Achillessehnenbeschwerden

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Patienteninformation.

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Ihre Mobilität unterstützen wir am OAG Campus durch präzise Diagnostik und individuell abgestimmte Behandlungen.

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Achillessehnenbeschwerden

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Patienteninformation vom OAG Campus.

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Die Achillessehne – Ursachen, Symptome und Therapie

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Die Achillessehne ist die robusteste und kräftigste Sehne des Menschen. Sie verbindet den dreiköpfigen Wadenmuskel mit der Ferse. Durch sie können wir beim Laufen die Fersen abrollen, abspringen, auf Zehenspitzen stehen oder im Auto aufs Gaspedal treten.

Dauereinsatz für die stärkste Sehne
Im Alltag und vor allem beim Sport ist die Achillessehne im Dauereinsatz. Auf sie wirken enorme Kräfte. Ein anschauliches Beispiel zeigt der Weltrekord im Marathon: Bei dieser Leistung überträgt die Achillessehne bei ca. 600 bis 800 Schritten pro Kilometer etwa 30.000-mal das Gewicht eines Kleinwagens. Kein Wunder also, dass Achillessehnenbeschwerden im Profisport aber auch im Alltag zu den häufigsten Beschwerden zählen.

Wie ist ein Schmerz einzuordnen?
Ob eine gezielte Belastung der Achillessehne sinnvoll ist, oder das Risiko einer einer akuten Verletzung erhöht ist nur durch die eine exakte Diagnostik zu beurteilen.
Schmerzen im Bereich der der Achillessehne können ganz unterschiedliche Ursachen haben. Um diese zu erkennen kombinieren wir in der Orthopädie am Gürzenich in Köln unsere langjährige sportorthopädische Erfahrung mit moderner Bildgebung (Ultraschall, MRT) und innovativen Bewegungsanalysen. Gerade im Bereich der Achillessehne ist eine schnelle und gezielte Behandlung entscheidend um Langzeitfolgen oder einen chronischen Beschwerdeverlauf zu vermeiden!

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Achillessehnenbeschwerden / Achillodynie

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Mögliche Ursachen

Bei einer Achillodynie unterscheidet man zwischen Problemen des Achillessehnen-Ansatzes am Fersenbein und der Sehne selbst im mittleren (Midportion), bzw. oberen Drittel. Für beides kommen mehrere Ursachen in Frage.

Am Achillessehnen-Ansatz:

Oberer Fersensporn/Ansatzverkalkungen
Haglund-Exostose
Schleimbeutelenzündungen (Bursa subachilla und Bursa subkutanes)
Stressreaktionen/Stressbrüche des Fersenbeins
Bei Kindern: Entzündungen der hinteren Wachstumsfuge des Fersenbeins (Apophysitis calcanei)

Im Bereich der Achillessehne selbst:

Akute Entzündungen der Sehnenscheide und/oder der Sehne
kuter Achillessehnenriss
Chronischer Verschleiß des Sehnengewebes (Tendinose) mit:
- Teilriss der Achillessehne
- Chronischem Achillessehnenriss

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Definition:

Achillodynie beschreibt meist chronische Schmerzen im Bereich der Achillessehne, häufig bedingt durch Überlastung oder degenerative Veränderungen. Bei einer Achillodynie unterscheidet man zwischen Problemen des Achillessehnen-Ansatzes am Fersenbein und der Sehne selbst im mittleren (Midportion), bzw. oberen Drittel.

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Diagnostik:

Klinische Untersuchung, Ultraschall zur Darstellung der Sehne, ggf. MRT.
Häufige Beschwerden: Belastungsschmerzen, morgendliche Anlaufschmerzen, Druckempfindlichkeit.

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 Therapie:

Um eine Chronifizierung zu vermeiden ist schnelles Handeln gefragt. Die auslösenden Belastungen sollten schnellstmöglich reduziert werden. Es können je nach Ursache konservative Maßnahmen wie exzentrisches Training, gezielte Physiotherapie, Stoßwellentherapie sowie regenerative Verfahren wie ACP-Therapie helfen.

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Akute Achillessehnenruptur

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Definition:

Der Grund für eine akute Achillessehnenruptur ist meist eine ungewohnte, heftige Belastung einer vorgeschädigten Sehne. Sie ist durch plötzliche Bewegungen, z. B. Sprints oder Richtungswechsel, überfordert. Bei älteren Patienten entstehen Rupturen häufiger durch verschleißbedingte Vorschädigungen.

Oft liegt ein Achillessehnenriss im sogenannten Midportion-Bereich, dem schlecht durchbluteten Bereich etwa zwei bis fünf Zentimeter über dem Ansatzpunkt der Achillessehne am Fersenbein. Das obere Drittel der Achillessehne im Bereich des Muskel-Sehnen-Übergangs oder ansatznahe, bzw. knöcherne Ausrisse der Sehne am Fersenbeins treten insgesamt seltener auf.

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Diagnostik:

Klinische Tests, Ultraschall und MRT zur Bestätigung. Häufige Beschwerden: Akuter Schmerz, plötzlicher Funktionsverlust (z. B. Unfähigkeit, auf den Zehenspitzen zu stehen), Schwellung.

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Therapie:

Operative Rekonstruktion oder – in ausgewählten Fällen – konservative Behandlung mit funktioneller Ruhigstellung und anschließender intensiver Physiotherapie.

Chronische Achillessehnenruptur

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Definition:

Die Gründe für chronische bzw. veraltete Achillessehnenrupturen sind vielfältig:

nicht erkannte oder nicht rechtzeitig behandelte akute Achillessehnenrisse
erneute Risse (Rerupturen) nach einer bereits erfolgten Erst-OP oder einer konservativen Behandlung
nicht erfolgreich konservativ oder operativ therapierte akute Risse mit einhergehenden Krafteinbußen.

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Diagnostik:

Klinische Untersuchung, MRT zur genauen Beurteilung von Lücke und Gewebequalität. Häufige Beschwerden: Anhaltende Schwäche, Unsicherheit beim Gehen, eingeschränkte Bewegungsfähigkeit.

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Therapie:

Die operative Behandlung ist hier die Therapie der Wahl. Primäres Therapieziel ist hierbei die Rekonstruktion der korrekten Achillessehnenlänge und somit die Wiederherstellung der Kraft und Funktion.

Je nach Anzahl der Vor-OPs, der Gewebsqualität der Sehne und der Größe des Sehnendefektes muss jedoch mit einer gewissen Krafteinbuße gerechnet werden!
Grundsätzlich können zwei Arten von Rekonstruktionstechniken unterschieden werden

Rekonstruktionen mit eigenem Achillessehnengewebe wie z. B. die Umkehrplastik. Dabei wird ein Sehnenstreifen aus den oberen Sehnenanteilen gewonnen, nach unten geklappt und somit der Sehnendefekt überbrückt.
Rekonstruktionen mit anderen Sehnen z. B. der langen Großzehenbeugersehne.
Letzten Endes ist die operative Therapie chronischer Achillessehnenrisse keine Standardtherapie und sollte immer individuell an den Patienten und den jeweiligen Befund angepasst werden.

Letzten Endes ist die operative Therapie chronischer Achillessehnenrisse keine Standardtherapie und sollte immer individuell an den Patienten und den jeweiligen Befund angepasst werden.

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Weitere Beschwerden:

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Überlastungsreaktion am Fuß

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Achillessehnenbeschwerden

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Peronealsehnenbeschwerden

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Tibialis-Anterior-Sehnenbeschwerden

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Bandverletzungen Sprunggelenk

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Knorpelschäden Sprunggelenk

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Plattfuß

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Der kindliche Fuß

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Rheumafuß

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Vorfußballenschmerz

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Fersenschmerz

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Haglundferse

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Hallux valgus

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Hallux rigidus

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Krallenzehen

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Schneiderballen

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Die Achillessehne – Ursachen, Symptome und Therapie

Achillessehnenbeschwerden / Achillodynie

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Mögliche Ursachen

Am Achillessehnen-Ansatz:

Oberer Fersensporn/Ansatzverkalkungen
Haglund-Exostose
Schleimbeutelenzündungen (Bursa subachilla und Bursa subkutanes)
Stressreaktionen/Stressbrüche des Fersenbeins
Bei Kindern: Entzündungen der hinteren Wachstumsfuge des Fersenbeins (Apophysitis calcanei)

Im Bereich der Achillessehne selbst:

Akute Entzündungen der Sehnenscheide und/oder der Sehne
kuter Achillessehnenriss
Chronischer Verschleiß des Sehnengewebes (Tendinose) mit:
- Teilriss der Achillessehne
- Chronischem Achillessehnenriss

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Definition:

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Diagnostik:

Klinische Untersuchung, Ultraschall zur Darstellung der Sehne, ggf. MRT.
Häufige Beschwerden: Belastungsschmerzen, morgendliche Anlaufschmerzen, Druckempfindlichkeit.

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 Therapie:

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Akute Achillessehnenruptur

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Definition:

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Diagnostik:

Klinische Tests, Ultraschall und MRT zur Bestätigung. Häufige Beschwerden: Akuter Schmerz, plötzlicher Funktionsverlust (z. B. Unfähigkeit, auf den Zehenspitzen zu stehen), Schwellung.

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Therapie:

Operative Rekonstruktion oder – in ausgewählten Fällen – konservative Behandlung mit funktioneller Ruhigstellung und anschließender intensiver Physiotherapie.

Chronische Achillessehnenruptur

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Definition:

Die Gründe für chronische bzw. veraltete Achillessehnenrupturen sind vielfältig:

nicht erkannte oder nicht rechtzeitig behandelte akute Achillessehnenrisse
erneute Risse (Rerupturen) nach einer bereits erfolgten Erst-OP oder einer konservativen Behandlung
nicht erfolgreich konservativ oder operativ therapierte akute Risse mit einhergehenden Krafteinbußen.

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Diagnostik:

Klinische Untersuchung, MRT zur genauen Beurteilung von Lücke und Gewebequalität. Häufige Beschwerden: Anhaltende Schwäche, Unsicherheit beim Gehen, eingeschränkte Bewegungsfähigkeit.

[/fusion_tab][fusion_tab title=“Therapie“ icon_color=“var(–awb-color1)“]

Therapie:

Rekonstruktionen mit eigenem Achillessehnengewebe wie z. B. die Umkehrplastik. Dabei wird ein Sehnenstreifen aus den oberen Sehnenanteilen gewonnen, nach unten geklappt und somit der Sehnendefekt überbrückt.
Rekonstruktionen mit anderen Sehnen z. B. der langen Großzehenbeugersehne.
Letzten Endes ist die operative Therapie chronischer Achillessehnenrisse keine Standardtherapie und sollte immer individuell an den Patienten und den jeweiligen Befund angepasst werden.

Letzten Endes ist die operative Therapie chronischer Achillessehnenrisse keine Standardtherapie und sollte immer individuell an den Patienten und den jeweiligen Befund angepasst werden.

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Weitere Beschwerden:

Überlastungsreaktion am Fuß

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Achillessehnenbeschwerden

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Peronealsehnenbeschwerden

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Tibialis-Anterior-Sehnenbeschwerden

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Bandverletzungen Sprunggelenk

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Knorpelschäden Sprunggelenk