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IN ACHILLES TENDINOPATHY

The Achilles tendon is a fibrous structure that transmits to heel the force generated by the triceps surae. It's the biggest tendon and robust of the human body as subject to strong stress during the step, and especially during the race. The ground reaction force during support varies from 1.5 to 5 times the body weight; running at a rate of 5 minutes per kilometer, this involves about 5,000 contacts per hour of travel.

Considering these huge loads, it is clear that even small abnormalities can result in a significant alteration in the distribution of loads on the tendon.

The race is subject to a high incidence of tendinitis of the Achilles. The tendonitis of the Achilles is a simple tendon inflammatory process and/or surrounding tissues (peritenonio, pre or post bag-Yarrow), which is usually caused by sports overrun, possibly associated with mechanical defects that can cause abnormal distribution of loads (PES cavus, Flatfoot, tendon retraction, etc.).

The tendon tissue is not vascularized, and therefore has little resilience. Therefore the cronicizzarsi of this condition can lead to degenerative processes against the tendon structure, that go by the name of tendinosis: this involves the loss of normal collaginea structure, which is replaced by amorphous material, with calcifications within it, leading to the decrease of resistance of the tendon. The Achilles tendon at this stage looks sore and volume, and increased risk of experiencing breakage.

The Achille tendinopathy is a pathology to sneaky, that trend began gradually with pain, at first only during major efforts, but then progresses to become constant even during everyday life or at rest. Because of its insidious trend the Athlete turns to medical care only when symptoms are persistent, so when the anatomical-pathological picture is already advanced, that require long healing times.

The treatment of tendonitis of the Achilles is non-surgical, and generally can be physical or medical rehabilitation, together with the use of a spurs to download the tendon. Surgery includes several techniques, which include any long recovery times; so this option is reserved for refractory cases, after the failure of a well-run rehabilitation Protocol for the duration of 6 months.

The medical therapy makes use of NSAIDs (non-steroidal anti-inflammatory drugs), which raises many questions, however, because we know that the disease has an inflammatory substrate only in early stages, whereby these are able to affect the course of Pathology only at onset. Corticosteroids, used generally for local street, get a good anti-inflammatory effect but may cause further weakening of the tendon.

In recent years, you are stating the use ofoxygen-ozone therapy: this consists of local infiltration of a gaseous mixture of oxygen and ozone, can stimulate the release of oxygen from the blood to the tendon tissue, encouraging recovery. The advantage of this procedure is that you practice ambulatorily, which does not involve the use of drugs, and which acts directly on the cause of tendinosis, i.e. the slow metabolism of the tendon.

Further therapeutic opportunity is provided by regenerative medicine. This provides leak with platelet concentrates extracted from the patient's own blood (platelet gel or PRP -Platelet Rich Plasma): platelets, once injected, release of "growth factors", i.e. of molecules capable of stimulating tissue regeneration.

The physical therapy is the use of laser and ultrasound: both these therapies have anti-inflammatory effect; In addition, given the deep heat, stimulate blood supply to the tendon, and thereby accelerate recovery.

The rehabilitation therapy is the reduction of sports loads, avoiding activities that cause pain; the absolute immobility is contraindicated as it is known that the tension is important for inducing proper reorganization of tendinous fibers. The eccentric bracing exercise has proved to be higher than that concentric in terms of clinical findings. Important are stretching exercises, but contraindicated in acute phase. Massage therapy can be beneficial. The use of local ice is indicated immediately after physical activity.

The return to sporting activity can occur within 2-4 weeks for acute cases (tendonitis), and establishes a degenerative process of tendon (tendinosis), you will need 4-6 months.

Given the variety of conditions that can favour the onset of a tendinitis of the Achilles, the importance of early and effective intervention, the variety of treatments available and their different efficacy at various stages, it is recommended that you contact a qualified repairman to treat this condition.

Dr. Francesco Di Caprio copyright October 1, 2009.

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