Человек, у которого имеется патология связок стопы, не может нормально ходить, ему трудно стоять и опираться на пораженную ногу, при пальпации травмированной зоны болевой синдром усиливается. Рассмотрим причины и симптомы повреждения связочного аппарата, а также существующие схемы лечения недуга.
Растяжение связок: сущность, код по МКБ-10
Связки стопы фиксируют голеностопный сустав, служат для крепления костей ступни, обеспечения ее стабильности и подвижности.
В районе стопы имеется несколько групп связок:
- наружные: пяточная, задняя таранно-малоберцовая, передняя;
- дельтовидная (внутренняя);
- межберцовый синдесмоз;
- поперечная, межберцовые (задняя и передняя).
Растяжение связок стопы – одна из самых частых травм нижних конечностей. Получить повреждение можно при совершении неосторожного движения ногой, быстром передвижении или беге без соблюдения техники безопасности, хождении по неровной поверхности.
При растяжении происходит разрыв эластичных волокон связки, частично или полностью теряется их способность выполнять свои функции.
Исходя из характера повреждения связочного аппарата, определяют:
- Нарушения целостности участков отдельных связок: способность к передвижению сохраняется.
- Разрыв большого количества связок: движения сильно затруднены, но возможны.
- Полный разрыв: разрушаются все связки, возможность двигаться отсутствует полностью.
В международной классификации болезней (МКБ-10) травмы голеностопного сустава и стопы обозначены кодом S93.
Симптомы
Растяжение связок стопы проявляется следующими симптомами:
- боль (интенсивность болевых ощущений зависит от степени тяжести недуга);
- образованием подкожной гематомы вследствие разрывов кровеносных сосудов;
- отеком, распространяющимся на всю область ступни;
- повышением температуры больного участка;
- ограничением подвижности.
Интенсивность проявления болезненности зависит от степени растяжения (первой, второй, третьей).
Легкое растяжение связок
Характеризуется небольшим надрывам связочного пучка. Сопровождается несильной тянущей болью, движения конечностью не затруднены, человек может свободно передвигаться.
Средняя степень
Наблюдаются значительные повреждения волокон, болевые ощущения становятся более выраженными, движения ограничены. Нормально ходить человек не может в течение пяти-семи дней.
Тяжелое растяжение связок голеностопа
Происходит полный отрыв связки. Симптоматика схожа с переломом: кости конечности смещаются, стопа теряет способность двигаться, на ногу нельзя ступить или опереться. Болевой синдром сильный, присутствует отечность рядом расположенных тканей.
Провоцирующие факторы
Ступня – часть нижней конечности, наиболее подверженная травмам. Спровоцировать повреждения связок и сухожилий в данной области способны:
- ношение обуви на высоком каблуке;
- хождение по неровной, скользкой поверхности;
- активный бег;
- падения с высоты своего роста;
- резкие повороты и выпады, подворачивания ноги;
- прыжки.
В группе риска находятся:
- пожилые;
- дети;
- спортсмены;
- люди, чья профессиональная деятельность связана с движением, перемещением тяжестей вручную (грузчики).
Вероятность появления недуга повышается у лиц, страдающих от ожирения, воспалительных процессов в суставах, разрушения хрящевой ткани, заболеваний нервов и мышц, имеющие анатомическое недоразвитие связок, врожденные аномалии скелета нижних конечностей (косолапость, высокий свод стопы), плоскостопие. Часто подворачиваться ноги могут в результате усталости от длительной ходьбы.
Патология также наблюдается при сильных ушибах конечности.
Диагностика
Устанавливают наличие травмы посредством следующих мероприятий:
- визуальный осмотр и сбор анамнеза больного;
- ультразвуковое обследование сустава;
- магнитно-резонансная томография: помогает оценить состояние сочленения и близкорасположенных мягких тканей;
- рентгенография: устанавливает наличие переломов, смещения костей.
Схема лечения пострадавшего определяется врачом-травматологом исходя из результатов проведенных диагностических обследований.
Первая помощь при растяжении
При травмировании конечности в области стопы необходимо:
- Максимально обездвижить поврежденную ногу, придать ей возвышенное положение: так отек не будет усиливаться.
- Приложить холодный компресс: он поможет унять болевые ощущения, облегчит состояние пострадавшего.
- Наложить на больную зону компрессионную повязку. Можно воспользоваться эластичным бинтом.
Если боль очень сильная, то можно принять обезболивающие препараты, противовоспалительные местные средства.
Больного человека нужно срочно доставить в травмпункт в том случае, если:
- сочленение полностью обездвижено;
- конечность деформирована, видны патологические костные выступы;
- присутствует выраженная гипертермия кожи в зоне получения травмы, сильная припухлость, кровоподтеки, повышается температура тела;
- состояние пострадавшего не улучшается в течение нескольких дней, стопы сильно болят, ими трудно или невозможно пошевелить.
Чего делать нельзя?
Первые три дня после получения травмы больному категорически не рекомендуется:
- двигаться: физическая активность способствует дальнейшему травмированию;
- осуществлять тепловые процедуры и массаж – они усиливают отек.
Пациентам с повреждениями связок нельзя употреблять спиртные напитки: это значительно тормозит процесс восстановления. Игнорировать признаки растяжения связок запрещено.
Лечение
Растяжение связок стопы предполагает комплексное лечение, что подразумевает применение медикаментозных средств, физиотерапевтических и нетрадиционных методов. В случае перелома, сильного смещения костей, наличия осколков больному показано оперативное вмешательство.
К сведению. Срок восстановления после травмирования зависит от степени его тяжести и характера, возраста и общего состояния здоровья пациента.
Медикаменты
Больному прописывают следующие группы медикаментозных средств:
- Противовоспалительные и обезболивающие: Диклак гель, Вольтарен, Ибупрофен.
- Противоотечные: Троксевазин, Троксерутин, Лиотон, Гепариновая мазь. Применяются, начиная со второго дня после получения травмы.
- Согревающие: Капсикам, Финалгон, Апизартрон, Випросал, Долобене.
Инъекционно или перорально используются такие лекарства, как Ибупрофен, Найз, Нурофен, Темпалгин, Индометацин, Седалгин.
Физиотерапия и массаж
Физиотерапевтические процедуры способствуют лучшему усвоению лекарств, стимулируют кровообращение и питание пораженной зоны, благотворно влияют на обменные процессы.
При растяжении связок голеностопного сустава назначаются:
- электро- и фонофорез;
- УВЧ, магнито- и лазеротерапия;
- грязевые и минеральные ванны;
- парафиновые и озокеритовые лечебные сеансы;
- массаж.
Физиотерапевтические процедуры нельзя назначать при открытых ранах, проблемах с почками, сердцем, психических расстройствах, онкологических и инфекционных заболеваниях, беременности.
Народные методы
Что делать при растяжении связок стопы ноги, знает нетрадиционная медицина. Чтобы снять отек и облегчить самочувствие пострадавшего, можно сделать компресс из:
- водки или спирта: в жидкости смачивают ткань, прикладывают на больное место, оставляют на 6-8 часов;
- лука: две луковицы трут на терке, добавляют ст. ложку соли. Смесь наносят на пораженный сустав;
- картошку: в тертую картофельную массу вводят измельченную луковицу, сок нескольких капустных листьев, чайную ложку сахара. Полученный состав выкладывают на больное место под повязку на ночь, утром снимают.
Для лечения растяжения связок в домашних условиях также используются:
- Ванночки для ног из герани: 2 ст. л. измельченных листьев заливают водой, проваривают на медленном огне в течение получаса.
- Примочки из полыни: две столовые ложки рубленного растительного сырья заваривают 1 стаканом кипятка.
Следует помнить, что данные методы не являются основными. Они не способны вылечить патологию окончательно, а лишь дополняют медикаментозную терапию. Перед тем, как лечить растяжение связок на ноге народными рецептами, нужно обязательно проконсультироваться с врачом.
Хирургическое лечение
Если произошел полный разрыв связок стопы, то поврежденные волокна требуется сшивать вручную. С этой целью пациенту назначается операция. При необходимости травмированный участок связочного аппарата заменяют искусственным.
Несвоевременно проведенная процедура может спровоцировать усугубление состояния пациента и привести к частичной или полной утрате им трудоспособности.
Осложнения
Лечить растяжение связок стопы, сухожильные повреждения следует своевременно. Игнорирование симптомов недуга приводит к возникновению серьезных осложнений. Среди основных:
- неправильное срастание поврежденных элементов и нарушение нормального функционирования сустава;
- развитие воспалительного процесса в результате проникновения в открытую рану инфекции.
Если больному не оказать вовремя квалифицированную медицинскую помощь, то в дальнейшем его могут ожидать инвалидизация или летальный исход. 
Реабилитация
Реабилитационный период после перенесенной травмы подразумевает:
- Использование бандажа. Устройство фиксирует сустав, уменьшает нагрузку, снижает риск повторного травмирования.
- Занятия лечебной физкультурой. Они:
- восстанавливают тонус;
- улучшают деятельность внутренних органов и систем;
- активируют кровоток;
- предупреждают мышечную атрофию;
- укрепляют суставы.
Приступать к занятиям рекомендуют, начиная с третьего дня после начала лечения.
Упражнения выполняются в щадящем режиме. При осуществлении каждого из них нужно строго соблюдать технику безопасности, увеличивать нагрузку постепенно.
Для полного восстановления после травмы связок стопы может потребоваться не менее полугода. В это время целесообразно придерживаться диеты: есть натуральные продукты, богатые кальцием, свежие овощи и фрукты, холодец, пить достаточное количество воды, соблюдать покой и не перетруждать конечности.
Профилактика
Чтобы снизить риск появления травмы в области стопы, следует:
- носить удобную повседневную обувь;
- ходить по ровным поверхностям, избегать неровностей, скользких поверхностей;
- укреплять связочный аппарат с помощью регулярного выполнения физических упражнений;
- соблюдать технику безопасности на работе, при проведении тренировок, спортивных соревнований;
- вести здоровый образ жизни.
Вывихи, разрывы и растяжение связок – недуги, которые причиняют много неприятных ощущений. Пролечивать их следует обязательно и до полного выздоровления больного. Недолеченные растяжения способны повлечь за собой рецидивы, спровоцировать осложнения.
Зачастую растяжение связок и мышц стопы происходит после травмы, ушиба или вывиха голеностопа. Такое случается при перемещении по неровной или скользкой поверхности либо может быть следствием повышенной нагрузки на ступни при прыжках с большой высоты. После растяжения человека беспокоят характерные симптомы: нога отекает, появляется выраженная и острая боль. Восстановление проходит под наблюдением врача, но если случился надрыв связок, без операции не обойтись.
Каковы причины нарушения?
Растяжение связок стопы зачастую связано с травмированием или вывихом нижней части конечности. Голеностопный сустав имеет сложное строение, и одна из групп связочного аппарата, расположенная вдоль лодыжки, особо подвержена травмированию и растяжению. Травму или ушиб голеностопа можно получить под воздействием таких факторов:
- чрезмерная нагрузка на нижние конечности;
- занятия тяжелоатлетическими видами спорта;
- подворачивание голеностопа;
- большая масса тела;
- постоянное ношение обуви на высоком каблуке;
- врожденные аномалии строения опорно-двигательного аппарата.
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Характерные симптомы
Если человеку удалось растянуть связки, его сразу же начинают беспокоить острые боли, иррадиирующие от пятки и выше. На месте повреждения образуется опухоль, из-за которой подвижность конечности ограничивается. При внутреннем кровоизлиянии образуется гематома, локально наблюдается повышение температуры, кожа становится покрасневшей. При разрыве связок на ноге человек не может ходить.
Первая помощь
Лечить растяжение связочного аппарата должен врач после диагностических исследований. Но до приезда скорой пострадавшему, который подвернул ногу, нужно помочь. Первая помощь при растяжении связок стопы состоит из таких этапов:
- В первую очередь нужно избавиться от обуви, потому что если стопа сильно распухнет, снять ее не получится.
- Если беспокоит сильный болевой симптом, можно дать обезболивающие таблетки, например, «Нимесулид», «Ибупрофен».Также поможет «Нурофен» при растяжении связок.
- Конечность обездвиживают при помощи подручных материалов или специальной шины.
- Чтобы снять отек и обезболить, к пораженному участку прикладывают холодный компресс.
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Что делать дома при растяжении связок стопы?
Если диагностика показала несущественное повреждение без разрывов, проводится лечение растяжения связок голеностопа в домашних условиях. Доктор прописывает препараты и мази, которые помогут устранить неприятную симптоматику и ускорить процесс восстановления. Кроме медикаментозной терапии, лечение связок проводится с помощью упражнений, физиотерапевтических процедур, массажа. Разрешено также лечение народными средствами.
Препараты
Чтобы быстро снять воспаление и отечность, перорально или инъекционно назначаются нестероидные противовоспалительные лекарства:
- «Нурофен»;
- «Нимесил»;
- «Ибупрофен»;
- «Найз»;
- «Темпалгин».
Сосудостимулирующие средства помогут нормализовать кровообращение в пораженном участке:
Обезболивающее действие оказывают противовоспалительные мази. Быстро вылечить проблему помогут:
Если при растяжении образовалась гематома, снять ее помогут мази:
- «Троксевазин»;
- «Лиотон»;
- «Троксерутин»;
- гепариновая мазь.
После снятия отечности можно воспользоваться мазью Капсикам.
Когда отечность начнет сходить, по согласованию с врачом лечение дома можно продолжить с помощью разогревающих наружных средств, например, таких:
- «Финалгон»;
- «Долобене»;
- «Капсикам».
Чтобы укрепить связки и быстрее восстановить функциональность сустава, в острый период важно максимально ограничить подвижность конечности.
Ежедневные упражнения и курс ЛФК
Зарядку делать при растяжении ноги можно уже на 3—4 день после травмы, особенно если чувствуется слабость и ограниченность движений в голеностопе. Каждое утро после пробуждения рекомендуется выполнять такой комплекс упражнений:
- вращения в разные стороны;
- сгибание стопы в суставе вперед-назад;
- быстрые движения пальцами ступни.
С помощью физиотерапевта стоит подобрать курс ЛФК, который поможет:
- снять боль и отек;
- нормализовать функционирование сустава;
- натренировать мышцы;
- улучшить кровообращение.
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Физиотерапевтическое лечение и массаж
Когда состояние нормализуется и острый период минует, рекомендуется пройти курс физиопроцедур. Благодаря такому способу лечения удастся нормализовать кровообращение в пораженном участке, и ткани начнут заживать и регенерировать активнее. В составе физиотерапии присутствуют такие процедуры:
- фонофорез, во время которого вводится препарат «Гидрокортизон»;
- электрофорез с препаратами Са;
- лазерное прогревание;
- магнитотерапия;
- УВЧ.
Мануальный массаж тоже помогает в восстановлении, способствуя быстрому заживлению поврежденных связок. Процедуру разрешено выполнять после снижения отека и болевого симптома. Врач, который будет проводить манипуляции, должен быть ознакомлен с диагнозом. Сначала массажные движения выполняются осторожно. Через 2—3 сеанса растирания, похлопывания и постукивания становятся интенсивней. Главное условие — во время процедуры не должно быть боли и дискомфорта.
Народные средства
В качестве вспомогательных процедур, как дополнение к традиционным, можно проводить лечение народными методами. Все рецепты и способы их применения необходимо согласовать с врачом, потому что неправильное применение может спровоцировать негативные последствия. Рекомендуется использовать такие народные средства при растяжении голеностопа и связочного аппарата:
Для приготовления аппликации листья алоэ предварительно измельчают.
- Примочка из лука. Крупную луковицу измельчить до пюреобразного состояния. В готовую кашицу добавить 1 ст. л. меда, все хорошо перемешать. На ткань из натурального материала выложить готовое средство, приложить к голеностопу. Сверху зафиксировать полиэтиленом и надеть шерстяной носок.
- Аппликация из алоэ с облепиховым маслом. Крупный лист растения измельчить, добавить 2—3 капли масла. Компресс приложить к поврежденному участку на всю ночь, зафиксировав пищевой пленкой и бинтом.
Такие компрессы помогают снять отечность и избавить от болей. Чтобы нормализовать кровообращение, рекомендуют ежедневно делать на ноги водочный компресс. Процедура проводится по такому алгоритму:
- Приготовить теплую воду для ножной ванночки, добавив в нее 2—3 горсти морской соли.
- Попарить ступни 10—15 мин.
- Вытереться насухо, затем обмотать больную конечность хлопчатобумажной тканью, пропитанной водкой.
- Зафиксировать все пищевой пленкой, сверху надеть теплые носки.
Можно использовать другие народные средства при растяжении связок голеностопного сустава:
Чтобы приготовить мазь, листья лопуха нужно измельчить.
- Мазь из козьего жира и лопуха. Размягчить на паровой бане 2 ст. л. жира. Лопух помыть и измельчить. Соединить ингредиенты, после чего добавить еще 4 натертых зубчика чеснока. Мазать средство ежедневно на больной участок, желательно на всю ночь, чтобы вещества, входящие в мазь, могли полностью впитаться в кожу.
Вернуться к оглавлению
Когда нужна операция?
Если целостность связок голеностопного сустава нарушена, врач принимает решение о проведении хирургического лечения, во время которого разрушенные ткани восстанавливаются методом сшивания. Вид операции определяется врачом после диагностических исследований. Оперативная терапия проводится через 1,5 месяца после повреждения, потому что хирургические манипуляции сразу после травмы вызывают осложнения в виде контрактур. Хирург зашивает поврежденные связки или подшивает конец к кости. При необходимости удаляются поврежденные ткани.
Профилактика
Чтобы предотвратить повторное растяжение связок голеностопного сустава, важно укреплять мышечный корсет голени. После травмы рекомендуется обратить внимание на обувь, которую приходится носить ежедневно. Если она неудобная, на высоком каблуке или не подходит по размеру, стоит поменять ее, отдав предпочтение ортопедическим моделям.
Также немаловажно контролировать массу тела, и если до повреждения связок она превышала норму, в период и после лечения вес важно привести в норму. Это легко сделать с помощью правильного питания, регулярных физических нагрузок и активного образа жизни. Если дозировать нагрузки на нижние конечности, избегать тяжелых травм и ушибов, удастся предотвратить повторное растяжение или разрыв связок голеностопа.
Растяжение связок стоп – довольно распространенный вид травм. Именно на них лежит большая нагрузка во время ходьбы и занятий спортом. У прекрасной половины человечества подобные растяжения часто случаются при неудачной ходьбе в обуви на высоких каблуках.
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Предупредить
Чтобы предупредить травму голеностопного сустава, нужно избегать передвижений по неровным тротуарам или дорожкам. Резкое подворачивание ноги может привести к серьезным последствиям. Особенно, если прежнее растяжение связок стопы не было долечено. Причинами повреждения может быть избыточная масса тела, подъем тяжелых предметов, плоскостопие. Игнорирование занятий спортом и использование неудобной обуви также могут привести к ослаблению мышц.
Внимание! Повторяющиеся случаи растяжения связок провоцируют деформацию ступни и даже разрушение кости.
Понять и распознать
Симптомы разрыва мышечных волокон хорошо знакомы многим из нас. Это болевые ощущения в области наружной лодыжки ноги, отек, при сильных травмах – гематома. Возможно повышение температуры тела человека, ограниченность движений при ходьбе.
Специалисты выделяют три степени растяжений:
Лечение в домашних условиях
Чтобы быстро вылечить растяжение связок стопы, в первый день к поврежденному месту нужно прикладывать холод в виде холодных примочек или ледяной грелки. Следующие несколько дней нужно наносить йодную сетку. Она поможет снять воспаление в травмированном месте.
Затем можно начать накладывать на стопу компрессы. Хорошее действие оказывает компресс на молоке. Нужно смочить марлю в горячем молоке и прикрепить, поверх замотать пищевой пленкой или полиэтиленом и укутать теплой тканью для согревания. Компресс нужно накладывать свежий после остывания. Это снимет боль и способствует быстрому заживлению.
Только покой
Внимание! Если же с вами произошла подобная травма, знайте, что лечение связок стопы необходимо начинать незамедлительно.
Наряду с медицинской помощью, важно применять и народные средства в домашних условиях. Травмированная нога должна находиться в полном покое. Для этого рекомендуют использовать возвышенность – например, подушку. Так улучшится венозный отток от травмированного участка, убавится боль, спадет отечность.
Лучше избегать движений ногой с поврежденными связками в первые 2–3 дня. Иначе это может привести к еще более тяжелой травме, что негативно скажется на состоянии пострадавшего. Однако длительное обездвиживание может повлечь за собой атрофию мышечных волокон. Поэтому по истечении трех дней необходимо начинать постепенные движения больной ногой.
Внимание! Если боль снова стала продолжаться, значит, нужно сделать перерыв в лечебной гимнастике.
Бинтование
После приведения поврежденной ноги в состояние покоя, лечение лучше начинать с иммобилизации – обмотать травмированный участок эластичным бинтом. До проведения процедуры рентгенографии это поможет предотвратить возможный перелом. Можно использовать специальные ортопедические повязки – ортезы. Они уменьшат болевые ощущения, будут способствовать уменьшению отека, предохранят от внешних воздействий.
Внимание! Не следует делать бинтование слишком тугим и оставлять его на ночь.
Охлаждение
При отеке и покраснении к поврежденному участку необходимо незамедлительно приложить лед. Длительность «холодной» процедуры должна составлять 15 минут в течение первых 8–10 часов. Это будет способствовать сужению кровеносных сосудов и предупредит дальнейшее развитие гематомы. Рекомендуется принять анальгетический препарат. Кашица из репчатого лука, капусты или натертого сырого картофеля впитает в себя воду и позволит снять отек. Но при большом кровоподтеке в области травмы потребуется удаление крови.
Прогревание
На третьи-четвертые сутки на поврежденный сустав нужно накладывать согревающие компрессы и использовать мази с противовоспалительным эффектом. Спиртовой компресс способствует быстрому снятию отечности. Чтобы его сделать, нужно:
- марлевую повязку смочить в спиртовом растворе;
- наложить на травмированный участок;
- сверху накрыть полиэтиленом;
- надеть шерстяной носок или обмотать пуховым платком;
- оставить на 6–8 часов.
Полезный совет! Можно сделать аналогичный компресс с применением теплого молока.
Среди народных методов лечения растяжений также предлагается использовать лекарственные растения – отвары цветков ромашки, василька или зверобоя. Противовоспалительный и успокаивающий эффект окажут теплые компрессы из полыни, пижмы, почек тополя, арники, лаванды и других. Сухие компрессы также послужат прекрасным средством для прогревания поврежденной стопы. Для этого необходимо на хорошо раскаленной сковороде разогреть песок или соль. Затем пересыпать «горячее» средство на ткань и приложить к больному месту.
Мазь от растяжения
Чтобы быстрее вылечить растяжение, можно воспользоваться специальной мазью. Такую мазь можно приготовить в домашних условиях. Для этого понадобится 1 ст. л. обычного хозяйственного мыла, 1 желток куриного яйца, 2 ст. л. воды.
Натертое мыло смешайте с водой и добавьте желток. После тщательного смешивания нужно пропитать ткань или марлю этой смесью, закрепить при помощи бинта на стопе. Она снимет болевые ощущения от травмы, а растяжение связок быстро пройдет.
О первой помощи
Помните, что квалифицированная первая помощь при растяжении волокон обусловливает перспективу всего будущего лечения и восстановления ноги.
Первое время после получения травмы не стоит принимать горячую ванну или устраивать поход в сауну. Откажитесь от алкогольных напитков, иначе это может спровоцировать отечность стопы и приведет к длительной реабилитации. С массажем тоже лучше повременить, он будет эффективен уже в период восстановительного процесса.
Наберитесь терпения, поскольку продолжительность лечения, в зависимости от степени травмы и скорости регенерации тканей, может затянуться.
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