Разрыв ахиллова сухожилия: причины, диагностика и лечение.

Medical condition where the tendon at the back of the ankle breaks
Rupture typically occurs as a result of a sudden bending up of the foot when the calf muscle is engaged, direct trauma, or long standing tendonitis. Quick return to weight bearing (within 4 weeks) appears okay and is often recommended. While surgery traditionally results in a small decrease in the risk of re rupture, the risk of other complications is greater. Achilles tendon rupture occurs in about 1 per 10,000 people per year. Males are more commonly affected than females. Other ways the Achilles tendon can be torn involve sudden direct trauma or damage to the tendon, or sudden use of the Achilles after prolonged periods of inactivity, such as bed rest or leg injury. Some other common tears can happen from intense sports overuse. Twisting or jerking motions can also contribute to injury. As of 2016 the mechanism through which quinolones cause this was unclear. Additionally, even the occasional weekend exercise activity for "weekend warriors" may put one at risk. The risk continues to be higher in people who are older than 60, and also taking corticosteroids, or have kidney disease. Risk also increases with dose amount and for longer periods of time. It connects the calf muscles to the heel bone of the foot. The calf muscles are the gastrocnemius, soleus and the heel bone is called the calcaneus. It is approximately 15 centimeters (5.9 inches) long and begins near the middle part of the calf. Contraction of the calf muscles flexes the foot down. This is important in activities such as walking, jumping, and running. The Achilles tendon receives its blood supply from its muscular and tendon junction. Its nerve supply is from the sural nerve and to a lesser degree from the tibial nerve. Although a tear may be diagnosed by history and physical exam alone, an ultrasound scan is sometimes required to clarify or confirm the diagnosis. Once diagnosis is made, ultrasound imaging is an effective way to monitor the healing progress of the tendon over time. An ultrasound is recommended over MRI and MRI is generally not needed. MRI can be used to distinguish incomplete ruptures from degeneration of the Achilles tendon. MRI can also distinguish between paratenonitis, tendinosis, and bursitis. This technique uses a strong uniform magnetic field to align millions of protons running through the body. These protons are then bombarded with radio waves that knock some of them out of alignment. When these protons return they emit their own unique radio waves that is analyzed by a computer in 3D to create a sharp cross sectional image of the area. MRI provides excellent soft tissue imaging making it easier for technicians to spot tears or other injuries. Radiography can also be used to indirectly identify Achilles tendon tears. Radiography uses X rays to analyze the point of injury. This is not very effective at identifying soft tissue injuries. X rays are created when high energy electrons hit a metal source. X ray images are acquired by utilizing the different densities of the bone or tissue. When these rays pass through tissue they are captured on film. X rays are generally best for dense objects such as bone while soft tissue is shown poorly. Radiography is not the best for assessing an Achilles tendon injury. It is more useful for ruling out other injuries such as heal bone fractures.

Some conditions to consider when diagnosing an Achilles tendon tear are Achilles tendinitis, ankle sprain, and avulsion fracture of the calcaneus.

Treatment options include surgery and non surgical rehabilitation. Certain rehabilitation techniques have shown similar re rupture rates to surgery.

There are at least four different types of surgeries; open surgery, percutaneous surgery, ultrasound guided surgery, and WALANT surgery. During an open surgery, an incision is made in the back of the leg and the Achilles tendon is stitched together. In complete ruptures, the tendon of another muscle is used and wrapped around the Achilles tendon. Commonly, the tendon of the plantaris is used and this wrapping increases the strength of the repaired tendon. For sedentary patients and those who have vascular diseases or risks for poor healing, percutaneous surgical repair may be the better surgical option. Before, patients who underwent surgery would wear a cast for approximately 4 to 8 weeks. After surgery, they were only allowed to gently move the ankle once out of the cast. Recent studies have shown that is not the best method. Patients that are allowed to gently move and stretch the ankle immediately after surgery, have faster and more successful recoveries. These are custom made inserts that fit into the patient's shoe. They help with proper pronation of the foot, which is when the ankle leans toward the middle of the body. In summary, the steps of rehabilitating a ruptured Achilles tendon begin with range of motion type stretching. Studies have shown that the earlier movement is started, the better.

Of all the large tendon ruptures, 1 in 5 will be an Achilles tendon rupture. An Achilles tendon rupture is estimated to occur in a little over 1 per 10,000 people per year. Males are also over 2 times more likely to develop an Achilles tendon rupture as opposed to women. Achilles tendon rupture tends to occur most frequently between the ages of 25 40 and over 60 years of age. Sports and high impact activity is the most common cause of rupture in younger people, whereas sudden rupture from chronic tendon damage is more common in older people. The rate of return to sports in the months or years following the rupture (whether operated on or not, partial or total) is 70 to 80%.