Achilles tendon: exercises

This exercise program is designed for self-rehabilitation of the Achilles tendon after injury, rupture or fracture, after surgery or prolonged immobilization. These simple but effective exercises can be done at home, achieving good results.

Clothes should be loose, it is advisable to remove shoes. Perform all exercises (especially the first days) smoothly and gradually, remember the important principle “Endure mild pain, do not allow severe pain”

It is recommended to perform these exercises for at least 2 weeks.

Calf stretch

Standing facing the wall, arms resting at chest level. The heel of the developed (back) leg touches the floor, the toes point straight ahead. Bend your back knee and gently lean toward the wall until you feel a stretch in your shin. Hold the stretch for 15-30 seconds. Return to the starting position. Repeat 3 times

Why is this happening

The main problem of the Achilles is insufficient blood supply, which becomes the main reason for its slow recovery after injury or inflammation. It should be noted that problems with the heel tendon do not arise out of nowhere, they seem to accumulate in it. Day after day, during training, microtraumas and inflammations form on it. However, each of us has our own cup of patience, and the Achilles is no exception in this regard. Quite often, it is inflammation of the Achilles tendon that causes it to rupture.

First aid

In this case, the victim should be laid down and the limb should be slightly elevated to prevent its swelling from increasing. An ice pack or, at worst, a wet towel soaked in cold water is applied to the affected area. When transporting the patient, it would be useful to apply a tight bandage to the affected area, which, by limiting the mobility of the joint, will help reduce pain.

The main treatment for heel tendonitis will be to avoid strenuous activity for a period of time.

Preventive measures

To avoid damage to the Achilles tendons, you must follow these rules:

Increase the load gradually. It's better to walk a little every day, rather than walking once a week for many hours,
Buy the right shoes. Wear athletic or casual shoes that provide good support for your feet. If your doctor recommends wearing orthopedic insoles, you should definitely buy them.
Warm up your feet every day. To do this, stretch or perform circular movements with your feet. If you have a sedentary job, get up every 30 minutes to walk
Allow your legs to recover from hard training. After grueling sports activities, allow the body to recover; to do this, you can reduce the intensity of the load or give preference to mixed training. It is not worth loading the heel tendon every day, as the risk of their destruction increases,
Before training, do a dynamic warm-up (lunges with dumbbells, tiptoe exercises), and after it static stretching.

If painful sensations appear at the beginning of exercise, but disappear after warming up, then increase the duration of muscle warming up or pause between exercises. If discomfort appears after training, then reduce the load and keep your feet warm.

Surgery

Severe injuries, such as complete tendon rupture, require surgery. To do this, incisions are made above the site of damage, through which the damaged fibers are sutured. After which the wound is treated and sutured, and a splint or plaster is applied over it.

The operation can be open or minimally invasive. Open surgery leaves a long scar, but its advantage is excellent access to the injury site. With minimally invasive surgery, the incision is small, but there is a risk of damage to the sural nerve, which will lead to loss of sensation on the back of the foot.

Diagnostics

Only a doctor (traumatologist or orthopedist) can determine the severity and diagnose a tendon injury during the initial examination of the limb. As a rule, the victim is given an x-ray to rule out or confirm the presence of a fracture. If there is no fracture, then it is recommended to do an MRI or CT scan to understand how seriously the fibers, vessels, nerves and tissues are damaged.

Clinical picture of injury

A sprained Achilles tendon is accompanied by an unpleasant crunch and acute pain in the ankle; it can be so severe that the victim may lose consciousness from painful shock. Almost immediately a tumor appears at this site. When a large number of fibers rupture, it compresses the nerve endings, and the pain intensifies.

Symptoms of a sprain depend on its severity and may include the following:

hemorrhage or gradually developing extensive hematoma;
increasing swelling from ankle to ankle;
the occurrence of a failure in the posterior calcaneal region with complete separation of the tendon;
lack of motor ability of the foot.

During the initial examination, the traumatologist assesses the degree of damage by palpating and rotating the foot. Such manipulations are very painful, but can help determine the extent of damage to the ankle.

TREATMENT AND RESTORATION OF THE MUSCULOCAL SYSTEM

The Achilles tendon is named after the hero of the ancient Greek epic Achilles, whose mother, the goddess Thetis, wanting to make her son immortal, dipped him, according to one version, into the oven of Hephaestus, according to another - into the waters of the River Styx, while holding him by the heel. According to one version, Paris struck him at this ill-fated heel, which remained the hero’s only vulnerable spot, and according to another, the god Apollo himself, which led to his immediate death.

The Achilles (calcaneal) tendon is the strongest and largest human tendon, capable of withstanding loads of up to 350 kg. Through it, the muscles of the back of the lower leg move the foot, which allows you to stand on your toes and push off the ground when walking or running.

Achilles tendon rupture is one of the most common injuries among the working population. Most often occurs in men 30-40 years old who occasionally engage in sports. The rupture most often occurs at a distance of 4-6 cm from the heel tubercle (in this place the tendon is worst supplied with blood). The right heel tendon is more developed, because in most people, it is the right leg that experiences greater load and is the leading one, so the Achilles tendon of the left leg is more often damaged.

Symptoms of Achilles tendon rupture:

sudden pain, similar to being hit with a stick on the shin and ankle;
a crunching sound may be heard accompanying the rupture;
it is impossible to stretch out the foot or stand on tiptoes;
there is pain when walking;
the foot and ankle swell.

If the above symptoms occur, do not massage the calf muscles and tendons. Apply something cold to the tendon and see a doctor.

Diagnosis of Achilles tendon rupture:

examination by a specialist, conducting a series of diagnostic tests to confirm an Achilles tendon rupture;
radiography;
MRI examination;
Ultrasound.

Despite the apparent simplicity of the clinical picture, Achilles tendon ruptures are not diagnosed in a timely manner in 25% of victims. Therefore, the doctors at our Dr. Grigorenko Clinic pay especially close attention to all patients with complaints of weakness of the plantar impulse and gait disturbance, especially if the injury occurred shortly before treatment.

Mechanisms of Achilles tendon injury.

1. Closed injury:

a. direct: a blow with a blunt object to the strained Achilles tendon leads to a sudden sharp contraction of the calf muscle and rupture of the tendon (more often this mechanism occurs when playing sports);

b. indirect: as a result of a sharp contraction of the lower leg muscles when the leg is extended (when trying to jump in basketball or volleyball); with unexpected sharp dorsiflexion of the foot (when slipping down a step of the stairs); when falling from a height onto a leg with an outstretched toe (at the moment of jumping or landing in volleyball players, gymnasts, ballet dancers).

2. Open injury:

as a result of a cut with a sharp object on the lower part of the lower leg.

3. Achilles tendon rupture can occur due to chronic disease from overuse.

Treatment for Achilles tendon rupture:

Conservative and surgical methods can be used to treat heel tendon ruptures.

Conservative method.

Conservative treatment for rupture is recommended:

if the injury is fresh and the ends of the tendons can be compared;
if the patient does not play sports;
if the patient’s functional demands are reduced due to age, low physical activity or other reasons.

Conservative treatment is not much inferior in its results to surgical treatment, and most importantly, it is characterized by the absence of the risk of infectious complications. The disadvantages of conservative treatment are the longer rehabilitation period compared to surgical treatment. This treatment includes:

1. Immobilization of the leg with an extended toe for 1.5-2 months. This is necessary to bring the ends of the tendon closer to each other and ensure their fusion.

2. Development of the joint, it begins even during immobilization of the limb, and this approach allows improving treatment results. To restore the patient, therapeutic exercises and physiotherapy are recommended.

3. A course of osteopathy and manual therapy - helps accelerate tissue regeneration, gently corrects dysfunctions of the body, helps eliminate functional blocks of muscles, ligaments and joints, optimizes the circulation of fluids in tissues, activates internal reserves for natural healing.

4. Physiotherapy - has an effect on deep tissues, improves blood circulation, stimulates metabolism, maintains muscle tone in the damaged area, is aimed at improving muscle tone and elasticity, eliminating muscle spasms and eliminating congestion in the muscles, helping to avoid the appearance of edema.

5. A course of mud therapy - has a local analgesic, anti-inflammatory and absorbable effect on damaged tissue, normalizes metabolism, improves tissue nutrition, causes softening of scars, accelerates the process of tissue fusion, and reduces stiffness in joints.

6. A course of mechanotherapy - helps strengthen the muscular framework of the whole body and maintain the body in good shape, ensures functional restoration of joints, eliminates complications of diseases, develops physical qualities - strength, flexibility, endurance, mobility, develops correct stereotypes of movements and postures.

7. Functional training - helps to work out the movement mechanisms necessary for a person in everyday life, prepare the body for any load, promotes the development of coordination of movements, flexibility, increasing muscle strength and endurance, and strengthening the joint apparatus.

8. Therapeutic physical education – helps restore impaired properties of the musculoskeletal system, teach the correct and safe performance of movements, improve circulatory function, respiratory organs, metabolism, increase endurance, strength and coordination.

9. Acupuncture - helps improve blood circulation and nervous regulation at the site of injury, reduces the risk of loss of motor functions due to injuries.

10. Compliance with the necessary appropriate diet - muscle tissue must regenerate, and for this it is necessary to consume vitamins and minerals during the rehabilitation period and directly during treatment.

Surgical method.

Surgical intervention must be performed in cases where the Achilles tendon rupture was not diagnosed in a timely manner, the rupture occurred against the background of pre-existing connective tissue diseases, or conservative treatment did not produce the expected effect.

After surgical treatment, it is necessary to carry out a series of rehabilitation measures, similar to the methods used in the conservative method of treatment. Independent rehabilitation can be dangerous; transitions from one stage of rehabilitation to another should be carried out only under the strict supervision of a specialist.

Complications after an Achilles tendon rupture:

Complications of conservative treatment are considered to be a higher risk of re-rupture and fusion with elongation, leading to a weak plantar drive. However, timely and competent conservative treatment is rarely accompanied by these types of complications and is comparable in its effectiveness to surgical methods.

Complications of surgical treatment include primarily infectious complications, observed in 5-10% of cases. The less access to soft tissue during surgery, the lower the risk.

Important Tips

Active lifestyle - climbing a wall bars, walking barefoot over rough terrain, grabbing objects with your toes, jumping, swimming.
Outdoor games
Adequate shoes - flexible, comfortable, light, selected in size.
Monitoring the condition of the feet (calluses, wounds) and legs (bruises).
Observation of coordination (hitting doorways, feet getting tangled, stumbling), behavior (rituals, communication disorders, etc.).
Follow up with a doctor every 6 months.

For idiopathic toe walking NOT EFFECTIVE:

Wearing orthopedic shoes with a high hard back in the absence of orthopedic pathology. Orthopedic shoes, if not indicated, limit the range of movements and cause discomfort to the child, preventing the normal, full functioning of the foot muscles.
Massage. If a child has various neurological diseases, massage can be harmful.
Physiotherapy procedures (electrophoresis, magnets, currents, etc.) can bring unpleasant sensations to the child.
Paraffin/mud wraps (this method has a risk of burns, and also aggravates the situation in children with low muscle tone in the legs).
Vitamins. There is no connection between vitamin deficiency and idiopathic toe walking.
Nootropic drugs. It is believed that nootropics can stimulate mental activity, activate cognitive functions, improve memory and increase learning ability. It is assumed that nootropics increase the brain's resistance to a variety of harmful influences, such as excessive exercise or hypoxia. However, there is a lack of evidence base (there is no reliable data on the positive effect of this group of drugs on the child’s condition).
Rough stretch. Creates negative associations in a child with physical exercise.
Osteopathic correction. High cost and lack of positive effect.
Acupuncture and its alternatives. It is painful and unpleasant.9.