臨床整形外科59巻3号

2024年03月発行

特集 知ってると知らないでは大違い　実践！ 踵部痛の診断と治療

アキレス腱付着部症の診断・評価・治療

著者： 松井智裕¹

所属機関： ¹済生会奈良病院整形外科／運動器再生医療センター

ページ範囲：P.239 - P.244

アキレス腱付着部症はスポーツ活動や加齢性変化がもとになって生じる腱付着部の変性と慢性炎症を主体とした障害である．超音波が画像検査として有用であり，理学療法(遠心性収縮運動など)，装具療法(補高やヒールカップがついた足底板)，局所注射療法(ヒアルロン酸，Prolotherapy，多血小板血漿など)，体外衝撃波治療，手術療法(Speed Bridge法，Dorsal Closing Wedge Osteotomy，Endoscopic Calcaneoplasty，Percutaneous Ultrasound Tenotomyなど)が行われる．

参考文献

1）Benjamin M, McGonagle D. The enthesis organ concept and its relevance to the spondyloarthropathies. Adv Exp Med Biol 2009;649:57-70.

2）Benjamin M, Ralphs JR. Fibrocartilage in tendons and ligaments:an adaptation to compressive load. J Anat 1998;193(Pt 4):481-94.

3）Shaw HM, Santer RM, Watson AHD, et al. Adipose tissue at entheses:the innervation and cell composition of the retromalleolar fat pad associated with the rat Achilles tendon. J Anat 2007;211(4):436-43.

4）Benjamin M, Redman S, Milz S, et al. Adipose tissue at entheses:the rheumatological implications of its distribution:a potential site of pain and stress dissipation? Ann Rheum Dis 2004;63(12):1549-55.

5）Matsui T, Kumai T, Kamijo S, et al. Effect of ankle motion and tensile stress at the achilles tendon on the contact pressure between the achilles tendon and the calcaneus. J Foot Ankle Surg 2021;60(4):753-6.

6）Chimenti RL, Flemister AS, Ketz J, et al. Ultrasound strain mapping of Achilles tendon compressive strain patterns during dorsiflexion. J Biomech 2016;49(1):39-44.

7）Reeves KD, Sit RWS, Rabago DP. Dextrose prolotherapy:a narrative review of basic science, clinical research, and best treatment recommendations. Phys Med Rehabil Clin N Am 2016;27(4):783-823.

8）d'Agostino MC, Craig K, Tibalt E, et al. Shock wave as biological therapeutic tool:from mechanical stimulation to recovery and healing, through mechanotransduction. Int J Surg 2015;24(Pt B):147-53.

9）Hausdorf J, Lemmens MAM, Heck KDW, et al. Selective loss of unmyelinated nerve fibers after extracorporeal ahockwave application to the musculoskeletal system. Neuroscience 2008;155(1):138-44.