Haglund's deformity OSTEOPHYTE OF THE CANEAL BONE

Calcaneal osteophytes are bone growths that can form in different parts of the ankle joint. They have sharp edges and severely damage the surrounding soft tissue. When walking they cause severe pain and lameness. They constantly support the process of chronic inflammation in the area of ​​their presence. This can cause a number of additional pathological changes.

In this article you can learn about the potential causes, clinical symptoms and treatment of calcaneal osteophytes. We present to your attention the most effective conservative methods of combating this disease. Knowing the first symptoms of calcaneal osteophytes, you will have a chance to see a doctor and carry out full treatment at an early stage. This will help you avoid surgery, which can lead to various complications.

Deposits of calcium salts can occur as a result of injury, excessive load, ongoing inflammatory process, etc. The heel bone is part of the ankle. The plantar tendon is attached to it. Excessive load is constantly observed at the place of its attachment. Especially if a person suffers from flat feet and club feet, or excess body weight. As a result of constant friction, a violation of the integrity of the periosteum tissue occurs. In places where chips and cracks form, calcium salts begin to be deposited. These uneven bone growths create severe discomfort while walking. At an early stage, complete conservative treatment is possible. In advanced cases, shock wave therapy and surgery are used.

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What it is

Osteophyte is a word that is unclear to most patients. In fact, there is nothing complicated here. Osteophytes are pathological growths of bone tissue where it is normally absent. This condition is not an independent disease, but it accompanies many ailments of the musculoskeletal system. Essentially, this is a compensatory reaction of the periosteum to any adverse effects on the articular joint or the result of fractures.

The growths can have different shapes and sizes. For a long time, due to their small size, they do not cause inconvenience to the patient, but over time they make themselves felt. They often take the form of spikes and hooks.

The process of osteophyte formation is as follows:

• the bone structures of the ankle are deprived of joint fluid, or it becomes insufficient for normal functioning;
• friction increases, surfaces begin to collapse;
• gradually, in places of particularly active friction, compensatory ossifications appear, differing in shape and size from what is needed;
• The bone growth is fully formed.

Osteophyte is not a disease, but the result of a previous injury or other pathology.

Causes

Everyday stress on the spine over time leads to degeneration of the intervertebral discs and wear of the joints of the spine. A combination of factors such as age, injury, and poor posture increases the impact on the bone structures and joints of the spine. As the intervertebral disc wears out, more stress is placed on the ligaments and joints, which leads to thickening of the ligaments, the accumulation of lime in the ligaments, as well as friction in the joints, in turn, leads to excessive growth of bone formations. This promotes the formation of osteophytes.

Degenerative changes in tissue begin at a young age, but it is usually a slow process and does not affect nerve structures until a person reaches the age of 60-70 years.

Factors that can accelerate the degenerative process and growth of osteophytes in the spine include:

• Congenital features
• Nutrition
• Lifestyle, including poor posture or poor ergonomics
• Injuries, especially sports injuries or as a result of road traffic accidents.

The most common cause of the development of osteophytes is considered to be arthrosis of the facet joints, which often contributes to the occurrence of back pain in patients over the age of 55 years. Arthrosis of the facet joints can lead to lower back pain and stiffness in the morning; the pain decreases with physical activity, and intensifies again in the evening.

The most common cause of cervical and lumbar osteoarthritis is genetic predisposition. Patients may notice the onset of symptoms of osteoarthritis between the ages of 40 and 50. Men are more likely to develop symptoms at an earlier age, but women with osteophytes may experience more severe symptoms.

Why do osteophytes appear?

A number of factors play a role in the development of ankle osteophytes. They appear due to:

• frequent household, professional injuries and microtraumas of the ankle area;
• after fractures and damage to the ligamentous apparatus of the ankle;
• inflammatory processes caused by adverse effects on the joint;
• systemic and other diseases (degenerative-dystrophic).

Doctors cite excessive physical activity as one of the most important reasons for the formation of osteophytes. In this way, the body tries to “compensate” for the negative impact on it.

Varieties and most common localization

There are 4 main types of these formations.

1. Post-traumatic

Mainly affects the lower part of the musculoskeletal system, but can also involve the area of ​​the elbow and wrist. This is explained by the fact that these areas are most often injured even in everyday life not associated with major sports. It is important to remember that bone damage is not a necessary factor in the formation of a growth. A simple rupture of the periosteum is sufficient.

1. Periosteal

They develop when there is a constant inflammatory process in the ankle joint area. It is impossible to predict which areas will undergo ossification and how the process as a whole will develop in this case.

1. Degenerative-dystrophic

Most often it is a consequence of the development of arthrosis. Accompanied by impaired mobility in the foot area.

1. Massive osteophytes

A. b

A. massive osteophytes. b. osteophyte of the talus

Volumetric growths that can even change the configuration of the joint are mainly a consequence of the impact of tumor pathologies on the body.

Additionally, there is a classification of osteophytes based on cellular structure. Highlight:

• spongy defects formed from spongy bone tissue;
• metaplastic defects resulting from a violation of the bone structure;
• compact, formed from the outer layer of bone, affecting mainly the area of ​​​​the feet and fingers;
• cartilaginous, appearing under excessive loads instead of cartilaginous tissue.

The growths can be localized on any joint of the human body. Most often the elbow joint, knee area, hip joint, spinal column, and ankle are affected.

Patient complaints

Osteophytes are an insidious pathology. For a long period of time they do not remind anyone of themselves. Only when they reach a significant size will the first symptoms appear.

The patient will present the following complaints:

• the appearance of pain in the affected area, which may intensify with movement, sudden uncontrolled actions such as coughing or sneezing, or taking an uncomfortable position;
• negative changes in the mobility of the affected ankle;
• the appearance of crunching, creaking in the affected joint;
• the onset of an inflammatory process in surrounding tissues due to their damage;
• swelling of the problem area.

Ignoring pathological changes leads to a gradual but steady worsening of symptoms. Over time, a person may even become disabled if a diagnosis is not made in time and therapy is not started.

Clinical symptoms of calcaneal osteophyte

The clinical picture with the development of plantar osteophyte of the calcaneus develops gradually. All manifestations begin with minor inconveniences and unpleasant sensations. Gradually, these signs lead to the patient being unable to walk independently. This causes him unbearable pain. The destruction of the knee and hip joint begins, since while walking a person is forced to place his leg in such a way as to avoid pain.

Classic symptoms of calcaneal osteophyte may include the following:

• sharp pain in the heel bone, which intensifies with palpation and walking;
• in the morning after waking up, pain may be completely absent;
• the longer and more intense the physical activity, the higher the degree of discomfort;
• swelling and redness of the skin due to a chronic inflammatory process;
• limitation of foot mobility due to deformation of ligaments and tendons;
• the appearance of an unpleasant crunch or squeak while walking;
• lameness and changes in gait.

Since a person, when developing calcaneal osteophyte, tries to reduce physical activity, manifestations of muscle dystrophy of the lower extremities begin very quickly. The leg may decrease in volume. Very often, in advanced cases, ankylosis, limited ankle mobility, and contracture occur.

It is necessary to consult an orthopedist for examination. The doctor will conduct an examination, perform a series of functional diagnostic tests and prescribe additional examinations. They always begin with an x-ray. All osteophytes, cracks and chips of the heel bone are clearly visible on it.

In cases of difficulty in making an accurate diagnosis, the doctor may additionally recommend ultrasound of soft tissues, MRI and CT examination, angiography and neurography, arthroscopy, etc.

How to make a diagnosis

The diagnostic search process always begins with a conversation with the patient. During it, disturbing complaints are clarified, they are asked about their intensity, and they are interested in whether there have been any injuries in the past. Also at the appointment, an examination of the affected area is required. The doctor does not ignore changes in the configuration of the joint; he notes the presence of swelling, signs of redness and other negative changes.

Instrumental techniques play a significant role in the diagnosis of bone defects.

1. Radiography. The main diagnostic option. Allows you to see characteristic non-anatomical outgrowths that look like spines and hooks. A. X-ray of the ankle.
2. CT. A method to understand what structure osteophytes have. It also helps in detecting pathology at the initial stage, when the X-ray picture may not be enough to make a diagnosis.
3. MRI. Used in the diagnosis of osteophytes of the ankle joint, excluding controversial cases.

b. MRI of the ankle joint.

Treatment options

Treatment of osteophytes is not an easy task, in which it is necessary to eliminate not only the symptoms themselves, but also to influence the cause, if it has been established. It is an integrated approach to therapy that is the key to patients recovering.

Conservative

In the early stages of pathology development, when symptoms are still absent or mild, conservative treatment methods are used. Conservative therapy usually consists of:

• taking medications that can protect joints and cartilage from destruction (chondroprotector group);
• the use of local medications that can relieve symptoms of the disease (anti-inflammatory drugs, painkillers);
• selection of recommendations regarding the regime of rest and physical activity, physical therapy;
• selection of methods of physiotherapeutic influence on problem areas;
• massage effect;
• using orthopedic devices for proper fixation of the ankle joint.

In each case, the doctor individually evaluates the indications and contraindications for the use of medications, physiotherapy and exercise therapy. An individual approach to each patient who seeks help is another important point in the work of our clinic.

Operational

Recommendation for surgery is given only to those patients in whom conservative treatment methods have not produced a significant effect. The operation is also indicated for patients with severe bone defects that cannot be corrected using conservative means.

The most minimally invasive operation performed for osteophytes is arthroscopy. Using special equipment, the doctor makes a small incision, inserts an arthroscope through it into the joint cavity, which gives an overview of the operated area using a small video camera, and then removes the bone growths.

Diagnosis and treatment

Diagnosis of osteoarthritis and osteophyte is made after a medical examination and radiography.

The osteophyte treatment program depends on the size of the pathology and, accordingly, the severity of symptoms. In some cases, conservative therapy is sufficient (taking non-steroidal anti-inflammatory drugs, manual therapy, physiotherapeutic procedures). If the growth is significant, surgery is indicated. During the intervention, the surgeon removes the osteophyte.

Treatment of osteoarthritis can also be either conservative or surgical. Specific treatment tactics depend on the severity of the disease. Conservative treatment may include taking painkillers and anti-inflammatory drugs, physiotherapy, therapeutic exercises, massages, etc.

Surgical intervention is indicated when other methods do not give the desired effect. To do this, joint endoprosthetics is performed - that is, removing the affected joint and replacing it with an artificial one.

Osteoarthritis and osteophyte can greatly reduce the patient’s quality of life, so when the first symptoms and difficulty in movement appear, do not delay visiting a specialist. Registration for medical appointments is available 24 hours a day.

Principles of recovery after surgery

After surgery to remove osteophytes using arthroscopy (or open methods), a rehabilitation period is required. It is much shorter than during rehabilitation after open surgery, but it cannot be neglected. The recommendations are, in principle, quite standard. need to:

• in the first week, limit physical activity on the operated limb;
• medications to relieve pain and reduce swelling;
• Postoperative discomfort can be alleviated by applying cold for short periods of time;
• you need to use compression garments, which will relieve swelling and help alleviate pain;
• during the rest period, it is recommended to keep the leg above the level of the heart;
• It is necessary, based on medical recommendations, to return to an active life, increasing the load gradually, without sudden jumps.

In our clinic, patients can undergo all stages of treatment: arthroscopy or open surgery, preoperative, and postoperative. This is important for a full and quick recovery, which cannot be perfect without medical supervision.

Osteophytes are an unpleasant pathology that can reduce the quality of life of any person. They often accompany the development of other problems of the musculoskeletal system, which, if ignored, can even lead to disability!

The appearance of signs of pathology is a reason to visit a doctor for diagnosis and choice of therapy! Do not ignore the first symptoms of the disease!

Achilles tendonitis

Achilles tendonitis is a collective term that includes both tendonitis of the Achilles tendon itself and insertional tendonitis, retrocalcaneal bursitis and Haglund's disease.

Achilles tendonitis is a widespread pathology. The Achilles tendon is the largest and most powerful of all tendons in the human body, it also experiences the most significant stress during walking, running, and jumping and is the most frequently damaged of all tendons.

In simple terms, tendonitis is an inflammatory lesion of the tendon. Inflammation is a major form of the body's natural response to injury, and is characterized by swelling, pain and loss of function.

Tendonitis of the Achilles tendon itself, or non-insertional tendinitis, is characterized by degenerative changes, micro-tears, thickening and swelling of the body of the Achilles tendon. This type of tendinitis is most common in young, active people.

Achilles tendonitis

Insertional Achilles tendonitis refers to the same process, but in the area where the Achilles tendon attaches to the heel bone. Insertional tendonitis is also common in older, inactive patients.

Insertional tendonitis of the Achilles tendon

Both in the case of tendonitis of the Achilles tendon itself and with insertional tendonitis, if the process lasts long enough, calcification of the damaged tendon fibers can occur. With insertional tendinitis, this often leads to the formation of bone spurs, sometimes called heel spurs.

Diagram of the location of the Achilles tendon and its attachment to the heel bone

Most often, Achilles tendonitis cannot be attributed to a specific injury. The problem develops over a long period of time as a result of constant overload of the tendon. That is, tendinitis usually forms against the background of excess load, but excess load is determined by a number of provoking factors.

1) A sudden increase in training volume, such as increasing the running distance by a mile every day for a week, which does not provide the opportunity to adapt to the increasing load.

2) Stiff, rigid, insufficiently elastic calf muscles - with a sharp increase in load, they create additional opportunities for damage to the Achilles tendon.

3) The presence of a bone outgrowth – Haglund’s deformity – leads to additional trauma to the Achilles tendon closer to the insertion site.

4) A sudden change in training regimen, for example a sharp transition from long jogging to sprinting or team sports.

The most common symptoms of Achilles tendinitis are: pain and swelling, tightness in the Achilles tendon area that is detectable in the morning, pain in the projection of the tendon and heel bone that increases with exercise, severe pain in the Achilles tendon area the day after training, thickening of the tendon, formation bone spike in the area of ​​​​attachment of the Achilles tendon, swelling in the tendon area is observed constantly and worsens during the day after exercise. As tendonitis progresses, the risk of spontaneous Achilles tendon rupture also increases. During examination, it is necessary to determine the point of greatest pain; with insertional tendinitis, the pain is determined in the area of ​​attachment of the tendon to the heel bone; with tendinitis of the Achilles tendon itself, it is often located 3-4 cm above the attachment site. Also, upon examination, it is important to determine whether there is limitation in dorsiflexion of the foot.

The most common tests used to diagnose Achilles tendonitis include radiography, sonography, and MRI. X-rays are readily available and can detect such gross changes as calcification of the tendon, the formation of a bone spike in the area of ​​its attachment, and bone damage to the heel bone itself. MRI is indicated if invasive treatment methods are planned, as well as to determine the extent of damage to the tendon itself. Planning surgical tactics is extremely difficult if the level and extent of damage is not determined in advance, which leads to a significant increase in the volume of intervention. Ultrasound research methods in experienced hands are not inferior in sensitivity to MRI; unfortunately, sonography specialists of a sufficiently high level are difficult to find.

Conservative treatment of tendinitis is characterized by a long duration - from the start of treatment to the therapeutic effect, it usually takes 3-6 months. Conservative treatment is also not very effective - about 40-50% of patients are satisfied with the treatment.

Rest is the first and perhaps decisive factor in conservative treatment; reducing the level of physical activity allows you to avoid pain and additional trauma to the tendon. At the same time, you can stay in shape by using an exercise bike, an elliptical trainer, swimming and other sports that do not involve significant stress on the Achilles tendon.

The second important point is the cold. Cryotherapy using ice wrapped in a towel for 20 minutes as needed throughout the day is highly effective in reducing pain and swelling. If you use a rubber or plastic heating pad for freezing, you can give it the shape of a tendon, which increases the efficiency and comfort of its implementation.

Ibuprofen and naproxen can also reduce pain and swelling, but they do not reduce the severity of degenerative changes. With long-term use, the risk of side effects and complications increases.

In the conservative treatment of tendonitis, special importance is attached to exercises aimed at stretching and developing muscle balance in the lower leg muscles.

Stretching the calf muscles and Achilles tendon.

Stand directly in front of the wall, place your arms straight against the wall, place one foot in front and the other behind you, gradually squat without lifting your feet from the floor. Hold the maximum squat position for 10 seconds, then straighten your legs. Repeat 20 times a day.

Stretching the calf muscles and Achilles tendon

Eccentric muscle training refers to exercises that involve tensing a muscle while lengthening it. This type of exercise can cause additional damage to the Achilles tendon if not performed correctly. It is best to perform them under the guidance of a physical therapy instructor.

For double-sided heel drop, you will need a ladder. You need to stand on the edge of two adjacent steps with the toes of your feet. This position allows your heels to move up and down without hitting the steps. Hold the railing with your hands to maintain balance. First stand on your toes, then slowly lower your heels down to the maximum point, stay in this position for 10 seconds, repeat 20 times a day.

Eccentric calf training

A more challenging version of this exercise is to perform it on one leg or with additional weight.

Steroid injections into or around the Achilles tendon are not recommended due to the possibility of dystrophic changes and subsequent rupture.

In the fight against Achilles tendonitis, it is important to choose the right shoes. The most suitable option would be shoes with a soft back or no back at all. A small heel will reduce the tension on the Achilles tendon and reduce the load on it. In an acute situation, when the pain is extremely severe, it is recommended to wear a special orthosis that completely eliminates movement in the ankle joint.

Extracorporeal shock wave therapy has been proven to be effective and free of side effects in a number of studies. There are two treatment options - low-intensity, which requires 3 procedures, and high-intensity, which requires one procedure, but is accompanied by severe pain, which requires the use of anesthesia.

In 30-40% of cases, conservative treatment does not bring relief within 3 months; in such cases, the question of surgical intervention arises. Surgical treatment, according to various authors, is effective in 80-95% of cases. It is necessary at the preoperative stage to determine the presence of concomitant diseases: Haglund's deformity, retrocalcaneal bursitis, insertional tendonitis, as well as the depth and extent of the tendon involved in the pathological process, as this affects the surgical tactics. The access is dictated by the points of greatest pain, so if the pain is located more medially, it is advisable to use the medial approach and vice versa. It is necessary to determine whether the pathological process involves the paratenon, the tendon, or both. For paratendinitis, the surgeon excises all adhesions and also removes scarred areas of the paratenon. After the operation, a 3-5 day period of immobilization follows, followed by the development of movements and physical therapy.

For tendinitis involving less than 50% of the tendon thickness, a percutaneous longitudinal tenotomy can be used using a narrow number 11 or 15 scalpel. After longitudinal puncture of the skin, the blade is directed proximally and the foot is dorsiflexed, then the position of the blade is reversed and plantarflexion is performed. 5-7 similar cuts are used. The technique can significantly reduce the risk of infectious complications; according to the author of the technique, it is effective in 70% of cases.

A minimally invasive method for treating Achilles tendonitis – percutaneous longitudinal tenotomy

The main principle of operations for tendinopathies is the excision of scar adhesions and removal of degenerative tendon tissue. After excision of the thickened, scarred paratenon (tendon sheath), the calf fascia on either side of the Achilles tendon is released. Then several longitudinal sections of the tendon are made, which, on the one hand, makes it possible to detect areas of mucinous degeneration which are then removed, on the other hand, it helps to stimulate the remaining tenocytes to proliferation and synthesis of intercellular substance, and on the third, it promotes angioneogenesis (growth of new vessels). If less than 50% of the Achilles tendon is involved in the pathological process, the degenerative area in the thickness of the tendon is excised in the shape of an ellipse, followed by its longitudinal suturing.

With severe tendinosis (long-term tendinitis), a problem often arises associated with the involvement of more than 50% of the tendon thickness in the pathological process. If 50-80% of the tendon thickness is involved, the tactics are determined by the preferences of the surgeon, the patient and the volume of future sports loads. If more than 80% of the tendon thickness is involved in the degenerative process, plastic surgery is required, for which a tendon transfer, VY plastic, reduction of an inverted flap, or the use of an allograft can be used.

The most commonly used tendon transfer is the flexor hallucis longus tendon. This intervention is contraindicated if the patient plans to engage in rock climbing or ballroom dancing, since these sports require maximum plantar flexion strength of the first toe. A medial approach is used, the tendon is freed from all adhesions, the degenerative areas of the paratenon and tendon are removed, and the deep fascia of the leg is incised, allowing access to the belly of the flexor hallucis longus. The flexor hallucis longus tendon is isolated and cut at the level of the fibrous canal in the area between the medial and lateral tubercles of the posterior surface of the talus. The tendon should be transected as distally as possible. The flexor pollicis longus tendon, depending on its length, is fixed to the heel bone either with an anchor or inserted into a tunnel and fixed with an interference screw.

Release of the Achilles tendon from its paratenon, removal of paratenon scar tissue

Excision of degenerative areas of the Achilles tendon

Dissection of the deep layer of the fascia of the leg, isolation of the tendon of the long flexor of the big toe

Transposition of the flexor hallucis longus tendon to the insertion of the Achilles tendon, preparation of the Achilles tendon for the longitudinal suture after removal of degenerative areas.

Longitudinal suture of the Achilles tendon

Achilles tendon paratenon suture

VY plastic surgery (in Russian literature - dovetail) may be necessary when more than 80% of the tendon thickness is involved in the degenerative process over 2-3 cm. With such a significant defect, it is difficult to compare the fresh ends of the tendon. For VY repair, a wider approach will be required, extending proximally to 12-15 cm. After preparing the Achilles tendon for anastomosis, the degree of tendon length deficiency is determined using a reverse springiness test (both legs are bent at an angle of 90° at the knee joint, then the the angle of passive plantar flexion of the feet on the healthy and damaged side, normally it should be 15-20°); when the foot is brought into a normal position, the extent of the defect is assessed. After this, a V-shaped incision (“dovetail”) is made to correct the missing length. After performing the anastomosis, a repeat test for “springiness” is performed for control purposes.

The fresh ends of the Achilles tendon are stitched; when trying to match them, excessive tension is determined, which can lead to overcorrection and subsequent equinus of the foot, suture failure

A V-shaped incision is made proximal to the site of the Achilles tendon rupture, after which it becomes possible to compare and suture the ends of the Achilles tendon at the site of its rupture

After suturing the tendon at the site of its rupture, the missing length is assessed using the “springiness” test, after which the Achilles tendon is sutured at the site of the V-shaped incision and lengthened.

For even larger defects, 3-5 cm or more in length, plastic surgery with an inverted flap or the use of an allograft may be required. If, after releasing the proximal Achilles tendon and gradual traction for 10 minutes, the defect between the ends of the tendon is 5 cm or more, it is advisable to perform plastic surgery with an inverted flap. For this purpose, the incision is extended proximally by 25 cm in order to expose the fascia of the leg over a significant extent. Then, at a distance of 2 cm from the edge of the tendon, a U-shaped flap with a thickness and width of 1\1 cm and the required length is cut out proximally from the fascia (for example, for a defect of 6 cm, it is necessary to use a flap 12 cm long: 6 cm defect + 3x2 cm for the crossed area). In order to reduce the thickness in the area of ​​tendon duplication, it is advisable to turn the tendon inward rather than outward, the distal area of ​​the formed fascial defect is sutured to reinforce the graft origin.

A significant Achilles tendon defect is detected in a normal foot position

Defect length 6 cm

The marker indicates the upper limit of the graft collection site, taking into account the length of the defect and the length of the duplication - 12 cm

Allocation of a site for transplantation

Reduction of the transplanted area

Estimation of the length of the lowered section

The transplanted area is carried out medially to reduce the thickness of the duplication

Surgical treatment of insertional tendonitis involves excision of the retrocalcaneal bursa and protruding sections of the calcaneus, as well as removal of degenerative areas of the tendon. Subsequently, tendon reinsertion may be required using anchors or interference screws. For optimal visualization, a central transachillary approach to the distal portion of the tendon can be used. If the tendon is involved in the process over a significant length, plastic surgery using the above methods may be required.

Medial transachillary approach

With the help of gomens, the tendon is pulled apart

Excessive bone tissue is excised using an oscillating saw.

Excessive bone tissue is excised using an oscillating saw.

The removed bone fragment is shown, an anchor is installed in the calcaneus to strengthen the subsequent longitudinal suture of the Achilles tendon

X-ray showing the size of the resulting bone tissue defect and the location of the anchor in the heel bone

Longitudinal suture of the Achilles tendon using threads from an anchor fixator

In uncomplicated cases when plastic surgery is not required, in the early postoperative period the use of a U-shaped + anterior splint bandage in an equinus position made of plaster or a polymer bandage for 10 days is indicated. After removal of the sutures, walking with full load in a neutral position is allowed in a special rigid orthosis.

Rigid adjustable ankle orthosis

From weeks 6 to 12, passive and active range of motion is developed with isometric exercises. Swimming is allowed from week 3, exercise on the elliptical trainer is allowed from week 4. From week 12 you can start light training. Full recovery will take an average of 3-6 months.

After plastic surgery, a more gentle rehabilitation regime is required. For the first 10 days, the use of a U-shaped + anterior splint bandage in an equinus position (25-45 °) made of plaster or a polymer bandage is indicated. Then wearing an orthosis in the 20° equinus position is indicated for another 6 weeks with a gradual transition to a neutral position with a dosed load, while active dosiflexion of the foot is allowed as far as pain syndrome allows in the position of flexion in the knee joint. Swimming begins at 6 weeks; at 12 weeks, immobilization in the orthosis stops and training on an elliptical trainer is allowed. Full recovery may take 6-9 months.

Surgical treatment of tendonitis is characterized by good early postoperative results in 85-90% of cases, but over time, patients often note the return of the pathology, especially in cases where they continue to actively engage in sports.