Briefly, it can consist of inflammation or, worse, a rupture of the Achilles tendon, the strong tendon structure that connects the calf muscles (gastrocnemius and soleus) to the heel.
In this article, the author will discuss the causes, risk factors, and symptoms of yarrow tendinopathy in sports.
, in:- Traumatic;
- Microtraumatic;
- On a dysmetabolic and / or inflammatory basis.
The microtraumatic tendinopathies of the Achilles tendon are also defined as functional overload injuries and are able to determine the pathology with a direct and an indirect mechanism.
This type of injury can lead to the rupture of the Achilles tendon, which however represents the acute episode following a degenerative process (tendinosis); the latter, sometimes almost completely asymptomatic or preceded and accompanied by episodes of painful inflammation of the sheath, and involving more or less extensively the tendon structure, causes a decrease in mechanical resistance, which can be overcome by a " sudden stress, even if not excessive.
Functional overload of the Achilles tendon: the causes
The factors that can cause pathologies due to overload of the tendons (and in many cases also of the muscles) of the instep and foot can be generically divided into intrinsic and extrinsic, and act in a variable percentage from subject to subject.
Intrinsic Factors
As for the intrinsic factors, these are essentially represented by:
- Anatomical variability, resulting in a more or less marked alteration of the normal biomechanics of walking or athletic movement, which subjects the instep and foot to abnormal stress.
More specifically, one of the main problems is the overpronation of the instep and foot during running, which has a whipping action, like a bowstring, on the Achilles tendon, resulting in a high frequency of tendonitis. - Dysmetabolic diseases, which can favor local inflammatory reactions, as well as cause the alteration of the composition of the normal tendon tissue, leading to a more precocious aging;
- Last but not least, the age of the individual and the years of competitive activity. In fact, the aging of the tendon tissue causes a metabolic slowdown of the tissue collagen, with a gradual decrease in the cell-matrix ratio in favor of the latter, a decrease in the water content of the elastic fibers, proteoglycans and glycoproteins; furthermore, the blue line present at the osteo-tendon junctional level disappears, which plays an "important modulating and shock-absorbing action against mechanical stresses.
Extrinsic factors
As far as extrinsic factors are concerned, they often become decisive in the establishment of overload tendinopathy in the instep and foot.
There are three main factors:
- The incongruous training;
- The competition or training grounds;
- The shoe.
From recent studies, carried out on Cummins observations, Christensen has developed the theory of individual anatomical variations, according to which the fibers of the Achilles tendon coming respectively from the gastrocnemius and the soleus, as they descend towards the heel undergo a certain degree of rotation reciprocal, of variable entity in the various subjects.
According to Christensen, during certain movements, such as typically occur in running and jumping, a sort of saw-like rubbing can occur between the two groups of fibers, in relation to the individual variations of the degree of mutual torsion of the latter, and to the lack of perfect muscle coordination, as occurs more easily in poor training conditions.
In reality, the possibility of reciprocal damage to the tendon fibers has never been demonstrated; therefore, the foregoing is only a "suggestive hypothesis aimed at enhancing the weight of individual factors in the genesis of the rupture.
The etiological role played by the so-called "tendonitis" seems to be less direct than what was believed in the past and than the relatively high frequency, about 30%, with which this disease appears in the "anamnesis of subjects who undergo a rupture of the Achilles tendon.
Overload Achillea Tendinopathy: the various Classifications
Several classifications are proposed to define disorders of the Achilles tendon.
In particular, in functional hyperstress lesions (overuse) there are three stages:
- Peritendinitis (or inflammation of paratenone),
- Tendinosis, which involves degenerative changes within the tendon and may or may not coexist with peritendinitis and, finally, if the pathophysiological process continues,
- Partial or total rupture of the tendon.
Subotnick distinguishes the following pathological conditions affecting the Achilles tendon:
- Stretches of the medial and lateral teno-muscular junction,
- Paratenonitis yarrow,
- Yarrow tendinosis (rupture or central degeneration of the tendon) e
- Teno-periosteal tendonitis with or without calcinosis.
Other authors support the existence of a picture of post-traumatic inflammation within the tendon tissue (tendonitis).
Cyriax distinguishes four main sites of injury: the teno-periosteal insertion, the two lateral parts of the tendon body and the anterior part of the tendon.
Compared to the different pathological realities proposed by B.A.M. Van Wingerden argues that it is not always easy to recognize them through clinical examination and that the only way to be sure of the characteristics of the damage is surgical inspection or in some cases nuclear magnetic resonance imaging (MRI).
Achillea Tendinopathy: Causes and Risk Factors
In the etiological field, it is thought that repeated loads, exceeding the intrinsic repair capacity of the tendon, generate inflammation of the structure, while sudden loads would cause the tendon to rupture.
Soma et al. they attribute the causes of tendon disorders to intrinsic and extrinsic factors.
Intrinsic factors include a sudden increase in running duration, intensity, or frequency, which can lead to "inflammation from overuse.
The extrinsic factors concern sports shoes, for example those with a poor sub-heel pad, or with retro-heel buttresses that do not adequately stabilize the hind foot.
According to Neely FG, there is some evidence that an excessively pronated or supinated foot, a limitation of the ankle dorsiflexion, a limitation of the hip eversion range, an excessive ligament laxity, a discrepancy between the lower limbs and an increase angle Q are a significant risk factor for exercise-related yarrow tendinopathy.
Reid considers training errors, flawed anatomical alignment (heel varus compensated by "forefoot overpronation"), triceps stiffness and inadequate shoes as the main predisposing factors for yarrow tendinopathy.
Also according to Subotnick, when there are repeated overloads in pronation, the medial part of the tendon is injured, while, in the case of excessive supination of the foot, the damage is more likely to be found in the lateral area.
Some authors argue that hindfoot control is important to prevent yarrow tendonitis; in fact, an increase in the "angle of"touch down"results in compensatory overpronation that disrupts the normal pronation phase: the authors believe that all this causes an" exaggerated torsion of the Achilles tendon. "
prodromal.
Some authors argue that between 2-6 cm above the theno-periosteal insertion there is an area of tendon hypovascularization, which would predispose the tendon to rupture.
In this regard, however, Fredericson cites a study by Amstron and Westlin, from which it emerged that in symptomatic tendons there is an increase in blood flow (both at rest and during physical stress), compared to healthy control groups and contralateral asymptomatic tendons.
Patients with yarrow tendinopathy usually report pain symptoms between 2-6 cm. above the heel insert; symptoms may present as stiffness in the morning or early in the run, pain while walking, or even severe pain that prevents running.
A "history of sudden, severe, disabling pain in the tendon region points to a rupture."
Achillea Tendinopathy and Plantar Fasciitis: the relationship
As for the stiffness of the Achilles tendon, Kibler et al. Affirm that it is a predisposing factor to plantar fasciitis.
These authors recall that a rigid Achilles tendon limits the dorsiflexion of the ankle; if during the phase preceding the detachment of the toes, the tendon does not allow itself to be stretched, an abnormal pronation occurs, capable of causing excessive stress on the plantar fascia. .
Edited by Professor Rosario Bellia
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