From Big Medical Encyclopedia

ACHILLES TENDON [tendo calcaneus (Achillis) (BNA, PNA), tendo m. tricipitis surae (JNA), heelstring] — sinew of a tricipital muscle of a shin. The origin of the name «Achilles tendon» is connected with the Greek myth about Achilles. It is formed of connection of sinews of medial and lateral heads of sural and kambalovidny muscles and attached to a calcaneal hillock. At the top of Ampere-second. wide and rather thin, it is narrowed and thickened from top to bottom and at distance of 3,5 — 4 cm above a calcaneus extends again. The fascia of a shin forms a double case of Ampere-second.: the dense, connected with skin crossing points superficial leaf and deep which has fascial kletchatochnoye a structure and represents system of the sliding fabrics [Lang (J. Lang, 1960]. On a front surface of Ampere-second. the massive layer of the fatty tissue separating it from a deep leaf of a fascia of a shin is located. At the place of an attachment of Ampere-second. to a calcaneal hillock there is a synovial bag — bursa tendinis calcanei (Achillis).

Diseases of an Achilles tendon

Majority of diseases of Ampere-second. are a consequence of damages, meet its inborn shortening much less often (see. Horse foot ) and inflammatory diseases.

Damages of Ampere-second., which cause the direct injury of a sinew or excessive tension of a gastrocnemius muscle can be, happen opened and closed. The closed damages are observed at ballet dancers and athletes more often at unsuccessful jumps, playing soccer, etc. when there is a rupture of a sinew or a separation of the place of its attachment to a calcaneal hillock.

At the time of an injury the victim feels a crash in the lower third of a shin and an acute pain on its back surface, the possibility of bottom bending of foot is lost. At survey the smoothness or lack of contours of Ampere-second comes to light., the small hematoma is also available retraction of soft tissues on site of a gap; at a complete separation of a sinew — diastases.

First aid consists in imposing of the transport tire, at this stop ekvinusny situation is given, the knee joint is moderately bent.

At a partial rupture of Ampere-second. it is possible to be limited to local introduction of 10 — 20 ml of 0,5 — 1% of solution of novocaine and imposing of a circular plaster bandage in the provision of bottom bending of foot and bending in a knee joint at an angle 145 °. The term of an immobilization is 2 — 3 weeks.

Fig. 1. Plastics of an Achilles tendon according to V. Chernavsky: 1 — the ends of a sinew are refreshed and dissect; 2 — cutting out of a tendinous rag on a leg; 3 and 4 — options of a podshivaniye of a tendinous rag to a distal piece of an Achilles tendon.

At a complete separation of Ampere-second. operational treatment is shown. In position of the patient on a stomach after giving to foot of ekvinusny situation, under intra bone anesthesia make a section of skin on lateral edge of Ampere-second. also open a tendinous vagina. The central and peripheral ends of the injured sinew will mobilize and sew kapron seams across Kyuneo (see. Tendinous seam ). In addition at defect of Ampere-second. make plastics by V. A. Chernavsky's (fig. 1) method. For this purpose from the central end of Ampere-second. find a tendinous rag on a leg in 1/3 width of Ampere-second. also throw on the peripheral end over defect of a sinew. The tendinous rag is hemmed multiple seams. The wound is sewn up tightly. Apply a circular plaster bandage to an upper third of a hip, foot is given the provision of the maximum bottom bending. The immobilization proceeds 3,5 — 4 weeks then the bandage is removed, appoint remedial gymnastics, massage, bathtubs. The dosed loading is allowed in 5 — 6 weeks. Function is, as a rule, recovered completely.

At a separation of the place of an attachment of Ampere-second. with the bone platform from a hillock of a calcaneus the torn-off part is hemmed on the former place mylar or kapron seams. Terms of an immobilization the same.

At horse foot make an achillotomy for correction of the wrong provision of foot (i.e. a section of a sinew) which can be open and closed. The closed achillotomy is made at the maximum dorsiflexion of foot the curved tenotome entered under skin from medial edge of Ampere-second. The edge of a tenotome is brought under a sinew and it is careful, the sawing movements cut a sinew at simultaneous redressment of foot (see. Redressment ). After correction of deformation apply a plaster bandage. The open achillotomy is made from a section on lateral edge of Ampere-second. The section of a sinew and an achillotenoplasty can be made both in the frontal plane across Vulpius, and in sagittal according to Bayer.

Fig. 2. Plastics of an Achilles tendon: l and 2 — across Vulpius (1 — a section of a sinew in the frontal plane, 2 — the ends of a sinew are sewed); 3 and 4 — according to Bayer (3 — a section of a sinew in the form of a letter Z on a sagittal axis, 4 — the ends of a sinew are sewed).

By Vulpius's method section of Ampere-second. make in the frontal plane, for this purpose enter a scalpel into the middle of a sinew and originally cut it on two parts — front and back (fig. 2, 1 and 2). After a cross section of one part below, and another above make redressment of foot and sew the ends of a sinew. At an achillotenoplasty according to Bayer a sinew cut on an axis on two equal parts, one of which in transverse direction is cut above, another — below (fig. 2, 3 and 4). The section turns out similar to a letter Z. The dispersed ends of the cut sinew are sewed catgut or kapron seams. On Besalsky's way open a vagina of a sinew, on a sinew impose two loops from kapron threads at distance of 1 cm from each other and between them make a tenotomy. After redressment of foot the ends of kapron threads connect, a vagina of Ampere-second. sew.

Reason of an inflammation of a mucous bag of Ampere-second., located near the place of its attachment to a calcaneus — akhillodiniya — can be various diseases (rheumatism, gonorrhea, viral infections) or a long injury of close and tight footwear. The pains in a heel amplifying at a dorsiflexion of foot, a swelling at the place of an attachment of Ampere-second are observed. Treatment — rest, heat, bathtubs. At hron, operation — excision of a mucous bag is necessary for an akhillodiniya.

From new growths in the field of Ampere-second. it should be noted a synovioma and a fibrosarcoma.

Bibliography: Boychev B., Konforti B. and Chokanovk. Operational orthopedics and traumatology, the lane with bolg., Sofia, 1961; The Multivolume guide to orthopedics and traumatology, under the editorship of Η. P. Novachenko, t. 3, page 697, M., 1968; Chaklin V.D. Operational orthopedics, M., 1951; it, Orthopedics, book 2, M., 1957; Chumakov M. P., Prisman I. M. and 3 and c e p and T. S. Poliomielit's N, page 323, M., 1953; Lang J. Über das Gleitgewebe der Sehnen, Muskeln, Fascien und Gefässe, Z. Anat. Entwickl. - Gesch., Bd 122, S. 197, 1960. H. H.

Nefedyeva (injuries.), E. A. Vorobyova (An.).