My Achilles Heel
In Greek mythology Achilles was known as the great warrior of the Trojan War who ultimately succumbs to an arrow that strikes him in the tendon just above his left heel. The term “achilles heel” defines an area of weakness in something or someone that is otherwise constitutionally sound. While many of us mortals suffer metaphorically with our own achilles, others suffer physically from the actual anatomical source.
The achilles tendon is the largest tendon in the body and spans from the posterior mid-calf to the heel bone connecting three large powerful muscles to the back of the foot. These muscles which include the medial and lateral gastrocnemius, and the soleus allow for strong downward pushing of the foot essential for normal gait, jumping, running, lifting, climbing, and decelerating. Despite it’s size thetendon has a precarious blood supply which often hampers healing and may lead to chronic symptoms.
The tendon can be injured by acute overload, repetitive lesser loads, direct trauma, steroids, certain antibiotics including Ciproflaxin and Levaquin, and systemic diseases such as chronic renal failure and amyloidosis. The classic achilles tendon sudden rupture candidate is the sedentary forty- something chubby accountant playing racquetball. Athletes and non-athletes have an equal prevalence of lesser chronic achilles tendon issues.
Acute tendon ruptures usually occur on the tennis, racquetball, or squash court. The player typically feels a “pop” in the calf and swears someone just whacked him with a ball or racquet. Often, they can still walk with difficulty. These injuries need to be addressed expeditiously for a good outcome. Unfortunately, 10-20% of acute achilles ruptures are misdiagnosed as a “sprain” in ER’s and urgent care centers an X-Ray’s show normal bones and patients are not fully examined. Delayed diagnosis of acute ruptures leads to more involved surgeries and less favorable permanent outcomes.
More frequent achilles tendon problems involve acute and chronic inflammation, and partial tears. Many such injuries can be self-managed with common sense including activity modification, ice, heel cord stretching and over the counter medications.
When home remedies fail seek a board- certified orthopedist who can help identify the source of the problem and start appropriate treatment which may also include heel lifts, bracing, physical therapy, select injections of a corticosteroid or plasma rich protein (PRP), and infrequently surgical intervention in recalcitrant cases.