Achilles tendon rupture. Achilles tendonitis. Diagnostics & Therapy
Our treatment concepts from diagnosis to therapy.
Whether tear, inflammation or calcification: Achilles tendon injuries and diseases are often painful and tedious. In order to offer you the best treatment in our clinics, a precise diagnosis to clarify the complaint is necessary first. Depending on the nature and severity of the illness we'll find the appropriate therapy. Our specialists choose either conservative or surgical treatment for getting the best therapy results.
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How achilles tendon diseases are detected & treated.
Apart from changes in the bony Haglund exostosis or in the development of calcifications in the Achilles tendinitis, it is usually not possible to find tangible changes on normal x-ray images.
Chronic Achilles tendon illnesses.
The most important approach to treatment is the consistent stretching of the Achilles tendon (the so called eccentric training program). There are numerous sources of evidence on the effectiveness of this treatment method. The key to success is the consistent practice by patients themselves (see illustration). In addition, ultrasound applications, rubbing down with ice and friction massages can be used. Another conservative treatment measure is the shock wave. The exact mode of action is still not finally determined. It is assumed that the metabolic activity of the tendon is increased. Additionally, the sensitivity of the pain receptors is reduced. Degenerative tendon injuries are often associated with an abnormal vascular development in the tendon. There is evidence that an obliteration of these vessels also leads to an alleviation of symptoms. It has not yet been finally clarified whether risks to blood supply and stability of the tendon occur in the long term, as a result of the obliteration of the vessels. If the symptoms are not controlled by non-operative treatment options, surgical treatment must be considered. The principle here is to remove all unhealthy tissue to allow the body to rebuild new tissue.
Haglund exostosis is about a mechanical problem. The protruding bone of the heel rubs against the tendon. It is possible either to adjust the footwear to the shape of the heel or to cut off the bony protrusion in an operation. This will also remove the inflamed bursa. Shock wave treatments and frictions as well as a stretching treatment promise less success for this kind of mechanical problem.
Shock wave treatment and frictions, as well as ultrasound in conjunction with an eccentric extension treatment, are the domain of diseases of the connection of the tendon to the bone. If the symptoms do not subside, then calcification in the tendon is often the cause. The small pieces of calcium lead to a constant irritation. Here, it is necessary to consider, whether to remove the calcifications surgically.
Tearing of the Achilles tendon.
In principle, a tear of the Achilles tendon can be treated surgically and conservatively. Both treatments have specific advantages and disadvantages, so it is necessary to discuss carefully with the patient, which specific risks weigh particularly heavily for them. For almost all conservatively treated Achilles tendon ruptures, a significant loss of strength occurs, because the tendon heals with a certain amount of extension that sustainably influences the pretensioning of the muscle and thus the development of strength. The power loss is lower in surgical treatment since the exact length can be readjusted. Even here there is often a loss of power because of the necessary protection lasting several weeks, which only comes back after intensive training over many months. Here too, it is possible that a power deficit will remain on the healthy side. The main risks of operative treatment are disruptions to the healing of wounds. Attempts are made to circumvent this problem by sewing the tendon over very small incisions. This is possible when the two stumps can be firmly pushed together in the tendon sheath. If this is not possible, for example because the tendon is completely torn, open surgery is indicated, as before.
Intensive therapies for a fast recovery.
An improvement to Achilles tendon complaints can be achieved by an eccentric stretching program, so it makes sense to continue this stretching program over several months. It may be useful to incorporate stretching exercises for the Achilles tendon into the training program for life, especially for people who are prone to a shortening of the Achilles tendon. If diseased tendon parts are removed during an operation, the duration of the protection and relief depends on the scale of the weakening of the tendon. The typical period for wearing a splint (eg VACOped boots) is 4-8 weeks. During this phase, the load is increased gradually. Both for an operative and a conservative treatment of an Achilles tendon rupture, the affected tendon is relieved over 8 weeks in a VACOped boot. Pulling on the tendon can be avoided by an equinus position, although there is pressure on the leg. The load is built up gradually after the completion of the wound healing Sclerosing treatment and shock waves cause a weakening of the tendon, resulting in a reduction in athletic activities, especially jumping and sprinting, being recommended for 3 months. Cycling and swimming is possible.
Achilles tendon diseases
Deterioration of the Achilles tendon as well as and tears of the Achilles tendon are relatively common.
Our specialised clinics and hospitals for the treatment of diseases of the Achilles tendon at a glance.