When Achilles was a boy, his mother, the immortal goddess, Thetis dipped him into the Styx River. It was a ritual that was meant to make Achilles invulnerable to all forms of attack. Years later, Achilles will become a fierce warrior, winning many battles for the Greeks. Unfortunately, when his mother dipped him in the river, she held him by his ankle area and so the water failed to protect that part of his body. This little area would be his undoing during the Trojan war, as he was shot with an arrow in the very area where the river did not touch. This little area was the weakest part of his entire body and the reason for his death. This little area will come to be known as the Achilles heel.
Away from Greek mythology and into medical physiology, the Achilles heel is known to be one of the most fragile areas of the human body. This body part is home to one of the most common and most excruciating sports injuries – Achilles tendinitis. Here, we’ll look at what this injury is and see if it made sense for Achilles to die because of an arrow to his.
The Achilles tendon is the largest tendon in the body. It is a connective tissue between the calf muscles and the heel bone and is used when walking, running, stair climbing, jumping, and tiptoe standing. The Achilles tendon can endure significant strain from running and jumping, but it is also susceptible to tendinitis, a condition caused by excessive usage.
Achilles tendinitis, also known as Achilles tendinopathy, is a common condition that causes inflammation, soreness, and irritation to the large tendon that runs down the back of the lower leg. Achilles tendinitis occurs when there is an inflammation in the tendon. Changes to the tendon’s structure, ankle stiffness, and mechanical characteristics are associated with Achilles tendinopathy.
The most typical signs and symptoms are pain and inflammation near the injured tendon. Usually, the pain is more severe before an exercise session and gets better as it goes. The risk factors of Achilles tendinopathy are trauma, sedentary lifestyle, wearing high heels, rheumatoid arthritis, and using fluoroquinolone or steroid-class drugs.
Achilles tendinitis is classified into two types depending on which part of the tendon is inflamed. Both types can occur separately or at the same time.
- Noninsertional Achilles Tendinitis
Noninsertional Achilles tendinitis affects the fibers in the center of the tendon, above the point where it connects to the heel. The fibers could start to degrade and develop microscopic tears with time. This may cause swelling and thickening of the tendon. Younger, active individuals, particularly runners, are more susceptible to non insertional tendinitis.
- Insertional Achilles Tendinitis
Insertional Achilles tendonitis affects the lower part of the tendon, which connects to the heel bone (also known as the calcaneus). In both insertional and non-insertional Achilles tendinitis, the injured tendon fibers may calcify or harden over time. With insertional Achilles tendonitis, bone spurs often form on the heel. Despite still being most common in runners, insertional Achilles tendinitis can happen at any time or level of activity. The Achilles tendon insertion is typically aggravated by calf muscle tightness, a common cause.
There are different symptoms associated with Achilles tendinitis. The following symptoms of Achilles tendinitis include:
- Stiffness and pain along the tendon in the morning
- Pain along the tendon or on the back of the heel that gets worse with activity
- Severe pain the day after exercise
- Thickening of the tendon
- Formation of a bone spur (insertional tendinitis)
- Constant swelling that gets worse with activity or throughout the day
- Pain on the back of the heel when you wear shoes.
- Swelling, warmth, and tenderness of the Achilles tendon
- Difficulty walking
There are degrees of Achilles tendinopathy, depending on the injury’s severity. The more the severity of the injury, the more the severity of the damage.
- Mild: pain in the Achilles tendon during or shortly after a specific exercise (like running).
- Moderate: the Achilles tendon may bulge. Sometimes, the tendon may develop a hard lump (nodule).
- Severe: The Achilles tendon hurts when engaging in any activity that requires bearing weight. The Achilles tendon may occasionally rupture (tear). The rupture of an Achilles tendon may feel like a sharp blow to the heel.
There is no injury-specific cause of Achilles tendinitis. Repeated strain on the tendon is the common cause of Achilles tendinitis. When we ask our body to perform too much or too quickly, it damages the tendon. Achilles tendonitis can also be caused by the following:
- Overuse Injury: This happens when the Achilles tendon is overused to the point that it starts to degenerate and experience little tears. It appears that runners are particularly at risk. Additionally, there is a higher risk for those participating in sports like basketball that require jumping. An unexpected rise in exercise volume or intensity can also cause Achilles tendonitis. For instance, increasing your daily running distance by a few miles without giving your body a chance to adapt to the increased distance could lead to inflammation and discomfort.
- Arthritis: Ankylosing spondylitis and psoriatic arthritis are two examples of generalized inflammatory arthritis in which Achilles tendonitis can occur. Both tendons may be impacted in certain circumstances.
- Foot Problems: Some individuals are more prone to Achilles tendinitis than others due to flat feet or hyperpronated feet (feet that roll inward during walking). Calf muscles are pulled inward by the flattened arch, which also keeps the Achilles tendon under intense tension. The heel’s tendon may become inflamed, painful, and swollen due to the constant mechanical stress.
- Footwear: Wearing high heels or minimally supportive shoes while jogging or walking can increase the risk of Achilles tendinitis.
- Obesity and Overweight: Being obese puts extra strain on the body’s structures, especially the Achilles tendon.
- Quinolone Antibiotics: May occasionally be linked to Achilles tendinopathy or tendon rupture (tear) shortly after exposure to the drug.
- Tightened Calf Muscles. The Achilles tendon is under additional strain when the calf muscles are tight, particularly where it attaches to the heel bone.
- Haglund’s Deformity: This is a condition in which the bone is enlarged on the back of the heel. The Achilles tendon may become inflamed and painful if this rubs against it. Haglund’s deformity occurs when aberrant bone growth is close to where the Achilles tendon joins to the heel bone.
If you have felt a sharp or sudden pop in your heels, it may be that your Achilles tendon just got rumpled. You should visit your doctor immediately. Your doctor diagnoses by checking your medical history, including your exercise habits and footwear, conducting a physical examination, especially examining the thickness and tenderness of your Achilles tendon, and test that may include an MRI scan of the tendon, x-ray of the foot, ultrasound and occasionally blood tests to test for an inflammatory condition.
Recovery from Achilles tendinitis is often slow, depending on the injury’s severity and how carefully you follow the treatment plan and care instructions you are given. There are different treatment plans for Achilles tendinitis; we have nonsurgical and surgical treatment.
Most of the time, nonsurgical treatments for treating Achilles tendonitis can effectively help to reduce pain, though it might take a few months for symptoms to go away entirely. The pain may persist for over three months, even with early treatment. Types of nonsurgical treatment are anti-inflammatory and pain medications, activity modification, shoe wear modification, and physical therapy exercises.
The first step in treating Achilles tendon pain is to cut back on or altogether quit doing the things that worsen it. If you frequently engage in high-impact workouts (like running), switching to low-impact ones will lessen the strain on your Achilles tendon. Low-impact activities to help you stay active include cross-training activities like riding, elliptical training, and swimming. Your doctor may suggest an ankle brace or boot immobilization assist with this step.
Ice can be applied to the Achilles tendon’s most painful area throughout the day. The ice can be applied for up to 20 minutes, but it should be taken off immediately if the skin starts to feel numb.
- Anti-inflammatory Drugs and injections (NSAIDs)
Anti-inflammatory drugs such as ibuprofen and naproxen can help to reduce pain and swelling. Injections like cortisone and platelet-rich plasma may assist you in managing your pain well enough to carry out the physical therapy activities. However, they do not stop the deteriorated tendon’s thickening. You should evaluate the pharmaceutical use with your primary care physician if it has lasted longer than a month.
- Physical Therapy
Physical therapy can help with the treatment of Achilles tendinitis. Physical therapy can help to strengthen your calf muscle and reduce stress on the Achilles tendon. Exercises you can try are calf stretch, eccentric strengthening, heel drop (bilateral heel drop and single-leg heel drop), night splinting, etc.
- Supportive Shoes and Orthotics
Achilles tendinitis surgery should only be considered if nonsurgical treatment does not relieve the symptoms after six months. The location of the tendinitis and the degree of tendon injury determine the precise sort of surgery be performed. Surgeries that can be performed are debridement, gastrocnemius recession, and minimally invasive surgery.
Only after all other forms of treatment have failed is surgery advised. In this case, severely injured tendon sections may need to be removed. Surgery is needed to reattach the tendon if it has ruptured. Soon after surgery, rehabilitation is initiated, which includes flexibility and strength training. Usually, it takes around 10 weeks to get back to your routine. Some people might need to wait three to six months before they can resume playing competitive sports.
There are preventive measures to follow to avoid Achilles tendinitis. They include:
Incorporate stretching into your warm-up and cool-down routines
- Maintain an adequate level of fitness for your sport
- Do not abruptly increase your athletic training
- Rest the area if you feel pain in your Achilles tendon. If you try to “work through” the discomfort, your injury will only worsen.
- Put on supportive, high-quality shoes that are appropriate for your sport. Get orthoses if your feet are flattening or deformed.
- Avoid wearing high heels regularly. Your calf muscles will become shorter, and your Achilles tendon will become less flexible if you maintain a tiptoe position. An inflexible Achilles tendon is more susceptible to injury.
- Maintain a normal healthy weight.
Achilles tendon pain is common in athletes and active people. You should consult your doctor immediately if you experience Achilles tendon pain or pop in the back of your heels. The longer you wait to take care of it, the longer it takes to treat. Nonsurgical treatments for Achilles tendonitis include avoiding specific activities, adopting custom orthotics, and going for physical therapy. Consult your provider about surgery for Achilles tendonitis if nonsurgical remedies prove ineffective.