跟腱损伤包括腱旁组织的炎症和部分或完全撕裂。
跑步运动员中跟腱炎很常见。小腿肌肉通过跟腱附着到跟骨。跑步时，小腿肌肉参与协助步态抬起。跑步时重复用力加之缺乏足够的恢复时间，最初会引起腱旁组织（肌腱周围脂肪结缔组织）的炎症反应。跟腱完全撕裂 是种严重创伤，常由突然、强烈的应力所致。服用喹诺酮抗生素者即使轻微活动也可能会出现跟腱撕裂。
跟腱炎的症状和体征
跟腱炎症主要症状是脚跟后方疼痛，疼痛在锻炼开始时加重，随锻炼继续而减轻。
典型跟腱完全撕裂见于跑步或打网球时的突然方向性用力变化，通常伴有脚踝和小腿的背面已被如球棒一般的物体击中的感觉。
跟腱炎的诊断
临床评估
检查时，有炎症或部分撕裂的跟腱在手指间被挤压时是柔软的。完全撕裂时按如下进行鉴别：
肢体突然剧痛且不能行走
沿肌腱走向触诊有缺如感
Thompson试验阳性（伤者俯卧在检查桌上，检查者挤压其小腿部肌肉，该动作未引起正常预期足的跖屈）。
跟腱炎的治疗
冰、非甾体抗炎药(NSAIDs)和拉伸
动作修正
有时使用足跟垫
肌腱炎症治疗起始可用冷敷，小腿肌肉轻轻伸展以及服用NSAIDs药物。
可在鞋中放置后跟升高物消除肌腱张力。应指导运动员避免上坡和下坡跑步，直至肌腱不再疼痛，以及参加有氧交叉训练。
大多数临床医生治疗跟腱完全撕裂通常采用手术修复。然而，最近的研究（1, 2, 3）已经表明，非手术治疗（包括高度结构化的康复活动）在踝关节力量、踝关节活动范围、肌腱重复撕裂率以及预治疗能力方面可提供与手术修复相似的长期结果。 - 损伤活动。
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K.Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
治疗参考文献
1.Lantto L, Heikkinen J, Flinkkila T, et al: A prospective randomized trial comparing surgical and nonsurgical treatments of acute Achilles tendon ruptures.Am J Sports Med 44(9):2406-2414, 2016.doi: 10.1177/0363546516651060
2.Parisien RL, Dodson CC, Trofa DP, et al: Face off: Surgical versus nonsurgical treatment of acute Achilles tendon ruptures.AAOS Now July 2016, cover.
3.Myhrvold SB, Brouwer EF, Andresen TKM, et al: Nonoperative or surgical treatment of acute Achilles' tendon rupture.N Engl J Med 386(15):1409-1420, 2022.doi: 10.1056/NEJMoa2108447
