What are Achilles tendon injuries?

跟腱是连接小腿肌肉和脚后跟的纤维带组织. 这条肌腱的力量和柔韧性对跳跃、跑步和行走都很重要. 在日常活动中，你的跟腱承受着很大的压力, as well as during athletic and recreational play. 如果它变得发炎、肿胀和刺激，就叫做肌腱炎. 

What causes Achilles tendon injuries?

Achilles tendon injuries can be caused by the following:

Tendonitis

Tendonitis might be due to overuse or damage to the area. 它会导致腿后部和脚后跟周围的疼痛. 你可能会注意到，由于肌腱炎，你的部分肌腱变厚变硬了. This will get worse if you don't treat it. There are two main types of tendonitis:

• Noninsertional Achilles tendonitis. 肌腱中间纤维的小撕裂开始破坏它. This causes pain and swelling. This type of tendonitis usually affects active, younger adults.

• Insertional Achilles tendonitis. 这种损伤发生在你的跟腱和跟骨接触的地方. Bone spurs (extra bone growth) often form with this type. 这种类型的肌腱炎可以发生在任何年龄，甚至在不活跃的人身上.

Rupture

肌腱纤维的撕裂会导致肌腱完全或部分断裂(或撕裂). 你可能会听到一声砰的一声，似乎是从你的脚跟或小腿后面传来的. 这可能是肌腱断裂，需要立即就医.

Achilles Tendinosis: Q&A with Dr. Nigel Hsu

- Watch on YouTube

Dr. 许志强回答常见的跟腱病的诊断和治疗问题.

Key points about Achilles tendon injuries

• Your Achilles tendon can develop tendonitis. This is when it becomes inflamed, swollen, and irritated.

• The Achilles tendon can also tear or rupture, 哪一种声音听起来像是从你的脚跟或小腿后面发出的砰的一声. This needs immediate medical attention.

• 任何人都可能患上跟腱损伤，这通常与跟腱的重复性压力有关.

• Achilles tendon injuries often cause pain, stiffness, and swelling in the back of your leg near your heel.

• 跟腱损伤可以通过休息和药物治疗来缓解炎症. Exercises often help too. If needed, surgery can be done to repair the tendon.

• 你可以通过做一些事情来预防这些伤害，比如慢慢增加活动, wearing the correct shoes for your activities, and not exercising on uneven surfaces.

Who is at risk for Achilles tendon injuries?

Anyone can develop an Achilles tendon injury. They’re often linked to repetitive stress. The most common risk factors are:

• Increased amount or intensity of an activity or sport

• Starting a new sport

• 开始锻炼或运动时紧绷小腿肌肉，这会给你的肌腱施加更大的压力

• Bone spurs on your heel, which can rub against the tendon

• Wearing the wrong shoes when you exercise

• Exercising on an uneven surface

• Treatment with the antibiotic fluoroquinolone

What are the symptoms of an Achilles tendon injury?

Common symptoms of tendon injuries include:

• Pain down the back of your leg or near your heel

• Pain that gets worse when you're active

• A stiff, sore Achilles tendon when you first get up

• Pain in the tendon the day after exercising

• 肿胀和疼痛会随着白天的活动而加重

• Thickening of your tendon

• Bone spurs on the heel bone

• Difficulty flexing the affected foot

• 砰的一声，突然的剧痛，这可能意味着肌腱断裂

How is an Achilles tendon injury diagnosed?

跟腱受伤会导致你的腿后部靠近脚跟的地方疼痛. 有时医疗服务提供者会将跟腱损伤误诊为踝关节扭伤. 得到正确的诊断很重要，这样你才能得到正确的治疗. 几种常见的损伤会使你的跟腱疼痛或阻止它正常工作.

您的医疗保健提供者在做出诊断时会考虑以下因素:

• Your overall health and medical history

• A description of your symptoms

• 对你的跟腱进行体检，检查是否有骨刺、疼痛和肿胀

• 测试你是否能正确移动脚踝(活动范围)

• Imaging tests, such as ultrasound, X-ray, or MRI. x光片显示骨骼，可以显示骨刺以及肌腱是否钙化或硬化. 你的医生通常会用核磁共振成像来检查肌腱损伤的严重程度，以及最适合你的治疗方法.

How are Achilles tendon injuries treated?

Treatment depends on how badly injured your tendon is. It may include:

• Rest

• Ice

• 缓解疼痛的非甾体抗炎药，如布洛芬或萘普生

• Specific exercises to strengthen your calf muscles

• Physical therapy

• Eccentric strength training. 这种类型的运动有助于加强你的小腿肌肉，减轻肌腱的压力

• Low-impact activities, such as swimming

• 鞋跟提升，矫形鞋，石膏，夹板，或步行靴

• Extracorporeal shockwave therapy. 这种疗法使用高能冲击波脉冲来帮助刺激受损肌腱组织的愈合过程. This treatment isn’t often used. 然而，你的医疗保健提供者可能会推荐它，看看你是否可以在不手术的情况下改善

如果这些治疗不起作用，或者如果损伤严重或完全，可以考虑手术. 手术的类型取决于肌腱损伤的位置和程度. 这也取决于其他因素，比如肌腱炎的严重程度. Some of the surgical procedures used include:

• Surgery to lengthen your calf muscles (gastrocnemius recession)

• 切除受损肌腱组织或骨刺并修复肌腱的手术(清创)

• Surgery to remove your damaged tendon tissue, fix the remaining tendon, 通过将另一根肌腱移动到跟骨，给它额外的力量

What are possible complications of Achilles tendon injuries?

Complications of an Achilles tendon injury may include:

• Pain, which can be severe

• Difficulty walking or being active

• Warping of your tendon area or heel bone

• Tendon rupture from reinjury

由于跟腱损伤的治疗方法，其他并发症也会发生. For instance:

• Sometimes cortisone injections can cause the tendon to tear

• Surgery can lead to pain and infection

How can I prevent Achilles tendon injuries?

These steps can help prevent injury to your Achilles tendon:

• 在锻炼、运动或其他重复性运动前热身.

• Increase activity slowly, rather than all at once.

• Wear the correct shoes for your activities.

• Don't exercise on uneven surfaces.

• Stop activities that cause pain.

• 请注意氟喹诺酮类药物的风险，如果你正在服用这种药物，请谨慎运动.

How to manage an Achilles tendon injury

• 听从医疗保健提供者的建议，多休息，控制疼痛和肿胀.

• Choose other ways to be active.

• 尝试低强度的运动，不要给你的肌腱施加太多压力, such as swimming or bicycling, rather than a high-impact exercise like running.

• 如果这些策略不能帮助减轻疼痛，一定要让你的医疗保健提供者知道, swelling, and loss of function.

When should I call my healthcare provider?

如果听到砰的一声，腿后部或脚后跟突然疼痛，立即打电话给你的医疗保健提供者. 否则，如果疼痛或移动困难影响了您的日常活动，请安排预约.