4 minute read
The Achilles' Tendonitis
By Dr. Michael M. Cohen, DPM, FACFAS
It is said that the heart and soul of every running athlete is in his Achilles' tendon. In ancient mythology Achilles is described as the swiftest and fastest of heroes. His perfect form and lightning speed rendered him untouchable by his enemies. He was totally impregnable with one exception, his Achilles heel. Truly many athletes especially runners fall victim to the same crippling malady as Achilles did himself. If not dealt with rapidly and properly, the condition frequently becomes debilitating and in certain instances even life altering. Three large calf muscles, the gastrocnemius and soleus muscles merge to form the largest tendon in the body otherwise known as the Achilles or triceps surae. The tendon is anchored into the back of the heel bone and its principal function is to pull the heel up and push the foot in a downward direction. This allows the athlete to rise vertically and propel forward. A second unappreciated function of the Achilles tendon and its calf muscle is to decelerate the leg as it swings through the air and stabilize the knee while it flexes to absorb shock when the foot hits the ground. The calf is ultimately converted into a shock absorber damping the blow sustained during impact, and with each foot strike absorbs three to five times the body weight while running. Repetitive movement of the Achilles tendon may result in a chronic overuse injury such as tendinitis (tendon(itis) referring to inflammation of a tendon).
Some physicians prefer the term Achilles tendinosis to Achilles tendinitis because scientific research has revealed little inflammation around the tendon. Initially Achilles tendinitis is noticed during the first step out of bed in the morning. There is a feeling of discomfort, stiffness and tenderness in the back of the ankle. One may often limp until the calf muscle and tendon have stretched out and warmed up. If the condition is left unchecked the discomfort increases in intensity and becomes particularly noticeable throughout exercise until it is disabling. Most athletes recognize Achilles tendinitis as a well localized pain in the midsection of the tendon. A second common location may be at its attachment at the back of the heel. Studies show that one in 10 runners will suffer from Achilles tendinitis and 16% will be forced to end their careers due to chronic pain and recurrence. Therefore, rapid treatment is essential to prevent long term problems.
Treating Achilles tendinitis is predicated on the degree of injury and level of damage. Acute injuries often result in swelling and even partial tearing of the tendon fibers. Chronic changes may result in scarring, thickening and degeneration. A foot and ankle specialist will often order an MRI to distinguish the type and amount of damage to the tendon. Activity modification and at times immobilization is warranted to allow the tendon time to heal. A well-developed cross training regimen is essential to prevent an athlete from losing fitness while recovering from the injury. Addressing detrimental biomechanical factors such as tight inflexible calf muscles, pronation, or alternatively supination is paramount. Athletes should avoid running with zero drop or negative heel shoes as this may aggravate symptoms. One may also benefit from reviewing proper running technique, add various strengthening programs and consider the use of orthotics and heel lifts. Many studies emphasize the value of eccentric strengthening in the treatment of Achilles tendon injuries. Eccentric exercises should start early and are performed by standing on a step or platform and slowly dropping your heel towards the ground. This exercise allows the tendon to elongate and strengthen while accelerating the repair of damaged tendon cells. Ice therapy may reduce the extent of tendon degeneration. The value of anti-inflammatory medication is controversial, and its long-term use may be detrimental. Corticosteroid injections are generally not used and illogical in the treatment of this degenerative condition. However, the use of PRP or injectable placenta/amniotic membrane tissue have been proven to be useful. Ultimately a recurrent condition may result in much frustration and a feeling of hopelessness, oftentimes leading to surgical procedures which could have been avoided with rapid treatment.
▸Michael M Cohen, DPM, is a Board-Certified Foot and Ankle Surgeon and Diplomate of the
American Board of Foot and Ankle Surgery. He is a Fellow of the American Board of Foot and
Ankle Surgeons and Board Certified and Diplomat of the American Board of Podiatric Medicine. He practices with the Foot, Ankle and
Leg Specialists of South Florida specializing in lower leg injuries and reconstructive surgery of the foot and ankle. The practice includes Carlo
Messina DPM, Al DeSimone MD, Alexander
Bertot MD, David Shenassa MD, Franz Jones
DO, John Goodner DPM and Warren Windram
DPM. The South Florida Institute of Sports
Medicine in Weston is located at 1600 Town
Center Blvd., Suite C, (954) 389-5900 and in
Pembroke Pines at 17842 NW 2nd Street, (954) 430-9901. Our practice website is www.southfloridasportsmedicine.org
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