Orthopedics - Oleksa A.P. 2006

Pain syndromes of the extremities
Achilles tendonitis

Aseptic tenosynovitis and tendinitis occur As a result of physical overload. In the FOOT area, tendinitis and tenosynovitis of the Achilles tendon or the tendons of the tibial and fibular Muscles that flex the foot are most common.

Achillitis can be non-insertional, meaning pain is localized in the proximal part of the tendon, or insertional, when pain is localized in the distal part near its insertion into the calcaneus.

Patients complain of pain along the proximal part of the tendon or the posterior surface of the foot, which occurs during walking.

Upon inspection, the Skin over the Achilles tendon appears normal. The patient experiences pain during active Movements of the foot and upon Palpation of the tendon. Sometimes in non-insertional achillitis, a thickening of the tendon can be visualized and especially palpated, giving it a fusiform shape. In chronic cases, crepitation can be felt with the palm over the tendon and its sheath during flexion and extension of the foot. This helps to some extent to differentiate achillitis from an infiltrate following a sprain or partial tendon rupture.

Diagnosis of a complete tendon rupture within the sheath is straightforward, as it is based on the Anamnesis and a visual and palpable tendon defect caused by the contraction of the triceps surae Muscle. The patient can actively flex the foot because the movements are performed by the crural muscles, but they cannot stand on the toes of that foot because the crural muscles cannot support body weight.

Insertional tendinitis of the Achilles tendon occurs at the site of its insertion into the posterior surface of the calcaneus due to overload and intratendinous calcification. It is often combined with achillobursitis and clinically manifests as Haglund's deformity, i.e., a "puffed-up protrusion" of the upper part of the calcaneal tuberosity.

Patients complain of heel pain when walking in shoes, but do not feel it when barefoot or wearing slippers.

Upon inspection, Haglund's deformity is striking, which is painful upon palpation in cases of bursitis. Hyperkeratosis is pronounced in this area, and edema sometimes occurs.

Insertional achillitis is treated conservatively. First of all, patients are recommended to wear shoes with a heel insert to elevate the heel. This significantly changes the pressure of the shoe on the heel protrusion, eliminating pain. Patients are prescribed non-steroidal anti-inflammatory drugs and physical therapy. In the past, success was achieved through The Use of anti-inflammatory doses of radiotherapy.

If conservative Treatment is ineffective and pain relapses frequently, surgery is sometimes performed, which involves the removal of the inflamed and pathologically altered bursa.

Tendinitis and tenosynovitis of the tibialis posterior muscle, which passes along the medial side of the ankle joint and foot, occur quite frequently, particularly in overweight women, pregnant women, individuals with flat feet, and during physical overloads of the feet.

This tendon plays an important role in the supination and adduction of the foot, supporting its longitudinal arch.

During overload and pronation/supination of the foot, especially a flat or Flat-valgus foot, pain occurs. An accessory navicular bone may also cause pain.

During examination, Orthopedic Deformities of the Foot are visually detected, while no deformations are visible in the area of the tibial muscle tendon. Upon palpation and lateral Rotation of the foot, the patient feels pain in the area of this tendon.

Treatment consists of prescribing orthopedic insoles with an adequate arch support for the patient, which unload the arches of the feet and reduce stress on the tendon. Elastic bandaging and thermal Procedures are also helpful. However, the mainstay of treatment is the elimination of the ROOT cause of tibialis posterior tenosynovitis.

Tendinitis and tenosynovitis of the peroneal muscles are rare. The function of these tendons is to flex the foot. These tendons can be palpated posterior to the lower area of the lateral malleolus, and their tenderness upon pressure and foot movements indicates an inflammatory process. In tenosynovitis of these tendons, crepitation cannot be detected.

The cause of peroneal tenosynovitis is usually physical overload, but pain can also be caused by the presence of an accessory sesamoid bone embedded within the tendon of the peroneus longus muscle in the foot area, causing irritation and inflammation.

Sometimes pain occurs during subluxation or dislocation of the tendons in the area of the lateral malleolus, which arise after a sprain or rupture of the retinaculum of these tendons. This can be checked by palpation during flexion and extension of a pronated foot.

Treatment of peroneal tendinitis and tenosynovitis is conservative. Patients are advised to use orthopedic shoe inserts or bandage the ankle joint with an elastic bandage, take anti-inflammatory drugs, and undergo physical therapy. In cases of frequent tendon subluxation, surgery is recommended to restore the integrity of their retinaculum.