Podiatry: Archilles Heel

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Homer - and Achilles Heel

The Iliad, by Homer, was written around 2700 years ago. It covers a snapshot period of about fifty days in the tenth year of the Trojan War. In the Iliad, Homer describes how Thetis, a Sea Goddess and Achilles' mother, dips the infant Achilles into the river Styx to make him invulnerable. The water washes every part except the heel, covered by his mother's hand. Achilles dies in the Trojan War. An arrow, shot by Paris, hits his one vunerable area - the heel which was not washed by the Styx.

Nowadays the Achilles Heel is still a common injury site, although in this day and age it is usually sport, rather than arrows, which cause the problem. The injury usually involves the heel cord, or Achilles Tendon. This is the lower part of the calf muscle, and unlike muscle fibres, which are relatively elastic, the Achilles Tendon is inelastic. It provides attachment for the calf muscle to the back of the heel bone.

Injury types

The most common Achilles Tendon injury is strain. This can be caused by poor or no warm-up, such as stretching, before the sporting activity, or by a simple foot mechanics problem - more common than is usually recognized.

The strain will start with micro-tears in the tendon and surrounding structures. The usual response from the sufferer (since the discomfort is not present all the time) is to carry on their sporting activities without seeking help. If the damage is allowed to continue, the tendon will start to give pain, or feel very tight on rising after sleep. Eventually the problem will become chronic. The appearance of a classic chronic Achilles Tendonitis is pretty much the same for all patients - no redness but plenty of swelling around the tendon. On examination, it will be generally a little tender, with a very tender spot somewhere along the tendon - probably the site of the original micro-tears.

What to do

If you suspect Achilles Tendonitis, and the problem has been bothering you for more than a week or so, seek specialist advice (Osteopath, Chiropractor or Physiotherapist are all fine). If the problem does not respond to treatment, or returns, ask for a referral to a Podiatrist for a biomechanical assessment - orthoses may be needed.

What not to do

Do not let anyone inject Cortisone into your tendon - not initially, anyway. Cortisone can actually damage the tendon - worst case scenario? It can snap.

Torn or snapped Achilles Tendons

Nasty! A partially worn tendon needs immediate medical attention. In most cases it can repair itself, once a Walking Cast has been put over the whole lower leg. It can take months and months before the leg and ankle are functioning properly again. A snapped Achilles Tendon is much the same, only this time an operation is needed to join the two bits of tendon together before the Walking Cast is applied.

Snapped and torn Achilles Tendons usually happen when someone has not exercised for ages, and suddenly starts to play an energetic game, like Squash, for instance. 'Use it or lose it' - a phrase most personal trainers are familiar with applies equally well to Achilles Tendons.

As always, please feel free to email me with any shoe or foot related questions. Use the enquiry form on my website (www.ortho-pedclinic.com).

Please feel free to use the enquiry form at www.ortho-pedclinic.com for all foot-health and foot-related matters.
David Holland BSc(Hons), MSc(Dunelm), MChS
Consulting Podiatrist.