Treatment and physiotherapy approach after Achilles tendon rupture

Abstract

Ahilova tetiva je najjača i najduža tetiva u ljudskom tijelu, smještena na stražnjoj strani potkoljenice, gdje povezuje mišiće stražnje strane potkoljenice s petnom kosti. Njena glavna funkcija je prijenos sile mišića potkoljenice na stopalo, čime se omogućuje kretanje poput hodanja, trčanja i skakanja, kao i stabilizacija gležnja tijekom opterećenja. Unatoč iznimnoj čvrstoći i sposobnosti podnošenja velikih opterećenja, Ahilova tetiva je sklona ozljedama zbog relativno slabe vaskularizacije i anatomske građe, osobito kod fizički aktivnih osoba povećanjem životne dobi. Ruptura Ahilove tetive, bila parcijalna ili totalna, ozbiljna je ozljeda koja značajno narušava funkcionalnost donjeg ekstremiteta. Do rupture najčešće dolazi pri naglim i snažnim pokretima, poput skakanja ili iznenadne promjene smjera kretanja. Klinička slika uključuje bol, oticanje, smanjenu funkciju i nemogućnost stajanja na prste. Dijagnostika se temelji na specifičnim testovima, među kojima su najpouzdaniji Thompsonov test i Matlesov test, koji procjenjuju integritet tetive kroz promatranje plantarne fleksije stopala pri kompresiji potkoljenice. Liječenje rupture može biti operacijsko (otvorena, perkutana ili endoskopska metoda) ili konzervativno (imobilizacija i funkcionalna rehabilitacija), a izbor pristupa ovisi o dobi, aktivnosti i opsegu ozljede pacijenta. Operacijsko liječenje češće se primjenjuje kod mlađih i aktivnih osoba, dok se konzervativni pristup preferira kod starijih ili manje aktivnih pacijenata. Fizioterapijski proces započinje procjenom koja uključuje subjektivni i objektivni pregled, mjerenje opsega pokreta, mišićne snage i provođenje specifičnih testova. Rehabilitacija se individualno prilagođava i obuhvaća terapiju pokretom, elektrostimulaciju, terapijski ultrazvuk, laser, udarni val, manualne tehnike i vježbe za jačanje mišića. Dodatne metode, poput kinesio tapinga, IASTM, PNF tehnike i TECAR terapije, mogu doprinijeti oporavku. Cilj rehabilitacije je povratak funkcija, prevencija komplikacija i omogućavanje povratka pacijenta svakodnevnim i sportskim aktivnostima, uz naglašenu važnost timskog pristupa između pacijenta, fizioterapeuta i liječnika radi optimalnog ishoda liječenja.The Achilles tendon is the strongest and longest tendon in the human body, located at the back of the lower leg, where it connects the muscles of the calf to the heel bone. It' s primary function is to transmit the force generated by the calf muscles to the foot, enabling movements such as walking, running, and jumping, as well as stabilizing the ankle during weight-bearing activities. Despite it's exceptional strength and ability to withstand significant loads, the Achilles tendon is prone to injury due to its relatively poor vascularization and anatomical structure, particularly in physically active individuals and with increasing age. A rupture of the Achilles tendon, whether partial or complete, is a serious injury that significantly impairs the functionality of the lower limb. Ruptures most often occur during sudden and forceful movements, such as jumping or abrupt changes in direction. The clinical presentation includes pain, swelling, reduced function, and the inability to stand on the toes. Diagnosis is based on specific tests, with the most reliable being the Thompson test and the Matles test, which assess the integrity of the tendon by observing plantar flexion of the foot during compression of the calf. Treatment of a rupture can be surgical (open, percutaneous, or endoscopic methods) or conservative (immobilization and functional rehabilitation), with the choice of approach depending on the patient's age, level of activity, and extent of the injury. Surgical treatment is more commonly used in younger and more active individuals, while conservative management is preferred for older or less active patients. The physiotherapy process begins with an assessment that includes subjective and objective examination, measurement of the range of motion, muscle strength testing, and the use of specific diagnostic tests. Rehabilitation is individually tailored and includes movement therapy, electrical stimulation, therapeutic ultrasound, laser therapy, shockwave therapy, manual techniques, and strengthening exercises. Additional methods, such as kinesio taping, IASTM, PNF techniques, and Tecar therapy, can contribute to recovery. The goal of rehabilitation is to restore function, prevent complications, and enable the patient to return to daily and sport's activities, with an emphasis on a team approach between the patient, physiotherapist, and physician for an optimal treatment outcome