La tendinite achilléenne ou tendinite d’Achille est une blessure de surmenage causant une douleur au tendon d’Achille. Le tendon d’Achille est le tendon épais et solide situé derrière la cheville. La tendinite d’Achille peut être difficile à soigner et demande une prise en charge complète médical et paramédical.
La tendinite d’Achille provoque ainsi une douleur intense près de l’arrière du talon. Bien que le tendon d’Achille soit l’un des plus longs et solides du corps humain, il peut avoir besoin de temps pour guérir. Cette condition est souvent causée par une pronation et par une sollicitation excessive du tendon, et représente une blessure très fréquente chez les coureurs.
I- ETIOLOGIES
Très nombreuses relevant « d’une enquête policière » :
- répétition du même geste sportif
- technique de course inadaptée avec une attaque par le talon
- modification des habitudes d’entraînement, mise en place d’un programme non adapté par le patient.
- changement de terrain d’entraînement
- couse systématique sur sol dur
- mauvaises chaussures, avec des chaussures usées ou destinées à un autre sport
- Troubles de la statique plantaire : pieds creux ou pieds plats, d’où la necessité d’une prise en charge podologique
- pas de pratique d’étirements sportifs (même si les étirrements avant ou après l’effort ne fait pas consensus dans le monde du sport, il peut avoir un effet bénéfique dans la prévention de l’apparition de tendinopathies.)
- mauvaise alimentation
- mauvais soins dentaires
- hydratation insuffisante, par prolongement une mauvaise hygiène alimentaire peut provoquer des tendinites.
- trouble métabolique
- prise de médicaments
- surentraînement
II- SIGNES CLINIQUES
La tendinite d’Achille chronique présente les symptômes suivants :
- Début d’une douleur dans le tendon d’Achille sur une période de plusieurs semaines ou mois.
- Douleur au début et pendant une séance d’exercice.
- Douleur dans le tendon d’Achille en marchant ou en montant des escaliers.
- Raideur dans le tendon d’Achille, surtout le matin ou après une période de repos.
- Présence possible de nodules ou de bosses dans le tendon d’Achille au-dessus du talon.
- Sensibilité du tendon d’Achille au toucher lorsqu’on appuie dessus ou qu’on le presse sur les côtés.
- La zone au-dessus du tendon d’Achille peut être enflée ou s’être épaissie.
III- TRAITEMENT
Le traitement se concentre initialement sur la prise en charge de la douleur et de l’inflammation pour diminuer la gène fonctionnel et facilité un retour graduel à l’activité. Il n’existe pas de traitement unique pour la tendinite du tendon d’Achille; l’approche est plutôt constituée d’une combinaison de méthodes pluridisciplinaire nécessitant de la patience. Il est important de rechercher un traitement le plus tôt possible pour empêcher la blessure de devenir chronique.
Des orthèses plantaires sur mesure aideront à contrôler le mouvement vertical du talon et à conserver un bon alignement pour soulager le stress du tendon d’Achille.
Parmi certains remèdes pour le tendon d’Achille, on peut notamment inclure :
- L’application de froid pour réduire la douleur et l’inflammation.
- Un repos suffisant pour empêcher la blessure de devenir chronique.
- Appliquer de la chaleur au tendon avant une séance d’entraînement pour le réchauffer.
- L’utilisation de K-TAPE peut permettre de soulager les douleurs du tendon.
Un traitement professionnel inclurait notamment :
- Un IRM et ultrason pour diagnostiquer avec plus de précision l’étendue de la blessure;
- Un diagnostic de la cause de la blessure et la recommandation d’orthèses plantaires ou un changement de la méthode d’entraînement pour éviter une nouvelle blessure;
- Plâtrer si nécessaire;
- Électrothérapie et thérapie laser pour soigner la blessure;
- En dernier ressort, l’intervention chirurgicale.
Voici l’exercice de choix pour le traitement des tendinopathies achiléennes (aussi appelées tendinite ou tendinose d’Achille). Cet exercice excentrique pourra être pratiqué 2 fois par jour, 3 séries de 20 à 40 répétitions. Une progression de difficulté est aussi proposée pour augmenter l’exigence ou rendre l’exercice plus fonctionnel. Cet exercice peut aussi être pratiqué pour les périostites / shin splint, les tendinopathies des péroniers et du tendon du tibial postérieur et les fasciapathies plantaires (fasciite).
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