Ozljede Ahilove tetive obuhvaćaju upalu tkiva paratenona te djelomične ili potpune rupture.
Tendinitis Ahilove tetive se vrlo često javlja u sportaša koji trče. Mišići potkoljenice su Ahilovom tetivom povezani s petnom kosti. Pri trčanju, mišići potkoljenice pomažu izvođenjem podizačkog dijela pokreta. Ponavljane sile koje djeluju pri trčanju, u kombinaciji s nedostatnim vremenom oporavka, mogu u početku izazvati upalu paratenona (hranjivog i zaštitnog sloja masnog tkiva koji oblaže tetivu). Potpuni razdor Ahilove tetive ozbiljna je ozljeda, obično nastala iznenadnim, snažnim stresom. Razdor tetive može se pojaviti uz minimalan napor u osoba koje su na terapiji fluorokinolonskim antibioticima.
Simptomi i znakovi
Simptomi i znakovi Ahilove tetive
Prvi simptom upale Ahilove tetive je bol u stražnjem dijelu pete, koja se na početku pojačava s početkom vježbanja i često slabi kako vježbanje napreduje .
Potpuna ruptura Ahilove tetive bično se događa pri iznenadnoj, snažnoj promjeni smjera tijekom trčanja ili igranja tenisa i često je popraćeno osjećajem kao da je nešto udarilo u stražnji dio gležnja i lista, poput bejzbol palice.
Dijagnoza
Dijagnoza tendinitisa Ahilove tetive
Prilikom pregleda, upaljena ili djelomično rupturirana Ahilova tetiva je bolna kad ju se pritisne prstima. Kompletna ruptura se razlikuje po
iznenadnoj, jakoj boli i nestabilnosti pri hodu
opipljivom defektu duž tetive
pozitivnom Thompsonovom testu (dok pacijent leži ispružen na stolu za pregled, ispitivač pritisne mišiće potkoljenice; ovaj manevar ne dovodi do normalno očekivane plantarne fleksije stopala).
Unilateral Abnormal Thompson Test
Video courtesy of Danielle Campagne, MD.
Liječenje
Liječenje tendinitis Ahilove tetive
Upalu tetive u početku liječenja treba tretirati ledom, nježnim istezanjem mišića potkoljenice i upotrebom NSAR-a.
Podizači pete se mogu staviti u obuću kako bi se smanjila napetost tetive. Sportaše treba uputiti da izbjegavaju trčanje uzbrdo i nizbrdo sve dok tetiva nije bezbolna te da se uključe u druge treninge aerobnog kondicioniranja.
Kompletan razdor Ahilove tetive obično zahtijeva kirurški popravak. Međutim, neke su nedavne studije (1-2) pokazale da neoperativno tretiranje (uključujući visoko strukturirane aktivnosti rehabilitacije) daje slične dugoročne rezultate u pogledu snage, raspona pokreta i sposobnosti za obavljanje aktivnosti kao i prije ozljede. Podaci se još uvijek procjenjuju, ali razuman je pristup izvođenje kirurškog popravka za sportaše i visoko aktivne osobe i razmatranje nekirurškog tretiranja kao učinkovite alternative za starije i / ili manje aktivne pacijente.
Vježbe za rastezanje Ahilove tetiveStanding Ankle Plantarflexion Stretch
1. Stand facing or next to wall with hands on the wall.
2. Bend knee on involved side to place top of involved foot down toward the floor with toes pointing down.
3. Bend knee on uninvolved side and slowly lower body until stretch is felt over the top of the foot and ankle.
4. Hold exercise for 30 sec.
5. Perform 1 set of 4 repetitions, 3 times a day.
6. Special Instructions
a. Perform plantarflexion stretching while either sitting or standing, whichever is most comfortable.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Sitting Ankle Plantarflexion Stretch
1. Sit in chair.
2. Bend knee on involved side to place top of involved foot down toward the floor with toes pointing down.
3. Slowly sit forward in the chair and push foot into plantarflexion until a stretch is felt over the top of the foot and ankle.
4. Hold exercise for 30 sec.
5. Perform 1 set of 4 repetitions, 3 times a day.
6. Special Instructions
a. Perform plantarflexion stretching while either sitting or standing, whichever is most comfortable.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Standing Gastrocnemius Stretch
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep rear leg straight with knees and toes pointing toward the wall, keep rear heel on the floor.
4. Bend knee on uninvolved leg and lean hips toward the wall to feel a stretch along the calf of the rear leg.
5. Hold exercise for 30 sec.
6. Perform 1 set of 4 repetitions, 3 times a day.
(It is important to maintain a straight back posture with the heel firmly planted [not lifted] during the stretch.)
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Standing Soleus Stretch
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep heels on the floor and slowly bend both knees to feel stretch along the calf of the rear leg.
4. Hold exercise for 30 sec.
5. Perform 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Toe Walking
1. Stand on balls of feet with heels off the floor.
2. Walk on balls of feet while keeping knees straight.
3. Walk as far as able during given time frame, stop at point of fatigue.
4. Perform 3 sets of 1 minute, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Heel Walking
1. Stand on heels with balls of feet off the floor.
2. Walk on heels while keeping knees straight.
3. Walk as far as able during given time frame, stop at point of fatigue.
4. Perform 3 sets of 1 minute, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Heel Raises
1. Stand with both feet on step with heels off edge of step. Hold on for support.
2. Raise up on ball of feet.
3. Focus on slowly lowering heels to below the height of the step.
4. Return to starting position and repeat.
5. Perform 3 sets of 10 repetitions, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Literatura
1. Lantto L, Heikkinen J, Flinkkila T, et al: A prospective randomized trial comparing surgical and nonsurgical treatments of acute Achilles tendon ruptures. Am J Sports Med Am J Sports Med 44(9):2406-2414, 2016. doi: 10.1177/0363546516651060
2. Parisien RL, Dodson CC, Trofa DP, et al: Face off: Surgical versus nonsurgical treatment of acute Achilles tendon ruptures. AAOS Now July 2016, cover.