| Sažetak | Ahilova tetiva (AT) najčvršća je tetiva u ljudskome tijelu, ali i često ozljeđivana. Zajednička je tetiva m. soleusa i m. gastrocnemiusa koji čine m. triceps surae. Njezine ozljede vežemo najviše uz populaciju srednje dobi, prvenstveno mušku, te ujedno uz sportaše i rekreativce. Kada fiziološko istezanje tetivnih vlakana prijeđe 8 % istezanja, dolazi do oštećenja. Razne aktivnosti i deformiteti mogu dovesti tetivu do nemogućnosti vraćanja u prvobitno stanje što na kraju dovodi do degeneracije i oštećenih tetivnih vlakana. Kvalitativne i kvantitativne analize pokazale su da je Ahilova tetiva loše vaskularizirana kroz svoju duljinu zbog malog broja krvnih žila u poprečnom presjeku. Zbog toga se smatra da i loša vaskulariziranost može biti prepreka u adekvatnom popravljanju tkiva nakon traume i dovesti do daljnjeg slabljenja tetive. Haglundova bolest odnosno sindrom može se opisati kao bolno stanje pete uzrokovano mehanički izazvanom upalom retrokalkanealne burze, suprakalkanealne burze te Ahilove tetive. Dijagnoza se postavlja klinički, mjerenjem kretnji u gležanjskom zglobu, palpacijom te uz pomoć radiografije. Neoperativno liječenje obuhvaća korekciju obuće, uloške za pete, oralne protuupalne lijekove, lokalnu injekciju za olakšavanje bolova te ekstrakorporalnu terapiju udarnim valom (ESWT) i iontoforezu. Tendinitis je upalna reakcija AT, a može biti kronični i akutni. Može nastati zbog djelovanja unutarnjih čimbenika kao što su deformiteti stopala i vanjskih od kojih su najčešće greške u treningu. Lokaliziran je 2 do 6 cm iznad hvatišta AT uz prisutnost edema i boli. Za tendinitis vežemo „zvuk škripanja snijega“. U konzervativno liječenje akutnog tendinitisa spada korekcija obuće, nošenje jastučića, primjena krioterapije te primjena terapijskog UZV i lasera, dok u liječenju kroničnog oblika pomažu vježbe istezanja, iontoforeza, ESWT i mobilizacije mekih tkiva. U slučaju sumnje na rupturu AT, fizioterapijskom procjenom uz pomoć Thompsonovog testa i testa pasivne dorzifleksije gležnja u proniranom položaju lako možemo potvrditi rupturu. Ako je potrebno, može se napraviti UZV i MRI. Ozlijeđena se tetiva kod neoperativnog liječenja mora imobilizirati u čizmi, udlazi ili gipsu te je važno da osoba slijedi rehabilitacijski protokol po tjednima. Entezopatije se nalaze na hvatištu Ahilove tetive na petnu kost, gdje postoji mogućnost formiranja koštanih ostruga i kalcifikacija unutar same tetive na mjestu hvatišta. Liječenje obuhvaća prvenstveno vježbe ekscentričnog tipa, injekcije po potrebi te se preporuča povišenje za pete. Dobre je rezultate pokazala ESWT te manipulacijske i mobilizacijske tehnike. |
| Sažetak (engleski) | The Achilles tendon (AT) is the strongest tendon in the human body, but it is also frequently injured. It is the common tendon of the m. soleus and m. gastrocnemius muscles, which together form the m. triceps surae. Injuries to the AT are most commonly associated with middle-aged individuals, primarily males, as well as athletes and recreational exercisers. When the physiological stretching of the tendon fibers exceeds 8%, damage occurs. Various activities and deformities can lead the tendon to the point where it cannot return to its original state, ultimately resulting in degeneration and damaged tendon fibers. Qualitative and quantitative analyses have shown that the Achilles tendon is poorly vascularized along its length due to a small number of blood vessels in the cross-section. Therefore, it is believed that poor vascularization may also be a hindrance to adequate tissue repair after trauma and may lead to further weakening of the tendon. Haglund's disease or syndrome can be described as a painful heel condition caused by mechanically induced inflammation of the retrocalcaneal bursa, supracalcaneal bursa, and the Achilles tendon. The diagnosis is made clinically by measuring the movements in the ankle joint, palpation, and with the help of radiography. Nonoperative treatment includes shoe correction, heel lifts, oral anti-inflammatory medications, local injection for pain relief, extracorporeal shock wave therapy (ESWT), and iontophoresis. Tendinitis is an inflammatory reaction of the AT, which can be chronic or acute. It can be caused by internal factors such as foot deformities and external factors, the most common of which are training errors. It is localized 2 to 6 cm above the AT insertion, with the presence of swelling and pain. Tendinitis is often associated with a "snow crunching" sound. Conservative treatment of acute tendinitis includes shoe correction, wearing pads, applying cryotherapy, and using therapeutic ultrasound and lasers, while stretching exercises, iontophoresis, ESWT, and soft tissue mobilizations help in treating the chronic form. In the case of suspected AT rupture, physiotherapy assessment with the help of the Thompson test and the passive dorsiflexion test of the ankle in a prone position can easily confirm the rupture. If necessary, ultrasound and MRI can be performed. In nonoperative treatment, the injured tendon must be immobilized in a boot, splint, or cast, and it is important for the individual to follow a weekly rehabilitation protocol. Enthesopathies are located at the insertion of the Achilles tendon on the heel bone, where there is a possibility of bone spur formation and calcifications within the tendon at the insertion site. Treatment primarily includes eccentric exercises, injections if necessary, and heel lifts are recommended. ESWT and manipulative and mobilization techniques have shown good results. |
