Achilles tendonitis

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The Achilles tendonitis or Achilles tendonitis (of tendinitis = tendinitis ) is a common especially for athletes inflammation of the Achilles tendon at its attachment on the heel bone and one of the insertional or Enthesiopathies . It is also because of its frequent occurrence in jumping sports and in runners runners heel (ger .: runner's heel referred).

root cause

Achilles tendinitis can be triggered by a sudden sharp increase in physical activity, especially in running and jumping sports such as medium and long-distance running, football, basketball, tennis and the like. a. Triggering factors can also be unsuitable footwear, new training exercises and local trauma. If the calf muscles are shortened, there is permanently increased tension on the Achilles tendon when walking, which puts additional stress on the tendon attachment. Achilles tendonitis is most common in 30 to 50-year-olds and significantly more common in men.

Achilles tendinitis can also occur more frequently in the context of rheumatic diseases, especially spondyloarthritis . Inflammatory changes in the Achilles tendon are also common in fibromyalgia .

Ingestion of a fluoroquinolone antibiotic can also rarely cause Achilles tendinitis.

diagnosis

Pain is the main symptom; it often appears weak at the beginning and as initial pain , later on continuously when walking, running and jumping and as pain at rest after greater exertion. A stretching of the Achilles tendon z. B. crouching can provoke pain, but greater stress on the Achilles tendon such as jumping and running aggravate the pain. On examination, there is significant pressure pain at the tendon attachment on the heel bone, sometimes especially in the area in front of the Achilles tendon. Pain can be provoked as stretching and resistance pain, e.g. B. when trying to get on tiptoe while standing on one leg. Occasionally there is swelling, rarely reddening. Often there is also a shortening of the Achilles tendon or at least the gastrocnemius muscle acting on two joints .

In addition, misalignments of the foot are often found, such as a bent foot with increased valgus deviation of the heel and a flat foot with a reduced longitudinal arch, although these misalignments are very common overall and a connection has not been scientifically proven.

For further diagnosis, ultrasound or magnetic resonance tomography can be used, which can show the inflammatory process. At most, X-rays show the swelling in the soft tissue and occasionally an irregular bone delineation at the tendon attachment on the heel bone. In the case of chronic complaints, calcifications can also occur in the area of ​​the tendon close to the attachment. A scintigraphy , an increased accumulation of the calcaneus, at an advanced tendinitis at the tendon.

Differential diagnosis

There are numerous other changes in the heel area that can be confused with tendinitis of the Achilles tendon:

  • Bursitis achillea : Under the skin on the hock, a bursitis caused mostly by pressure of the shoe, as well as at a hyperuricemia in the context of gout . However, no pain is to be expected when the Achilles tendon is tensed, and neither is pain in front of the Achilles tendon
  • Achillodynia : In this degenerative change, the tendon shows a painful thickening about four to ten centimeters above the tendon attachment, but not directly at the tendon attachment itself. The degenerative tendon change can also become inflamed locally, and above all there is a wear- related tendon tear at this pointpossible.
  • Calcaneal apophysitis , also known as Sever-Haglund's disease or sometimes Haglund's syndrome , is actually a bone necrosis in adolescent athletes. Before the end of the growth plate on the heel cap, excessive pull in athletes, especially during the growth spurt , can inflame the heel apophysis (heel cap) and develop bone marrow edema . In the real sense, however, there is no tendinitis. Apophysitis is self-healing and only requires temporary relief with a break in exercise.

therapy

In the painful acute phase, as with other tendinitis, treatment is also carried out according to the PECH scheme , with a pain-adapted sports break, cooling and local compression. An anti-inflammatory drug can be applied topically or taken systemically.

The temporary use of heel wedges on both sides or shoes with a slight heel can also be helpful, as this reduces the tension on the Achilles tendon when walking.

Physiotherapy and physical therapy procedures aim to improve the stretching of the Achilles tendon and the triceps surae muscle , relieve pain and increase blood circulation for better regeneration . Various methods can be used:

If the symptoms persist, a cortisone injection can also be given into the pretendinous area, but this must not be applied to the tendon.

After the acute pain has subsided, there is slow athletic endurance and build-up training, with isometric tension exercises and with light repetitive stress exercises below the pain threshold and initially with avoidance of peak loads. Nevertheless, repeated relapses of pain should be treated frequently and then treated again as in the acute phase.

For prophylaxis to repetitive stretching and warm-ups, particularly light jump training are to improve the elasticity.

Individual evidence

  1. ↑ Flexikon (accessed September 14, 2017)
  2. ↑ Michael Fleischhauer, Dieter Heimann, Ulrich Hinkelmann (editors): Guide to Physiotherapy in Orthopedics and Traumatology , Urban & Fischer- Verlag, Munich 2002, pp. 305–307, ISBN 3-437-45210-X
  3. ^ Günther T. Werner, Klaus Klimczyk, Jürgen Rude: Checklist: Physical and rehabilitative medicine . Thieme-Verlag, Stuttgart 1997, ISBN 3-13-106671-7 .