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Abstract: Achilles tendon injuries occur easily during sports such as running and jumping and are associated with sudden muscle pulling. In this case, the patient, swelling and pain occurred in the Achilles tendon area during accelerated running 5 hours before the visit. After coming to the hospital, he was confirmed to have an Achilles tendon injury with local edema and surrounding inflammation by MRI.
Basic information】Male, 22 years old
Disease Type】Achilles tendon injury
Hospital】Harbin First Hospital
Date of Consultation】March 2021
Treatment plan】Plaster fixation + pain relief (ketorolac aminotriol injection)
Treatment Period】7 days of hospitalization, 1 month of outpatient follow-up
Results] Achilles tendon repair, pain relief
I. Initial consultation
The patient came to the hospital with swelling and pain in the Achilles tendon. Upon inquiry, the patient was told that the condition suddenly occurred during accelerated running, and that he did not warm up sufficiently before exercising, and that he did not have the habit of warming up during normal exercise. At this point, based on the above information, the doctor considered that the patient might have suffered an Achilles tendon injury caused by strenuous exercise. Due to the lack of warm-up before exercise, the viscosity between the muscles is too large, and the resistance of the muscles is too large when they exert force; and not warming up before exercising for a long time can lead to accumulative subtle damage to the Achilles tendon, which is the pathological basis for the sudden injury of the Achilles tendon. Through a brief description and physical examination, the patient was instructed to undergo MRI to clarify the diagnosis and eventually confirm the Achilles tendon injury and determine the extent of the Achilles tendon injury. In order to repair the Achilles tendon, a plaster cast was applied to keep the Achilles tendon flaccid and the affected limb non-weight bearing, and the patient fully understood and cooperated with the treatment.
(MRI report)
II. Treatment history
According to the treatment plan, the doctor used a long-legged plaster cast to fix the affected lower limb with the knee joint flexed and the foot plantarflexed to ensure sufficient relaxation of the Achilles tendon. Depending on the patient’s review, the duration of immobilization is determined, which usually takes about 6 weeks. During plaster fixation, the toe is completely exposed outside the cast to facilitate observation of terminal blood circulation, terminal sensation, and toe movement to avoid the occurrence of over-tightening of the cast and compression of the vascular nerves of the lower extremity, leading to serious consequences such as osteo-fascial compartment syndrome. The patient should also elevate the affected limb continuously to eliminate swelling as soon as possible, restore blood supply to the Achilles tendon area, and promote Achilles tendon repair. Due to the pain in the acute stage, analgesic treatment was given, and ketorolac aminotriol injection was chosen for intramuscular injection.
III. Treatment effect
The patient was hospitalized for 7 days and underwent a series of systematic and active treatment. After the cast immobilization and application of analgesics, the painful symptoms at the Achilles tendon injury site gradually decreased, and the patient was able to actively elevate the affected limb and could assist in turning without inducing an increase in painful symptoms. After 1 week, the patient felt that the cast was loosening, mainly due to the edema of the Achilles tendon injury site, and in order to ensure the effect of cast fixation, the long-leg cast was replaced and continued to be fixed. 1 month after the follow-up, the pain symptoms disappeared and the Achilles tendon injury was gradually repaired.
IV. Precautions
We are glad that the patient’s discomfort was significantly reduced after the treatment. However, before full recovery, patients need to adhere to functional exercises every day, mainly lower limb muscle strength exercises, such as anterior straight leg lift and lateral leg lift exercises. Since self-exercise may have incorrect posture after going home, if local swelling and pain occur, stop immediately and contact the doctor by phone to confirm if a follow-up visit is needed. Weight-bearing walking is not advisable until the Achilles tendon has completely healed, as this can lead to further aggravation of the injury and affect the patient’s recovery. Patients also need to be aware that active or passive smoking can constrict the blood vessels supplying the Achilles tendon and affect the repair of the Achilles tendon, which needs to be taken seriously. In life, nutrition should be increased, more eggs, milk and other high-protein foods to enhance physical fitness and help accelerate the repair of the Achilles tendon.
V. Personal insight
In this case, since the patient did not have a serious Achilles tendon rupture, conservative treatment, such as plaster immobilization, can be used to limit muscle contraction and joint movement in the lower limb to ensure relaxation of the Achilles tendon area, thus promoting Achilles tendon repair. However, because the blood supply to the Achilles tendon is relatively low, the speed of repair after Achilles tendon injury is relatively slow. It is necessary to communicate with the patient about the treatment process of Achilles tendon injury in a timely manner so that the patient can actively cooperate with the clinician in the treatment of Achilles tendon injury and eventually achieve complete recovery. In addition, the patient in this case also reminded the majority of people who love sports, stretching or warming up far movement before exercise is necessary to effectively reduce sports injuries.