Don’t let this condition be your “Achilles heel”
Do you remember the Greek mythological legend, Achilles?
Achilles was a famous Greek warrior. He was the mightiest of the Greeks who fought against the Trojans, and was the hero of Homer’s “Iliad.” Being part immortal and part human, he was prone to injury from battle.
It is said that, when he was a boy, his mother held him up by his left ankle and bathed him in the mystical River Styx, rendering him immune from injury. However, because she could not bathe him where she held his ankle, this area became his weakness. Achilles was ultimately killed by the Trojans from a “divinely-guided” arrow that pierced the only place he was not immune from injury – his heel.
Picture courtesy of the Journal of the American
Academy of Orthopedic Surgeons.
Now let’s talk about a condition that can start as pretty mundane but has the capability to render one unable to function – Insertional Achilles Tendonopathy.
What’s the difference between traditional Achilles tendonitis and insertional tendinitis? According to the American Academy of Orthopedic Surgeons (AAOS) “Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches (inserts) to the heel bone. In both non-insertional and insertional Achilles tendinitis, damaged tendon fibers may also calcify (harden). Bone spurs (extra bone growth) often form with insertional Achilles tendinitis. Tendinitis that affects the insertion of the tendon can occur at any time, even in patients who are not active.”
Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much too soon, but other factors can make it more likely to develop tendinitis, including:
• Sudden increase in the amount or intensity of exercise activity – for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance.
• Tight calf muscles. Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon.
• Bone spurs – extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain.
• Weight gain coupled with tight calf muscles.
• For seniors, this next potential cause is a very real and present one – tissue degeneration. As we age, changes occur in the various tissues of the body – bones, cartilage, muscles and yes, even tendons and ligaments. Elasticity decreases, making tissues less pliable so there is a greater risk for pulled muscles as well as tendon and ligament injuries. Even stretching exercises done before activities won’t totally prevent the potential for injury or chronic inflammation.
Common symptoms of Achilles tendinitis can include:
• Pain and stiffness along the Achilles tendon in the morning;
• Pain along the tendon or back of the heel that worsens with activity;
• Severe pain the day after exercising;
• Thickening of the tendon;
• Bone spur (insertional tendinitis);
• Swelling that is present all the time and gets worse throughout the day with activity;
I can tell you from personal experience that this is not a condition to take lightly. I have had progressive symptoms for the past six months and they have steadily worsened. The pain along the backside of the heel can be almost nauseating to the touch, and if anyone has ever experienced the pain of plantar fasciitis and heel spurs, the same can be said for this, only it is along the backside of the heel bone. It is still being treated.
Getting a diagnosis
Be sure to provide your doctor, foot specialist or orthopedic surgeon with a good history of your symptoms – when they started, what makes them worse and what if any treatments you may have undergone prior to your visit. A good physical examination of the area will shed a lot of light on the problem too. Additional testing may be necessary and often times, x-trays and possibly even an MRI are ordered to determine the condition of the tendon itself.
Depending on the severity and duration of the symptoms, treatments can range from simple non-steroidal drugs such as Ibuprofen, Naproxen, Celebrex, Mobic and the like. Rest and icing can also help.
In more severe cases physical therapy, together with modalities such as ultrasound, ice massage, Iontophoresis (delivery of cortisone via extremely low voltage electrical current) and various levels of immobilization (brace, cast, walking boot, etc.) are typically employed.
In extremely severe cases, surgical debridement of the tendon may be warranted. On occasion, a tendon transfer may be needed because of significant Achilles tendon degeneration and injury.
Prevention tips include:
• Maintain optimal body weight;
• Avoid high-impact exercises or repetitive stresses to the tendon, especially if you’re over 55 years of age;
• Be conscious of the early symptoms of mild discomfort especially when getting up in the morning (much like plantar fasciitis);
• Get treatment early on.
Don’t let this condition get out of hand and become your “Achilles heel.”
Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. For more information on orthopedic-related topics, visit www.bone-and-joint-pain.com. Submit questions or comments to Ken at
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