shin tendon

Tendon ruptures and sprains are often caused by careless walking and inappropriate exercise. There are objective factors:

Synovitis and tenosynovitis – arthrosis.

The joints are subjected to enormous loads every day and can be injured even if we don't realize it. So it is not surprising that they catch fire from time to time. Synovitis, an inflammatory disease of the synovial membrane, the connective tissue that lines the inner surfaces of joints and tendons, is often diagnosed with osteoarthritis and arthritis.

The synovial membrane has an important function in the joint, namely the separation of the hard tissue. This allows the joint to move with minimal flexing of the components. The membrane is able to change its shape to adapt to the bearing surfaces and provide cushioning. Their condition affects the quality and quantity of synovial fluid, the lack of which causes coxarthrosis or gonarthrosis.

The connective tissue that makes up this membrane can become inflamed. The joint may swell, be painful when moved, and bleed. If the disease is not treated, the synovial membrane thickens and new blood vessels form in it. This leads to frequent joint bleeding in the future.

Untreated synovitis can lead to dysfunction of the joint.

What is tendonitis (tenosynovitis)?

Tenosynovitis is an inflammation of the tendon sheaths. The latter are tubular connective tissues filled with lubricating fluid. The sheaths surround the tendons, which are made of elastic, fibrous, collagenous tissue. It is this tissue that connects the muscle to the bone. When the outer covering of the tendon becomes inflamed, it is called tendonitis (tenosynovitis). Both inflammatory diseases are associated with pain when moving, so only a doctor can make an accurate diagnosis.

Tenosynovitis most commonly affects the hands, wrists, and feet

classification

• acute – the affected area is swollen, mobility of the joint is impaired and severe pain occurs when the joint or affected muscle is moved;
• chronic – develops without treatment in the acute phase and is accompanied by reduced mobility of the joint.

Depending on the localization, the following types of ligament inflammation (tenosynovitis) are distinguished

• Knee – inflammation of the patellar ligament, inflammation of the tendon of the quadriceps muscle of the thigh, goose foot, insertion of the iliac muscle ('runner's knee');
• Shoulder joint – tendinitis of the rotator cuff (supraspinatus, subscapularis, scapularis, sphincter major and minor), long head of biceps, rhomboid and deltoid muscle;
• Elbows - external epicondylitis (tennis elbow), internal epicondylitis (golfer's elbow), tunnel syndrome;
• Hip – tendinitis of the hip-thigh insertion, iliopsoas, sternocleidomastoid, gluteus maximus and medialis, hamstrings;
• Wrist and fingers – carpal tunnel syndrome, inflammation of the extensor ligament of the 1st finger (de Kerwen's disease), inflammation of the ligament of the adductor and/or propator muscle of the 1st finger (de Kerwen's disease), inflammation of the extensor tendon of the fingers;
• ankle – inflammation of the tendons of the long and short fibula, tibialis oculi muscle, tibialis posterior muscle, Achilles tendon.

Depending on the type of course, tendonitis can look like this

• tuberculous – develops as a result of infection with Mycobacterium tuberculosis and affects the synovial membrane of the tendon of the hand;
• stenotic – usually a pathological process affecting elbow, wrist, knee and ankle joints;
• chronic inflammatory – similar to tuberculosis, often in combination with rheumatoid arthritis.

Etiology and pathogenesis

Synovitis of the tendon sheath can arise from a variety of causes. It is most commonly caused by injury and trauma, followed by infection.

The main causes of tendonitis include:

• rheumatism
• Limb injuries
• Weakening of the body's immunity
• Infectious pathologies
• Abnormal joint changes
• high age
• Excessive load

Bacteria can also enter the tendon sheath from other parts of the body. The flexor tendons are most commonly affected by the pathology, the extensor tendons of the fingers are more rarely affected. Common pathogens are Staphylococcus aureus, gonococci, fungi, pseudomonads and Gram-positive bacteria.

Causes and forms of tendon pain

Factors predisposing to tendon pain include:

• Frequent or excessive physical activity, typically found in competitive athletes;
• Inadequate warm-up and stretching of the tendons before an intense workout;
• Recent and previous chronic tendon injuries that have not fully healed and consistently cause tendon re-inflammation;
• Postural disorders, in which the load on the musculoskeletal system is not properly distributed and some tendon fibers are overloaded;
• systemic diseases such as gout, rheumatoid arthritis or psoriatic arthritis.

If the above factors act on the body for a long time, the patient may develop the following conditions:

• tendinosis – dystrophic changes in the tendon, in which the tissue at the point of attachment to the bone is pinched and gradually replaced by bone;
• Tendovaginitis - inflammation of the connective tissue sheath around the tendon;
• Tendonitis - inflammation and degenerative changes in the tendon.

types of tendon pain

Tendon fiber pain is classified according to the following criteria:

By duration

• Acute pain – usually the result of trauma, arises immediately after injury to the tendon tissue and disappears within 2-3 days with early treatment
• Chronic – following untreated trauma or a chronic inflammatory or degenerative process, lasts 1-2 weeks and is less easily treated.

Depending on the time of occurrence.

• Tendon pain with walking and other movements - occurs only during or immediately after exercise;
• at rest - always disturbs the patient, regardless of physical exertion, and can be aggravated in the morning or at night or by other factors.

By cause of occurrence

Physiological pain occurs after intense physical exertion or overload, sometimes after a single injury. Pathological pain is associated with inflammatory and dystrophic processes in the tissues, which most often develop as a result of nasal trauma and microtraumas. Pathological pain is divided into the following subtypes:

• Traumatic - caused by a single serious injury or recurrent microtrauma against the background of overstrain;
• Musculoskeletal - caused by poor posture;
• Inflammatory-dystrophic - persistent, indicating tendinitis or degenerative-dystrophic processes in tissues.

symptoms

In the early stages Tibialis tendinosis Patients occasionally experience pain behind the inner part of the ankle. Over time, the pain increases and swelling occurs. The patient has difficulty standing and walking. Standing on the toes is usually accompanied by pain and may become impossible if the tendon is completely torn. With a complete rupture of the tendon, the foot is suddenly flattened (arch collapse) and sole pain may occur.

W Tenosynovitis of the posterior tibialis muscle The pain usually comes on suddenly, and the tendon may be thickened and swollen where it wraps the back of the foot on the inside of the ankle (inner malleolus).

diagnosis

Diagnosis is often based on symptoms and physical examination. However, in some cases, computed tomography (CT) and magnetic resonance imaging (MRI) are needed to confirm the diagnosis and determine the extent of tendon injury. In order to make or confirm the diagnosis, it is sometimes necessary. Read more .

For Tendinosis of the posterior tibialis muscle are usually aids that are inserted into the shoes (ortheses) and ankle splints with orthopedic shoes are sufficient. Complete tears require surgical treatment to restore normal function. Surgical treatment is particularly important in young, active people with spontaneous ruptures.

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Treatment of tendonitis and tendon sheaths

Pain relief can be achieved with rest or immobilization (eg, with a splint or immobilization), heat treatment (usually for chronic disease) or cooling (usually for acute inflammation), and high-dose NSAIDs (see Table ) for 7-10 days become. Indomethacin or colchicine may help if the cause is gout. Treatment Podagra is a condition caused by hyperuricemia (uric acid levels in the blood > 6.8 mg/dl [> 0.4 mmol/l]) that lead to the precipitation of sodium mononitrate crystals in and around the joints. Read more . Gentle exercise with gradually increasing movement is indicated several times a day while the inflammation subsides; this is particularly important to prevent rapid contractures of the shoulder joint.

Injections into the tendon sheath with glucocorticoids (eg, betamethasone 6mg/mL, triamcinolone 40mg/mL, or methylprednisolone 20-40mg/mL) may be helpful. These injections are usually indicated for severe or chronic pain. Depending on the injection site, the volume of the drug ranges from 0.3 to 1 ml. Injecting a similar or double volume of a local anesthetic (e.g. 1-2%ige lidocaine solution) through the same needle will confirm the diagnosis if the pain subsides immediately. Care should be taken not to inject directly into the tendon tissue (where there is greater resistance to injection) as this can lead to weakening and eventual rupture of the tendon. Patients are advised to rest in an adjacent joint to reduce the risk of a possible tendon rupture. In some cases, the severity of the clinical symptoms may increase within 24 hours after the injection.

Common sense and precautions

Corticosteroids should not be injected into tendons as this weakens them and increases the risk of rupture.

What happens after posterior tibial tendon surgery?

Your doctor will monitor you for a few hours after the operation. When you wake up, your ankle will be immobilized with a splint. Surgery on the posterior tibialis muscle tendon is often performed on an outpatient basis. This means you can go home the same day. Follow all of your doctor's instructions regarding pain medication and wound care.

You will feel pain after the operation, especially in the first few days. Medications can help relieve the pain. Elevating your leg after surgery can reduce swelling and pain. You will be using crutches and supporting your weight on your feet for a few weeks. Remember to tell your doctor right away if you get a fever or chills, or if your ankle or calf pain gets worse.

About 10 days after surgery, the stitches or staples will likely be removed. At this point, your doctor may want to replace the splint with a cast. In this case, all instructions for keeping the cast dry must be followed. In other cases, your doctor may use a special removable boot instead of the cast.

Your doctor will give you advice on when to shift your weight to the leg and how to strengthen your ankle and leg muscles during recovery. You may also need physical therapy. You may be in pain for a few months before noticing the benefits of the surgery. Follow all of your doctor's instructions for postoperative exercise. This will help ensure the success of the operation.

the next steps

Before agreeing to an examination or procedure, make sure you know the following

• the name of the examination or intervention
• the reason you are undergoing the examination or procedure
• what results to expect and what they mean
• the risks and benefits of the investigation or procedure
• What side effects or complications may occur
• When and where you should undergo the examination or treatment
• Who is administering the test or procedure and what qualifications that person has
• What happens if you don't have the test or procedure?
• What alternative tests or procedures you should consider
• When and how you will get your results
• Who to call after the test or procedure if you have any questions or concerns
• How much you will have to pay for the test or procedure

approaches to treatment

Pain in the tendons of the hands and feet requires a doctor's consultation. In the clinic, only a comprehensive approach to the treatment of this disease is followed. The prescribed therapy is safe for patients and aims to reduce the risk of recurrence.

The main method of therapy is osteopathy. This branch of medicine is actively used in the USA, Germany, Japan and other developed countries. It is based on a systemic approach to human health, in which the doctor not only tries to eliminate the symptoms, but also to identify the underlying cause. Osteopathic treatment also includes chiropractic techniques. All invasive procedures and the use of pharmacological drugs are excluded.

Physiotherapy and massage are recommended for patients with tendon pain. Both methods improve the blood supply to the tendon fibers and increase their elasticity. This has a positive effect on the patient's mood, which significantly speeds up the recovery process. Physical therapy is also recommended. Magnetic field, laser, electrophoresis can be applied. Physiotherapeutic treatments reduce tissue edema, improve blood circulation in the damaged areas and prevent dystrophic processes.

Shockwave therapy is used to eliminate connective tissue scars and areas of bone fusion. It is a modern method of treating chronic tendinitis and tendinosis. As a result of the action of microvibrations, scar tissue and hypertrophied bone tissue are destroyed and replaced with normal tendon fibers.

topography

The tibial nerve originates at the top of the knee and runs through the middle of the calf muscle. At the base of the big toe, it divides into two branches and almost reaches its apex, it also approaches the apex of the second toe.

Below the Achilles tendon, the tibial nerve enters the tarsus (foot root canal), where it is held in place by the great ligament. After exiting the canal, it divides into terminal smaller branches, the medial sagittal nerve and the lateral sagittal nerve.

Anatomy: areas of innervation

The tibial nerve is an extension of the sciatic nerve and belongs to the sacral plexus group. It innervates the ankle (along with the ankle nerve), the posterolateral surface of the lower third of the tibia, the outer edge of the foot, and the heel.

The terminal branches of the tibial nerve are responsible for innervating the small muscles of the foot, the skin on the inside of the foot and the first three and a half toes, and the dorsal surface of the other one and a half toes (little toe and half toe).

The muscles supplying the posterior tibial nerve:

surgical treatment
If conservative treatment is ineffective, surgical intervention may be necessary.

If the soft tissue of the tendon is thickening and conservative measures do not resolve the inflammation, surgical removal of this scar tissue around the tendon may be indicated. This method usually brings relief to the patient, but a visual inspection of the tendon itself is also performed and a decision is made about a possible plastic surgery. Local thickening can be removed at the surgeon's discretion. If the tendon is thin, there are many scars and local micro tears, then the tendon needs repair.

suture of the tendon
Large tears can be repaired by sewing the tendon. Occasionally, the tendon is sutured after removing the thickening if the surgeon suspects that the tendon will tear over time. Sometimes the integrity of the tendon cannot be restored. Then the surgeon may consider a tendon transplant.

tendon transplant
An age-related tendon rupture (more than a month old) or a severely degenerated tendon may require surgical intervention. A piece of tendon that is functionally less important is removed for the transplant. This is decided by the surgeon and the patient in advance. With this graft, the surgeon restores the integrity of the posterior tibialis tendon.

arthrodesis
For a long-standing, immobile foot deformity caused by damage to the posterior tibialis tendon, the orthopedist may recommend arthrodesis surgery to set the stage for fusion between the small bones of the foot. This type of surgery is used to relieve the foot pain associated with severe flat feet.

Immobilization with a cast may be recommended after surgery, depending on the condition of the tendon and the manipulation performed.

rehabilitation

Rehabilitation after conservative treatment
Unless contraindicated, physical therapy can help patients with this condition. The goal of treatment is to reduce pain and swelling. A physical therapist can prescribe procedures such as ultrasound, heat treatments, and massage.

Therapeutic exercise is important to keep the muscles of the lower leg and foot in good condition. Exercise should begin under the guidance of a trainer as soon as the acute inflammation has subsided.

In order to accelerate the treatment effect, suitable footwear should be chosen. A compression insert relieves the musculus tibialis posterior. The insoles should be worn throughout the day. Prolonged walking barefoot or wearing improper footwear increases stress on the posterior tibialis muscle and potentially worsens the condition.

Rehabilitation after surgery
Rehabilitation after the operation will take at least eight weeks. If a tendon repair or plication has been performed, you will need to wear a cast or plastic splint and use crutches. You may need the help of a trainer to learn how to use crutches.

The bandages are applied as instructed by the surgeon. The stitches are removed 10 to 14 days after the procedure. If the surgeon uses dissolvable sutures, they should not be removed.

Physical therapy can help reduce pain and swelling. Treatments are prescribed by the physiotherapist, provided there are no contraindications.

The physiotherapist will develop an individual rehabilitation program. Initially, the exercises are carried out under supervision, later they can be carried out independently. The exercises help the lower leg and foot muscles to regain their tension. Gradually, the load and the level of difficulty of the exercises is increased. Your doctor can decide with you whether you want to increase the load or not.

• Tibialis posterior muscle.
• Lamb Muscle Soreness.
• The long section of the big toe.
• Syndrome of the tibial nerve.
• The flexor muscles of the foot.
• Tendon of the tibialis anterior muscle.
• flexor muscle of the big toe.
• Long flexor muscle.