Structure and function of the Achilles tendon

Any tendon is the final structure of striated muscle in the form of bands of dense connective tissue, through which the muscles attach to the bones of the skeleton and make them move. Strong connective tissue provides a low elongation and a secure hold on the skeletal muscles.

Achilles tendon - is one of the strongest tendon in the body, but it is not for nothing has been called "Achilles" - a relatively shallow location makes it very vulnerable to damage. Achilles tendon is an extension of the three muscles (the two heads of the gastrocnemius and soleus muscles), located at the back of the leg. Achilles tendon attaches to the heel bone that allows a person to move his toes.

At the top of the Achilles tendon and a relatively wide thin, tapering down and thickens, and at 3, 5 - 4 cm above the calcaneus again expanding. The tendon is enclosed in a double case which formed the fascia (thin connective tissue membrane covering the muscles) tibia. These fascia allow the tendon to slide, as there is mucus in them - this reduces friction between the tendon and surrounding tissues. The site of attachment of the Achilles tendon to the heel bone is bursa. Achilles tendon allows you to run, stand on tiptoe up the stairs.

Damage to the Achilles tendon

The cause of damage to the Achilles tendon can be direct injury or strain calf muscles. Damage can be closed (without breaking the skin) and open (in violation of the skin).

Closed injuries are common in ballet dancers and athletes failed when jumping, playing football and so on, when there is a tendon tear or detachment place of its attachment to the calcaneal tuber. At the time of the injury the victim feels a crash in the lower third of the leg, and a sharp pain on the back of its surface, the process is broken plantar flexion of the foot. When viewed on the site of an Achilles tendon rupture is detected the absence of its contours and soft tissue retraction.

When providing first aid to the victim should be given an anesthetic, to fix the leg so that the foot was in relation to the tibia at an angle of 90˚ (you can splint from scrap materials or bandage legs to each other) and taken to hospital.

Treatment of Achilles tendon rupture is most often requires the use of surgical methods. When fresh (with not older than 2 weeks) closed full disconnection all tendons can be done using a closed percutaneous suture (stitching is applied to the skin and pull together, pull together the ends of the tendons to their full contact), followed by casting of. If skin violated or if the injury occurred more than two weeks ago, the operation usually carried out by open way with wide-area damage and stitching all the tendons in the usual way and then also apply a plaster cast for a period of 3, 5 - 4 weeks, after which the prescribed medical gym, massage and physiotherapy.

Partial rupture of the Achilles tendon topically administered an anesthetic (eg, Novocain), and put a plaster cast in the position of plantar flexion of the foot for a period of 2-3 weeks.

Bursitis of the Achilles tendon

Inflammation of the bursa, located at the place of attachment of the Achilles tendon to the heel bone is called bursitis Bursitis - if you have trouble walking   Achilles tendon or ahillobursitom. The cause of bursitis may be injured (including minor), a variety of diseases (rheumatism, gonorrhea Gonorrhea - self-ruled , Viral infections) in which infectious agents could enter into the synovial bag through the blood or lymph, long narrow traumatized tight shoes.

Ahillobursita signs are pain in the heel area, aggravated by dorsiflexion of the foot, as well as swelling and redness at the site of attachment of the Achilles tendon to the heel bone. In some cases the inflammatory process may lead to suppuration (abscess) bursa.

Ahillobursita confirm the diagnosis, you can use X-ray examination.

Treatment of bursitis of the Achilles tendon - is, above all, the elimination of the reasons he was called - the treatment of inflammatory diseases, wearing comfortable shoes and so on. If concerned severe pain, the prescribed thermal treatments (compresses, paraffin, ozocerite, etc.), ointments containing steroidal anti-inflammatories, relieving pain, inflammation and swelling Prevention and treatment of edema - it is important to understand the root cause   tissues (for example, diclofenac). In introducing processes and are used for chronic bursitis punctures to remove inflammatory content bursa and its washing with antiseptic solutions.

If conservative treatments fail, surgical excision is carried out of the bag.

Galina Romanenko

A little anatomy

The basis of the foot is composed of small and very small bones, interconnected tendons and ligaments. Such a large number of bones of the foot gives the ability to spring back when walking, that is, giving it a shock-absorbing ability, and ligaments firmly holds the bones of the joints formed by not allowing them to go beyond the limits of the possible movements. All the bones of the foot are divided into the tarsal bones, metatarsals and toes.

The rear part of the foot is called tarsal. It consists of the talus, calcaneus, navicular, cuboid, and three cuneiform bones. The middle part of the foot - metatarsus formed by five short tubular bones, the front - fingers, each of which is composed of three bones - phalanges, on the first toe - two phalanges. The foot has five longitudinal arch corresponding to the five metatarsal bones, which are connected by a transverse arch.

Astragalus - the lower part of the ankle joint, which is formed as the tibia and fibula, which cover the ankle talus laterally as a fork. Bottom anklebone connects to the heel bone, the front - with the navicular. Astragalus relatively large bone of complex shape, which is divided into several parts. The front part is called the head of the talus, the average - the body or unit, and connecting them - neck. Behind the talus is located; posterior process with internal and external tubercles, between which the tendon of the muscle - flexor hallucis longus muscle.

Types and causes of fractures of the talus

Fractures of the talus fractures are divided into, the body and the rear process. The mechanism of fracture is usually indirect. This occurs most often in the fall from a height of feet, during heavy braking of the machine, provided that the feet rest on the wall or in its controls and so on. This can occur compression fracture, that is squeezing the bone between its surrounding other bones (tibia and calcaneus).

Fracture of the neck of the talus occurs when sudden dorsiflexion of the foot, where the bottom edge of the tibia, resting on the neck, the talus splits into two fragments. This change can be no displacement of fragments of bone or back of the head displacement and dislocation of the bones of her body backwards. Fracture of the posterior process of the talus occurs during heavy plantar flexion of the foot.

Signs of fracture and diagnosis

At the turn of the talus ankle increases in volume, active movement in it sharply restricted or becomes completely impossible because of the severe pain. It is also possible reshaping the top of the foot and ankle. The nature of the deformation depends on the location and degree of displacement of fracture fragments bone. Upon careful palpation of the ankle can be expected to reveal the fracture site - this is the most painful part of the ankle. Pain increases with effleurage on the heel.

Fractures of the talus most fully diagnosed by x-ray of the foot and lateral projections and the X-ray of the ankle joint in the anteroposterior projection.

Treatment of fractures of the talus

Treatment of fractures of the talus without bias consists of a superposition of the cast to the knee with modeling arches of the foot. Plaster is applied for 3-4 weeks for fractures of the posterior process, and from 6 weeks to 3-4 months with a broken neck or body of the talus. After removing the plaster cast prescribed duration (4-5 months) unloading the limb as a walk on crutches. Assign also warm baths, physiotherapy, massage, wearing orthopedic insoles Orthopedic insoles - what are they for? .

For fractures of the talus with the displacement of bone fragments under local anesthesia or under general anesthesia produces closed manually reposition, ie the combination of bone fragments. At impossibility of closed reduction performed open reduction (ie, the operation is carried out in violation of the skin), followed by the compound of bone fragments (osteosynthesis) screw or spokes.

For fractures with dislocation Dislocation - Prevention and Treatment   the body of the talus posteriorly or compression fractures often develop aseptic necrosis (necrosis of bone tissue without the presence of infection) of the body of the talus, and subsequently - arthrosis Osteoarthritis - when the joint loses its function   (instead of the shattered bone grows connective tissue and disrupts the function of the joint) of the ankle and subtalar joints with persistent pain.

If you suspect a fracture of the foot Fracture of the foot - what dangers threaten you?   you should immediately consult a doctor - in this case it is better to be safe than not to treat a fracture in time.

Galina Romanenko