Inflammation of the tendons of the foot, tendonitis: a serious matter. Ankle tendonitis Tibialis tendinitis

Tendinitis tendon posterior tibialis muscle

Since we constantly load our legs, the muscles have to do a lot of work. Accordingly, a large load falls on the tendons. If a tendon is overloaded, its membranes become inflamed - this is called tendinitis. Tibialis posterior tendon is subject to heavy loads and tendonitis of this tendon is one of the common problems associated with overload of the lower extremities.

Anatomy

The tibialis posterior muscle is located in the posterior deep compartment of the lower leg under the triceps muscle. The muscle passes into the tendon in the lower third of the leg. The tendon passes behind the inner malleolus, then passes under the arch of the foot and attaches to the navicular bone on the outside. The tendon plays an important role in supporting the arch of the foot and keeping the foot in the correct position (internal rotation of the foot) during walking.

The disease develops gradually, in several stages. Initially, the outer sheaths of the tendon are irritated. Inflammation of the tendon membranes develops, which is called paratendinitis or tenosynovitis. As a rule, this is manifested by pain and sometimes crepitus (a sensation of crunching snow when touched) behind the inner ankle when flexing and extending the foot.

Tendon structure

Over time, if the overload of the tendon continues, then inflammation of the membranes and tendon periodically occurs. Under these conditions, the structure of the tendon begins to change: some of the fibers are damaged, and some are replaced by scar tissue, in which the blood supply is worse than in a normal tendon, which further aggravates the damage. As a result, the structure of the tendon changes.

If some of the fibers are torn, the tear site is replaced by scar tissue. When this happens, the tendon in that area thickens. These thickenings can be located both inside and outside. In the area of ​​these thickenings, the tendon is not as strong, and, as a rule, it is in these areas that the tendon can rupture.

Symptoms

Symptoms of tendinitis tendon posterior tibialis include pain in the instep and pain and swelling along the tendon behind the medial malleolus. In some cases, due to constant inflammation, the tendon weakens and eventually ruptures. If damaged tendon posterior tibialis muscle develops pronounced flat feet.

The diagnosis of tibialis posterior tendonitis is obvious after a physical examination. Sometimes, if the doctor suspects a tendon rupture, a magnetic resonance imaging (MRI) scan may be ordered. No injections are required with this technique. MRI is a research method that allows you to clearly see the soft tissues of the body. MRI uses magnetic waves that are analyzed by a computer to create images of tissue sections in standard planes.

Conservative treatment

Treatment of posterior tendinitis tibialis muscle begins with the selection of shoes. Shoes must have an insole-instep support - to support the longitudinal arch of the foot. This is the function that the tibialis posterior muscle performs. Therefore, properly selected shoes can reduce the load on this muscle. A necessary condition is to reduce the load on the legs; it is especially important to stop playing sports. If crepitant tenosynovitis develops, you may need to wear a plaster or plastic splint. In addition, anti-inflammatory drugs such as diclofenac, ibuprofen or voltaren may be prescribed.

If pain and inflammation do not go away after using the above methods, your doctor may suggest a cortisone injection. Cortisone is a strong anti-inflammatory agent that quickly relieves inflammation. Its repeated use is not recommended due to the negative effect on the tendon structure. Some doctors recommend the use of hormonal ointments in conjunction with physical procedures such as ultrasound or phonophoresis. Since the tendon is located close to the surface of the skin, the use of ointments in conjunction with physical therapy relieves inflammation well.

Surgical treatment

If conservative treatment is unsuccessful, surgery may be required.

If, after a long course of the disease, the soft tissue along the tendon thickens and the inflammation is not relieved by conservative methods, then surgical removal of this scar tissue around the tendon may be indicated. This method usually brings relief to patients; in addition, the tendon itself is inspected and the issue of possible plastic surgery is decided. Local thickenings can be excised at the discretion of the surgeon. If the tendon is thinned, there are many scar thickenings, and there are local micro-tears, then tendon plastic surgery is required.

Tendon suture

Large tears can be closed with sutures. Also, sometimes a suture is placed after excision of the thickenings if the surgeon assesses that a tendon rupture may occur in this area over time. Sometimes it is not possible to restore the integrity of the tendon. Then the surgeon can resort to tendon plastic surgery

Tendon plastic surgery

An old rupture (existing for more than a month) or a severely damaged tendon may require repair. For plastic surgery, a section of another tendon (graft), which is functionally less important, is taken. This issue is previously decided jointly by the surgeon and the patient. With the help of this graft, the surgeon restores the integrity tendon posterior tibialis muscle.

Arthrodesis

For long-term, fixed forms of foot deformity due to injury tendon posterior tibial muscle surgeon- an orthopedist may recommend an arthrodesis operation - creating conditions for fusion between the small bones of the foot. This type of operation is used to reduce foot pain associated with developed flat feet.

After surgical treatment, depending on the condition of the tendon and the manipulations performed, immobilization with a plaster cast may be prescribed.

Rehabilitation

Rehabilitation after conservative treatment

If there are no contraindications, then patients with this disease can benefit from physiotherapy. Treatment is aimed at reducing pain and swelling. A physiotherapist may prescribe procedures such as ultrasound, thermal procedures, and massage.

Physical therapy is necessary to maintain the tone of the muscles of the lower leg and foot. You should begin performing exercises under the supervision of a physical therapy instructor after the acute inflammation has resolved.

To speed up the onset of the effect of the treatment, you should choose the right shoes. The insole-support will remove load from the posterior tibial muscles. Wearing insoles should be constant throughout the day. Walking for long periods of time barefoot or wearing unsuitable shoes will increase and possibly aggravate the disease.

Rehabilitation after surgical treatment

Rehabilitation after surgical treatment will take at least eight weeks. If a tendon suture or tendon repair was used, it is necessary to wear a plaster or plastic splint and use crutches. To learn how to use crutches, you may need the help of a physical therapy instructor.

Dressings are carried out as prescribed by the surgeon. Sutures are removed 10 - 14 days after surgery. If the surgeon uses dissolvable sutures, they should not be removed.

Physical therapy can help reduce pain and swelling. Procedures are prescribed by a physiotherapist in the absence of contraindications.

A physical therapy doctor (PT) will develop an individual rehabilitation program. Initially, the exercises are performed under the supervision of a physical therapy instructor, then independent exercises are possible. Exercises will help restore the tone of the muscles of the lower leg and foot. The load and complexity of the exercises increases gradually. The issue of increasing the load is decided together with the attending physician.

The constant overload of the body is most reflected in the legs. Muscles and tendons have to do a lot of work every day. If overload occurs, inflammation begins, which is called the tibialis posterior muscle.

The tibialis posterior muscle is located on the back of the lower leg just below the triceps muscle, which joins it in the lower third of the lower leg.

The tendon runs behind the inner ankle and goes under the arch of the feet, eventually attaching to the navicular bone on the outside. It does a lot of work supporting the arch and keeping it in the correct position when we walk.

Progression of tendinitis

Tendonitis does not appear immediately. First, the outer shells suffer and are irritated, and a person may feel pain and crunching when moving. If the load is not reduced, inflammation increases, and the structure of the tissue begins to change. Some of its fibers are damaged, and some are replaced by scar tissue. As a result, a change in structure occurs.

If it ruptures, scar tissue forms in this place, which changes its outline. Thickenings can be on any side where cracks have formed.

Signs

The symptoms of such tendinitis are as follows:

• pain in the instep and behind the inner ankle;
• obvious flat feet develop;
• tendon rupture.

Diagnostics

The doctor conducts an examination and, to confirm the diagnosis, prescribes an MRI, which can be used to view changes in tissue structure. Significant thickening will be noticeable.

Treatment

Treatment is carried out using conservative methods. The first thing to do is to immediately change your shoes to orthopedic ones with an arch support insole that supports the foot. She will partially do the work, which will help relieve the load on the leg and give it a rest.

A person should move as little as possible and be in a state of rest.

In difficult cases, a plaster cast or splint is applied. Anti-inflammatory medications are also prescribed. Sometimes they are prescribed, but their use should be short-lived so as not to cause the opposite effect.

Some specialists prescribe special ointments containing hormones, along with phonophoresis or ultrasound. This tendon is close to the skin and these methods can be very effective.

In advanced cases, a special operation may be performed during which the scar tissue will be removed. Tendon repair may be required. It consists in removing a section of tendon from another place that is less important for life and transplanting it onto the tibial muscle. Such measures are taken only if conservative treatment has failed.

The rehabilitation period includes performing special exercises that should develop stagnant ligaments and tendons. Massage, ultrasound, etc. are also effective.

After the operation, the patient will need at least three months to recover. In some cases, during this period you will have to wear a splint or plaster cast, or walk on crutches. The stitches are removed after two weeks. Physical therapy relieves swelling and helps reduce pain. Gradually, they begin to carry out special exercises, which are done incrementally so that the leg can return to its previous functionality.

Prevention

To avoid such problems, you should follow simple rules:

• Don't overexert your legs;
• Training should be progressive. You should not immediately take on heavy loads;
• Before classes, warm up thoroughly and work out each limb so that it is ready for the load.

If anterior dislocations and ruptures of the posterior tibial tendon are extremely rare, “one-off” injuries, then peritendinitis is a common disease.

More often it affects middle-aged women whose work involves being on their feet for a long time. In sports medicine clinics, this pathology occurs in 3% of runners.

Clinical picture

Symptoms develop gradually and pain increases with increasing activity. Runners are sometimes forced to stop exercising.

Diagnostics

On examination, moderate swelling, induration and local tenderness along the tendon behind the ankle are detected. As a rule, during an exacerbation, patients cannot stand on their toes due to pain. In some cases, during active movements over the tendon, crepitus is detected. The pain intensifies with active inversion and passive eversion of the foot.

Ultrasonography and MRI are used to diagnose peritendinitis in modern conditions. According to a number of authors, ultrasound demonstrates higher accuracy (94% and 66%) and sensitivity (100% and 23%) compared to MRI. Miller reported two cases of peritendinitis with partial tendon ruptures not detected by MRI but detected by ultrasonography.

According to Kean, the diagnosis of tibialis posterior tendon peritendinitis is primarily clinical, and often only during surgery can the extent of degeneration of the tendon itself be determined.

According to Kean, to determine the extent of changes in the tendon, it is necessary to dissect it lengthwise, carefully examine and palpate it, excise non-viable fascicles and suture the usually unchanged lateral walls of the tendon.

There is a point of view that after such treatment the tendon sheath cannot be sutured due to a reasonable fear of the development of a scar-adhesive process; others warn about the possibility of tendon subluxation in such cases.

Treatment t endinita

At initial presentation, immobilization in a short cast or plastic boot is usually recommended for up to 3 weeks. Various physiotherapeutic treatment methods are also used. Usually, the administration of hormonal drugs is used only if there is no effect from immobilization.

There are supporters and opponents of topical use of steroids in the early period of the disease:

Supporters of the use of steroids:

Hayes, from the Department of Foot Surgery at the Iowa Medical Center, USA, writes: “Local steroid administration for painful tendon pathology is a simple, safe and effective treatment... This therapy has significantly fewer complications than surgical treatment.”

Opponents of steroid use:

There is a growing body of literature warning against the use of topical steroids due to concerns about secondary tendon ruptures. Trevino operated on 8 patients for peritendinitis of this tendon and found partial or complete ruptures in 5, three of whom were given local hormonal medications. Kean was very clear: “Based on experience, I have decided never to administer hormones for tendonitis.” Many experts consider hormonal therapy to be a predictor of increasing tendon degeneration.

Many orthopedists use surgical treatment methods for recurrent or persistent peritendinitis. Williams operated on 12 of 52 patients: in most cases it was a question of release of the tendon sheath, excision of adhesions and scar tissue and partial synovectomy. There are reports of resection of the changed part of the tendon when rounded seals form in it, followed by its downward movement and new fixation using an anchor method.

Recently, there have been reports of the use of therapeutic tendoscopy for peritendinitis and tendinosis of the tibialis posterior muscle. It was performed through two approaches for resection of adhesions, vaginal release and tenosynovectomy. Results were good in 3 of 4 patients.

The choice of treatment method for the foot deformity itself depends on many reasons:

• Degree of severity of deformation,
• Degrees of fixation of deformation,
• Weights,
• Lifestyle,
• Conditions of the cartilage of the foot joints.

Anterior lengthening osteotomy of the calcaneus

In case of abduction deformation of the forefoot with a “mobile” heel and without fixed supination of the forefoot, an anterior lengthening osteotomy of the calcaneus is indicated.

The osteotomy is performed in the sagittal plane 1.5 cm proximal to the calcaneocuboid joint between the anterior and medial facets. You must work very carefully with the osteotome so as not to damage the plantar nerve and artery on the inner surface. Distraction is achieved by manual forefoot adduction and two Steinman nails in the body and anterior process of the calcaneus and a laminectomy spreader. The resulting diastasis, on average about 10 mm, can be filled with a graft from the iliac wing.

You need to be sure that overcorrection of the deformity has not occurred. The osteotomy area can be fixed using an H-shaped plate for the humeral neck. It is very important to close the wound without tension. After surgery, plaster immobilization for 10 weeks without load (until fusion occurs in the osteotomy area). According to Hinterman, such osteotomy led to success in 18 of 19 patients.

Myerson medial displacement osteotomy

As an alternative to the anterior calcaneal lengthening osteotomy, the Myerson medial displacement osteotomy can be used to treat painful pes planus. According to Myerson, Corrigan, out of 32 patients with impaired function of the posterior tibial muscle and secondary planovalgus deformity of the foot, 94% of patients had significantly decreased pain, the longitudinal arch of the foot increased, and most patients were able to use regular shoes.

Medial osteotomy is more indicated for patients without significant midfoot abduction. Operation technique:

• The incision is below and parallel to the course of the peroneal tendons, posterior to the branches of n. suralis,
• Transverse osteotomy with an oscillatory saw along the skin incision line,
• Excision of the wedge, the osteotomy area is stretched to 10 mm,
• Fixation with screws, avoiding their penetration into the cavity of the subtalar joint,
• Moving the tendon m. peroneus longus on the inner edge of the foot.

For fixed painful deformities with pronounced arthrosis changes in the joints of the foot, the method of choice is triple arthrodesis. In elderly people with low activity, isolated arthrodesis of the talonavicular joint significantly reduces pain and corrects deformity to a certain extent. Subtalar arthrodesis may also be effective.

When performing any action, a person uses his muscles, tendons and ligaments, which are intertwined at the joints. Inflammation of one of these systems causes certain difficulties in movement. One of these inflammations is discussed in this article.

What is tendinitis?

What is tendinitis? This is degeneration and inflammation of the tendon. It is often a concomitant disease of other serious diseases of the body. It is more common in men (1.5% more often) than in women due to the type of activity of many representatives. Various injuries and heavy loads cause tendonitis.

Other names for tendinitis include tendinopathy, tendinosis, and enthesopathy to refer to inflammation of the tendon that attaches directly to the bone.

Classification

Tendinitis has its own complex classification, which should be designated:

By mechanism of origin:

• Primary – develops as an independent disease.
• Secondary – against the background of serious diseases of the body.

By localization of inflammation:

• Knee joint (“heavy knee”);
• Shoulder joint (this includes biceps tendonitis);
• Elbow joint (“tennis elbow”, lateral, “external epicondylitis”, medial);
• Achilles tendon (Achilles bursitis);
• Hip joint;
• Wrists;
• Feet;
• De Quervain's disease is an inflammation of tenosynovitis of a stenotic nature of the thumb;
• Gluteal muscles;
• Temporal tendinitis;
• Neck tendinitis;
• Tibialis posterior (post-tibial).

By form:

• Acute - occurs sharply and brightly, suddenly limiting movement and causing pain. It can be aseptic or purulent.
• Chronic - develops with constant stress on torn tendons. It can be fibrous and ossifying.

Due to the occurrence:

Based on the inflammatory exudate, the following types are distinguished:

• Serous;
• Purulent;
• Calcifying (calcific) – deposition of salts.

It is necessary to distinguish a sprain from a tendon rupture. A sprain is a rupture of several fibers at the same time, during which a repair process occurs. With tendinitis, there is a permanent rupture of tendon tissue.

It often occurs together with diseases such as tenosynovitis (tenosynovitis), in which the tendon sheath becomes inflamed, tenobursitis, in which the tendon bursa becomes inflamed, and myotendinitis, when the muscles adjacent to the tendon become inflamed.

Causes of tendinitis

There are many reasons for tendon tendinitis to develop. As an independent disease, it develops for the following reasons:

• Mechanical injuries occur with prolonged physical stress on the tendon.
• Physical activity on a specific muscle group causes the tendons to tighten. If the load occurs suddenly, this can lead to microtrauma.
• Inflammatory processes of a local nature: wounds, cracks, cuts, burns, etc., which become inflamed and allow infection to penetrate inside.

Here you cannot do without factors such as:

1. Infection: gonorrhea, streptococci, chlamydia, borreliosis, viruses, fungi, etc.
2. Rheumatic diseases: psoriatic, rheumatoid or reactive arthritis, osteoarthritis, scleroderma, lupus erythematosus.
3. Immune system disorders: colds, bone marrow transplant, long-term use of hormonal or antibacterial drugs, chemotherapy, radiotherapy, blood and hematopoiesis diseases.
4. Pathologies in metabolism - mainly gout, which makes the disease more masculine than feminine.
5. Joint degeneration: hormonal disorders, excessive stress on the joint, injuries, impaired nutrition and metabolic processes in the joint capsule.
6. Poor posture.

Factors such as muscle training, warming up of ligaments, the amount of load on the tendons, and the intensity of these loads become important. Repeated movements over a long period of time also cause tendonitis.

Don’t forget about age, which indicates the general condition of the body. It is also possible that there is a genetic pathology in the structure of the joint, which will cause various diseases, for example, bursitis.

Symptoms and signs of tendon inflammation

Signs and symptoms of tendon inflammation usually have a local form, that is, they appear in the place where the inflammation has developed:

• Pain that rarely radiates to other areas and intensifies when trying to move the inflamed joint.
• Difficulty in movement accompanied by swelling of the joint.
• Redness of the skin.
• Nodules under the skin.
• Crunching when moving.
• Local increase in skin temperature.
• Swelling of the skin.

In addition, symptoms of the disease that provoked tendonitis may be observed, for example, symptoms of rheumatic diseases (shortness of breath, deformation of fingers, joint pain, cardiac changes, blueness), gout (formation of tophi or gouty nodes) or infectious diseases:

1. cough, red throat, nasal congestion;
2. moderate temperature, headaches, poor appetite;
3. pain when urinating (cystitis), itching in the genital area, mucopurulent discharge from the urethra.

Tendinitis in children

Tendonitis in children develops for the following reasons:

1. Incorrect posture;
2. Flat feet;
3. Congenital tendon pathologies;

Eliminating these causes can save your baby from tendonitis.

Tendinitis in adults

Often in adults, tendonitis develops due to injuries, chronic diseases and metabolic disorders, and monotonous long-term loads. In men, it occurs more often due to physical work and sports activities. In women, it occurs due to stress during pregnancy, in sports or when wearing high heels.

Tendinitis is a disease of old people, since it is at this age that various pathologies, chronic diseases and loss of muscle tone begin to appear in men and women.

Diagnostics

Diagnosis of tendinitis is based on the patient’s complaints and a general examination by a doctor who checks for pain, the presence of nodules, swelling and mobility of a symmetrical healthy joint for comparison with the patient. The following laboratory and instrumental procedures are carried out:

• Ultrasound of the joint to exclude bursitis and arthritis.
• X-ray of a diseased joint.
• Blood analysis.
• Analysis of joint fluid.

Treatment

Treatment for tendonitis is prescribed depending on the cause of its development. If it was caused by a traumatic factor, then the patient is treated at home with preliminary treatment in the hospital. If the disease is a consequence of another disease, then inpatient treatment is possible in order to fully control the healing process.

How to treat tendonitis? The following measures are used here:

• The diseased joint is partially immobilized by applying a bandage or bandaging. Temporary crutches may be needed to relieve pressure on the sore area. Avoid physical activity and sports for a while.
• Cold compresses are used in case of injury.
• Anti-inflammatory medications are taken.
• Physiotherapeutic treatment is carried out.

What anti-inflammatory drugs are used to treat tendon inflammation?

1. Piroxicam;
2. Indomethacin;
3. Ketoprofen;
4. Ibuprofen;
5. Voltaren;
6. Diclofenac;
7. Viprosal;
8. Dolobene.

What physiotherapeutic methods eliminate tendinitis?

• Laser therapy;
• Cryotherapy;
• Magnetic therapy;
• Ultraviolet irradiation;
• Electrophoresis with lidase;
• Phonophoresis;
• Therapeutic massage, which is performed only by a specialist;
• Extracorporeal UV therapy;
• Therapeutic gymnastics is carried out only as recovery progresses.

At home, you can massage the sore joint, but only by stroking, without any pressure or rubbing. The following folk remedies will also help relieve symptoms:

• Grated potatoes are ground together with onions, clay is added in the same amount and applied to the sore spot overnight.
• Mash 2-3 cloves of garlic, add boiled water (50 ml) and leave for several hours. Soak gauze and a terry towel in the solution, apply it cold to the sore spot, hold until it warms up to body temperature.
• Apple or wine vinegar (0.5 l) is diluted with vodka (100 ml), lemon juice (half a fruit) is added. Leave for up to 5 hours and use as compresses.

Traditional methods do not help if tendonitis is a consequence of another disease. They help only with injuries that caused this disease. As for diet, there is none here. You can eat more fruits and vegetables (especially turmeric, walnuts, ginger) to fill the body with vitamins.

In addition to the above, you should not forget about diseases that provoke tendinitis or can become its complication. How to prevent this? With the help of medications:

• Antibiotics;
• Anti-inflammatory corticosteroid medications;
• Colchicine;
• Locally irritating ointments;
• Painkillers;
• Glucocorticoid injections.

Surgical intervention occurs in the following cases:

1. Pus has accumulated in the affected area. In this case, the tendon will be opened lengthwise and the pus will be removed. Treated with antibacterial drugs.
2. There is significant tearing of the tendon. In this case, there is a surgical connection of collagen bundles that have ruptured. At the end, a plaster cast is applied for up to a month or longer.
3. Tendon stenosis
4. Degenerative changes in tendons.
5. Osgood-Schlatter disease develops. In case of degeneration, the inflamed area is excised.

Life forecast

If tendonitis is treated, then it will not complicate a person’s life. How long do patients live? A full life. The duration of the disease is not affected, but can significantly worsen the prognosis of life if left untreated. Inflammation of adjacent areas, such as bursitis, myotendinitis or arthritis, may develop. This will not kill, but will worsen the condition of the patient, who may become disabled.

Prevent the disease, then tendonitis will not hurt you:

• Warm up your muscles before training.
• Exercise moderate amounts of stress on your muscles and tendons.
• Change the type of work from monotonous and monotonous to varied. Loads must alternately move to different parts of the body.
• Rest often, especially after physical activity.
• Eat a balanced diet so that your body has enough microelements and vitamins.
• Treat other chronic and infectious diseases of the body.