with relapses.

The acute form of the disease is divided into two types:

• Aseptic - as a result of injury to surrounding tissues, a hematoma is formed, ruptures of nerve fibers, tendons and blood vessels. The resulting defects in the tendons are filled with granulations, which gradually turn into scar tissue;
• Purulent - develops as a result of infection in the tendon, followed by necrosis and melting of the surrounding tissue.

The chronic form of tendinitis occurs in two types:

• Fibrous. Fibrous connective tissue forms at the site of pathology, often developing after prolonged stress on the tendon or repeated stretching;
• Ossifying. Salts are deposited on the tissue changed due to the disease, which leads to ossification of the tendon. Tendinitis develops as a result of open fractures of wounds.

Separately, there is tendinitis of the extensor toes. The disease rarely develops after injury to a limb while running, is easily treatable after confirmation of the diagnosis, and most often affects the little toe.

Symptoms

To make a preliminary diagnosis and carry out differential diagnosis, symptoms of foot tendonitis are identified:

• Pain of varying intensity occurs when moving the foot or when touching the source of inflammation. As the disease progresses, the pain syndrome is disturbing at rest, becomes aching in nature, and radiates to the foot or lower leg;
• Hyperemia of the skin in the area of ​​inflammation (the symptom indicates the spread of degenerative processes to the bone and cartilage tissue of the foot);
• Swelling of the leg in the ankle area;
• The appearance of crepitus in the affected tendon (crunching is heard both during movement and with the help of a phonendoscope).

Discomfort worsens after a night's rest or when trying to transfer body weight from the sole to the toes, so women find it difficult to wear high-heeled shoes.

When ankle tendonitis with tendon rupture occurs, a hematoma appears with severe pain and limited mobility of the limb.

On a note!

In the chronic form of tendonitis in purulent form, additional signs of the disease are hyperthermia and intoxication (weakness, nausea).

Diagnostics

As prescribed by a doctor, the following diagnostic methods are used to confirm the diagnosis:

• Laboratory research. With purulent tendonitis of the ankle joint, an increased level of ESR and leukocytes is noted, an infectious pathogen is identified, followed by the selection of drugs to destroy it;
• Magnetic resonance therapy can identify damaged or strained muscles, torn ligaments, and broken bones;
• Radiography. In the photo of foot tendonitis, the presence of bone growths, their location and shape are visually determined. Using the image, the doctor determines the presence and degree of degenerative processes in the bone;

• Ultrasound examination: allows you to identify structural changes in the tendons in the affected limb.

In addition to instrumental diagnostic methods, a rheumatologist or traumatologist examines and palpates the limb to determine the location of the pathology and assess the severity of the patient’s condition.

Drug therapy

After confirmation of the diagnosis, drug treatment of ankle tendinitis is carried out.

Main groups of medicines:

• Non-steroidal anti-inflammatory drugs (Diclofenac, Movalis) eliminate the symptoms of inflammation, prescribed by injection or orally;
• Antibiotics (Flexid, Tavanic) are used to treat tendinitis of the foot, the source of which is infection or injury. The drugs have antimicrobial and anti-inflammatory effects, help prevent the development of sepsis and pathological complications;
• Corticosteroids (Mitepred) are a decongestant and anti-inflammatory drug, prescribed when treatment is ineffective or in patients in serious condition.

The effectiveness of treatment for tendonitis of the foot increases when medications are combined with physiotherapy.

During therapy, it is necessary to apply an immobilizing bandage to the foot and ankle to limit the load on the injured limb and prevent its injury.

Physiotherapeutic treatment

The goal of physiotherapy is to stimulate metabolic processes that will relieve inflammation and accelerate regeneration processes. Patients with traumatic tendonitis are prescribed 3-5 procedures. For tendon ruptures, the healing process takes 1-2 months.

Basic methods of physiotherapy:

• Laser therapy (has an analgesic effect, activates restoration processes at the cellular level);
• Magnetotherapy (improves the absorption of medications, accelerates metabolism);
• Ultrasound therapy (prevents tissue ossification and the spread of inflammatory processes);
• Electrophoresis (eliminates swelling, helps relieve restrictions on joint mobility).

Physiotherapy procedures are prescribed after relieving acute pain and inflammation, combined with massage of the lower leg and foot, and swimming.

Folk remedies

The use of traditional methods in combination with medications and physiotherapy is carried out at the discretion of the doctor and consists of using the following recipes:

• Compresses with saline solution;
• Alcohol infusion: pour 1 glass of walnut partitions with 500 ml of vodka and leave for 14 days. Take the finished product 3 times a day, 1 tsp.
• Potato compress: mix grated potatoes with chopped onion and clay in equal proportions, apply the resulting mixture to the sore foot and wrap it with a cloth, leaving it overnight.

An effective anti-inflammatory remedy for foot tendonitis is ginger infusion or turmeric, which is added to dishes as a seasoning.

Interesting!

Surgical intervention is carried out when conservative therapy is ineffective, and consists of dissecting the affected tendon with its subsequent excision for surgical restoration of the ligaments and allowing the regeneration of surrounding tissues.

Forecast

Timely diagnosed tendinitis of the foot can be effectively eliminated with conservative treatment methods. The rehabilitation period is 1 month.

If surgical intervention is necessary, the limb is immobilized for 2 months, and full recovery and restoration of motor function of the foot returns after massage, gymnastics and physiotherapy.

To prevent relapses and tendonitis, it is necessary to strengthen the lower leg muscles and wear special shoes that prevent injury to the foot and ankle during training.