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Nama: herdanti

Npm 1102010 121


LI 1. Memahami dan menjelaskan struktur makro dan mikro dari Tendo Achilles
L0 1.1 letak dan fungsi anatomis
ANATOMI
Tendon Achilles berasal darigabungan tiga otot yaitu
gastrocnemius,soleus, dan otot plantaris. Pada manusia,letaknya
tepat di bagian pergelangankaki. Tendon Achilles adalah
tendontertebal dan terkuat pada tubuh
manusia.Panjangnya sekitar 15 sentimeter,dimulai dari
pertengahan tungkai bawah.Kemudian strukturnya kian
mengumpuldan melekat pada bagian tengah-belakang
tulang calcaneus
Fungsi anatomis
Saat otot betis gastrocnemius berkontraksi, maka tendon akan ikut tertarik
atas menarik kalkaneus sehingga kaki dapat berjinjit. Inilah yang
memungkinkan kaki kita dapatdigunakan untuk
sprinter,melompat,memanjat menaiki dan menuruni tangga. Dapat
menahan beban tubuh hingga 12 kali lipat saat berlari

ke

Lo 1.2 mengetahui dan menjelaskan sifat mikroskopik


achilles

tendo

Unsur-unsur dasar dari tendon adalah


bundel kolagen, sel-sel,
dan substansi dasar berupa
ekstraselular matriks, suatu
zat kental kaya
proteoglikan. kolagen memberikan
tendon kekuatan tarik, substansi dasar
memberikan dukungan struktural
untuk serat kolagen dan mengatur
perakitan prokolagen
ekstraselular ke kolagen dewasa,
Tenocytes, sel datar ujung meruncing,
didistribusikan di
antara fibril kolagen, mensintesis substansi dasar dan bangunan procollagen. Tendon Achilles tidak
memiliki banyak suplai darah. Pasokan darah lemah ditemukan di titik antara 2 dan 6 cm di atas
penyisipan ke dalam kalkaneus

1.3 Kinesiologi
Tendo Achilles merupakan bagian dari kompleks unit. Myotendinous yang
membentang di 3 sendi. Ketika otot otot dari tendo Achilles berkontraks maka lutut akan
fleksi, pergelangan kaki plantar fleksi dan supinasi subtalus.

LI 2 memahami dan menjelaskan ruptur tendo achilles


2.1 etiologi
Tendo mulai mengalami perubahan degenerasi pada umur 25-30 tahun. Robekan tendo kalkaneus
biasnya terjadi 5 cm di atas insersinya atau tepat pada perlekatannya di kalkaneus, bisa bersifat total
atau parsial. Robekan dapat pula terjadi hanya pada muskulus plantaris pada batas antara otot dan
tendoPenyebab utama terjadinya ruptur adalah ketika kita mengabaikan rasa sakit dan memaksa terus
menggunakan kaki tanpa istirahat. Ruptur biasanya diawali tendonitis yang overuse. Tendonitis
adalah penebalan tendon dan rasa sakit saat disentuh akibat penggunaan berlebihan dan akan sangat
terasa ketika dipakai berjalan. Pelatihan yang berlebihan misalnya pada penggunaan untuk berlari
yang menanjak serta pemakaian sepatu berhak dapat menyebabkan tendoitis Tentu saja faktor utama
adalah sesak yang berlebihan dari otot-otot kaki posterior, kontraksi terusmenerus otot-otot betis dan
paha belakang dapat berkontribusi untuk tendonitis Achilles berkepanjangan. Juga penyebab2 lainya
seperti Penyakit tertentu, seperti arthritis dan diabetes.Obat-obatan, seperti kortikosteroid dan
beberapa antibiotik yang dapat meningkatkan risiko pecah

2.2 gejala klinis

Rasa sakit mendadak dan berat dapat dirasakan di bagian belakang pergelangan kaki atau
betis
Terlihat bengkak dan kaku serta tampak memar dan kelemahan
Sebuah kesenjangan atau depresi dapat dilihat di tendon sekitar 2 cm di atas tulang tumit
Tumit tidak dapat digerakan turun atau naik

Klasifikasi
a.
-

b.

Robekan pada ligamen lateral


Robekan ligamen total
Trauma adduksi yang hebat dapat menyebabkan robekan total pada ligamen
lateral. Diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan klinik serta
foto stres pada pergelangan kaki. Pengobatan dengan restorasi ligamen secara
konservatif atau operatif.
Robekan ligamen parsial (strain)
Diagnosis dtrain ligamen lateral sama dengan yang total tetapi dengan
pemeriksaan foto stres tidak ditemukan adanya robekan. Pengobatan dengan
pemasangan verban elastis atau pemasangan gips dibawah lutut.
Robekan pada ligamen medial (ligamen deltoid)

Robekan terjadi karena adanya trauma abduksi. Robekan dapat bersama-sama dengan
lepasnya fragmen kecil pada robekan ligamen lateral. Pengobatan seperti robekan ligamen lateral

Lo 3 memahami dan menjelaskan pemeriksaan ruptur tendo achilles


3.1 pemeriksaan klinis
Pemeriksaan thompson (tes simond)
Tes ini dilakukan untuk mengetahui kelainan tendon yang terjadi di tulang calcaneus. Cara melakukan
tes ini, penderita tidur dengan posisi tengkurap, dengan kedua kaki dipinggir tempat tidur, lalu
dilakukan kompresi pada otot betis. Pada otot yang normal, setelah dilakukan kompresi maka akan
terjadi flexi plantar, sebaliknya jika setelah dilakukan flexi plantar dan tidak terjadi flexi plantar, maka
telah terjadi ruptur tendon achilles
3.2 pemeriksaan radiology
Magnetic Resonance Imaging dapat menunjukkan secara rinci kondisi tendon yang benar-benar
pecah. Achilles tendon orang yang normal dipandang sebagai daerah intensitas sinyal rendah pada
semua urutan. Hal kemiringan lancar tanpa cacat fokus. Gelap band tendon sendiri dapat dibedakan
dari tinggi intensitas sinyal pad lemak pra-achilles

Real-time, resolusi tinggi USG adalah murah, cepat, dan dinamis. Namun, sangat tergantung penafsir
karena memerlukan pelatihan dan pengalaman untuk benar menafsirkan gambar. . Gel USG
digunakan untuk
memastikan bahwa jumlah energi yang optimal dikembalikan ke
transduser penyelidikan, memungkinkan gambar dinamis dan panorama baik dari tendon. Serat
kolagen membujur di
Tendon Achilles mencerminkan energi ultrasonik, dan frekuensi tinggi
probe menunjukkan yang terbaik tendon
. Sebuah tendon yang normal muncul sebagai
sebuah, hypoechogenic pita seperti gambar yang terkandung di antara dua
hyperechogenic band. Band-band dipisahkan ketika
tendon santai dan lebih kompak ketika tendon
di bawah ketegangan. Ketika tendon Achilles pecah, ultrasonografi menunjukkan diskontinuitas
tendon dengan echogenicity menurun atau meningkat, tergantung pada kronisitas dari pecah

Radiografi dapat lebih membantu dalam diagnosis oleh mengesampingkan diagnosis lain seperti
avulsions kalkanealis atau lainnya

Li 4 memahami dan menjelaskan penatalaksanaan ruptur tendo achilles


4.1 2 jenis operasi untuk ruptur tendo achilles
There are two types of surgery to repair a ruptured Achilles tendon

In open surgery, the surgeon makes a single large incision in the back of the leg.

In percutaneous surgery, the surgeon makes several small incisions rather than one large
incision.
In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery
may be delayed for about a week after the rupture, to let the swelling go down.
What To Expect After Surgery
After either type of surgery, you will likely wear a cast, walking boot, or similar device for 6 to 12
weeks. At first, the cast or boot is positioned to keep the foot pointed downward as the tendon
heals. The cast or boot is then adjusted gradually to put the foot in a neutral position (not pointing up
or down). Many health professionals recommend starting movement and weight -bearing exercises

early, before the cast or boot comes off. Your total recovery time will probably be as long as 6
months.
Why It Is Done
This surgery is done to repair an Achilles tendon that has been torn into two pieces.
How Well It Works
In general:

Both open and percutaneous surgeries are successful. More than 80 out of 100 people who
have surgery for an Achilles tendon rupture are able to return to all the activities they did before the
injury, including returning to sports. 1

Although percutaneous surgery has traditionally been viewed as having higher rerupture rates
than open surgery, studies now show that the rerupture rates are similar. About 5 out of 100 people
who have surgery for an Achilles tendon rupture will rerupture after surgery. 2

Open surgery is more likely than percutaneous surgery to result in wound healing
problems. But damage to a nerve is more likely with percutaneous surgery. Newer techniques for
percutaneous surgery may make nerve damage less likely than when older techniques are used.
It is sometimes difficult to know how surgeries compare, because the ages and activities of those
having the surgeries differ. The success of your surgery can depend on your surgeon's experience, the
type of surgical procedure used, the extent of tendon damage, how soon after rupture the surgery is
done, and how soon your rehabilitation program starts after surgery and how well you follow it.
Talk to your surgeon about his or her surgical experience and success rate with the technique that
would best treat your condition.
Risks
The risks of Achilles tendon surgery include:

Skin infection at the incision site.


Normal complications of surgery or anesthesia , such as bleeding and side effects from
medicines.
Nerve damage.
Risk of repeat Achilles rupture. This risk, though, is typically less than the risk after
nonsurgical treatment.

The possibility that the healed tendon will not be as strong as before the injury.

Decreased range of motion.


4.2 pencegahan
Achilles Tendon Injury Prevention
Specific steps to minimize the risk of Achilles tendon injury include:

Wear the right shoes and sports shoes. The way a person walks, runs, and
jumps is related to their individual bio-mechanics: their bone, muscle, and
tendon structure. Achilles tendon injuries can be caused by common biomechanical issues such as high arches, low arches, having legs of slightly
different lengths, etc. Bio-mechanical issues can often be addressed by
wearing the right shoes: see Footwear .

Warm up before stretching or exercising. The term warm up should be


taken literally: exercise muscles a little to heat them up just prior to
stretching or exercise. Spend a minimum of ten minutes warming up.Warm
up examples include: walking slowly at the beginning of a long or fast walk,
slow cross court movements and volleys prior to playing tennis, a brisk walk
before jogging, jogging before running, lifting lighter weights before lifting
weights, etc. Focus on the leg muscles, with particular attention to the calf
muscles.

Stretch between warming up and exercising, and then again after


exercising. Although there is some controversy about the value of
stretching, many professionals believe that stretching helps prevent injury
and that flexibility is a key component of fitness. Stretch the back, hip, thigh,
and calf muscles. Tightness in one can lead to undue strain and tightness on
the others.
Pay particular attention to stretching the calf muscles because they are
directly connected to the Achilles tendon. Stretching can be done lying
down, sitting, or standing, and without any equipment.
However, some stretches are easier to do with an elastic band pull, when
leaning against a wall or on an inclined surface. Stretches are usually named
after the muscle being stretched, ie, gastroc (gastrocnemius) stretches and
soleus stretches for the calf muscles. Stretch gently and slowly. Hold each
stretch for half a minute to a minute.
As part of a stretching program, also consider massage. Lightly massage the
calf muscles before exercising and massage the calf muscles and Achilles
tendons after exercising. Although there is some controversy as to the
benefits of massage, many health professionals believe that massage:
reduces muscle and tendon tightness, promotes healing, reduces the time
muscles need to recover from exercise, and increases flexibility. Use the
fingers to massage the Achilles tendons.Use a rolling pin (or similar
commercial device) for the calf muscles.Apply ice therapy after massaging
the Achilles tendons.
Flexibility is difficult for many people to achieve: it often takes weeks or
months of consistent stretching to achieve greater flexibility. For the best
results: read some exercise books, consult with a trainer at your gym, or
consult with a physical therapist.

If you do aerobic and strengthening exercises on the same day, do the


aerobic exercises first. In aerobic exercises, such as running or tennis, the
leg muscles act as shock absorbers to protect the Achilles tendons, plus they
work to keep the body aligned so that the Achilles tendons are not unduly
twisted, stretched, or strained. Strengthening exercises, such as weight
lifting, are done to the point of muscle exhaustion. If strengthening exercises
are done first, then the muscles will be too tired to do a good job protecting
the Achilles tendons during the aerobic activity, increasing the chance of
injury.

Strengthen the leg muscles, particularly the calf muscles. Many people
with Achilles injuries have disproportionately weak calf muscles.Leg
exercises can be done without any equipment, with an elastic band pull, with
free weights, or with exercise machines. Good leg strengthening exercises
include: lunges, hip flexion band pulls, half (chair) squats, clean and press,
leg press, inner and outer thigh band pulls, leg raises, leg extensions, and leg
curls.

Of particular benefit to the calf muscles, and therefore to the Achilles


tendons, are calf raises and ankle band pulls. In order to help the Achilles
tendon, focus on strengthening the eccentric (calf lowering) rather than
concentric (calf raising) motion.
The anterior tibialis is the opposing muscle group to the calf muscles, so
strengthening the anterior tibialis helps to stretch the calf muscles. The
anterior tibialis is the small muscle group on the front of the lower leg: just
to the right of the right leg's shin bone and just to the left of the left leg's shin
bone. Its primary function is to flex the foot upward.
All of these exercises can be done in a variety of ways. For example, calf
raises can be done with one or two legs using: standing or sitting calf raise
machines, various leg press machines, a stool, a block of wood, a stairway,
or on a curb.
If the exercises are done consistently and properly, muscle strength will
improve in as little as two weeks. Proceed consistently and gradually. For the
best results: read some exercise books, consult with a trainer at your gym, or
consult with a physical therapist.

Test for injuries after working out. Using the thumb and forefinger, lightly
pinch different spots up and down the Achilles tendons. If the Achilles
tendons are not sore, great. If they are sore, this may be an indication of
Achilles tendinosis, which should be addressed right away.

Achilles Tendon Exercises and Stretches