DISORDERS OF THE ACHILLES TENDON

by Jonathan B. Feibel, M.D.

Have you ever been curious about the meaning of the term “Achilles heel”? According to Greek mythology, Achilles’ mother dipped him into the river Styx making him invincible. As the myth goes, she held him by his heel to submerge him in the river. Achilles became protected everywhere except his heel where he had been held by his mother. Hence the term “Achilles heel.”

The Achilles tendon attaches the calf muscles to the heel bone (calcaneus) and is responsible for plantar flexing the foot (pushing down like on a gas pedal). It is the largest and strongest tendon in the body. Unfortunately, it is also prone to injury because of the amount of impact it experiences.

There is a very wide spectrum of Achilles tendon disorders. Some are caused by overuse type injuries, while others are associated with a sudden injury. Achilles tendon ruptures (tears) are usually the result of a sudden injury. It is very common in the 20-50 year old athlete, often the so called “weekend warrior.” Sports that often lead to this injury include basketball, volleyball, skiing and other jumping sports. Patients often complain of feeling a pop followed by excruciating pain. Often he/she is unable to walk after the injury. Patients often swear that another player kicked them or that they were shot in the back of the calf.

There are not a lot of non-operative treatments for patients in this age group with Achilles tendon ruptures. Most of the time, surgery will give the best, most reliable result for improvement in long-term function of the Achilles tendon. Surgery will be followed by a period of immobilization and eventually rehabilitation through a formal physical therapy program. Patients can expect a return to sports within four to six months.

Chronic problems with the Achilles tendon can occur as a result of overuse injuries. These can occur at the mid-portion of the Achilles tendon or where the Achilles tendon inserts into the heel. The initial treatment of these disorders is conservative treatment with anti-inflammatories and activity modification. If pain continues or worsens, then the patients are often immobilized in a removable boot. A majority of patients improve with this type of treatment. For those who don’t get better, surgery is the next step. The tendon is debrided (cleaned up) at the sight of inflammation. If this occurs at the site where the Achilles tendon inserts into the heel, it is usually associated with a bony spur off the heel that needs to be resected at the time of surgery. Results of surgery are usually good with this type oftreatment. Immobilization and rehabilitation is similar to that of an Achilles tendon rupture surgery.

Unlike Achilles whose weak point was his heel, with improved treatments both surgical and non-surgical, patients don’t have to live with the lifelong Achilles tendon condition that he experienced.

Did you know?

The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain flexibility in the ankle joint.