Simpson Michael R, Howard Thomas M
Virginia Commonwealth University, Fairfax Family Practice, Fairfax, VA 22030, USA.
Am Fam Physician. 2009 Nov 15;80(10):1107-14.
Because our understanding of tendinopathy has evolved in recent years, the condition is now considered a degenerative process; this affects the approach to treatment. Initial therapy should always involve relative rest and modification of physical activity, use of rehabilitative exercises, and evaluation of intrinsic and extrinsic causes of injury. The posterior tibial tendon is a dynamic arch stabilizer; injury to this tendon can cause a painful flat-footed deformity with hindfoot valgus and midfoot abduction (characterized by the too many toes sign). Treatment of posterior tibial tendinopathy is determined by its severity and can include immobilization, orthotics, physical therapy, or subspecialty referral. Because peroneal tendinopathy is often misdiagnosed, it can lead to chronic lateral ankle pain and instability and should be suspected in a patient with either of these symptoms. Treatment involves physical therapy and close monitoring for surgical indications. Achilles tendinopathy is often caused by overtraining, use of inappropriate training surfaces, and poor flexibility. It is characterized by pain in the Achilles tendon 4 to 6 cm above the point of insertion into the calcaneus. Evidence from clinical trials shows that eccentric strengthening of the calf muscle can help patients with Achilles tendinopathy. Flexor hallucis longus tendinopathy is most common among ballet dancers. Patients may complain of an insidious onset of pain in the posteromedial aspect of the ankle; treatment involves correcting physical training errors, focusing on body mechanics, and strengthening the body's core. Anterior tibial tendinopathy is rare, but is typically seen in patients older than 45 years. It causes weakness in dorsiflexion of the ankle; treatment involves short-term immobilization and physical therapy.
由于近年来我们对肌腱病的认识有所发展，现在认为这种病症是一个退行性过程；这影响了治疗方法。初始治疗应始终包括相对休息和调整体育活动、进行康复锻炼以及评估损伤的内在和外在原因。胫后肌腱是足弓的动态稳定器；该肌腱损伤可导致伴有后足外翻和中足外展的疼痛性扁平足畸形（以多趾征为特征）。胫后肌腱病的治疗取决于其严重程度，可包括固定、矫形器、物理治疗或转至专科治疗。由于腓骨肌腱病常被误诊，可导致慢性外侧踝关节疼痛和不稳定，有这些症状之一的患者应怀疑患有该病。治疗包括物理治疗并密切监测手术指征。跟腱病通常由过度训练、使用不合适的训练场地以及柔韧性差引起。其特征是跟腱在插入跟骨点上方4至6厘米处疼痛。临床试验证据表明，小腿肌肉的离心强化训练有助于跟腱病患者。拇长屈肌腱病在芭蕾舞演员中最为常见。患者可能主诉踝关节后内侧隐匿性疼痛；治疗包括纠正体育训练错误、注重身体力学以及强化身体核心。胫前肌腱病很少见，但通常见于45岁以上的患者。它会导致踝关节背屈无力；治疗包括短期固定和物理治疗。
