The story Of Achilles
Most people are familiar with Achilles, the famous Greek warrior who died after he was shot by an arrow in his tendon, now called the Achilles tendon.
The vulnerability of the Achilles tendon in sports is probably one of the most debilitating injuries that end a lot of sport careers.
If you look at an anatomy chart you will see what a tremendous strength this tendon must have to withstand everyday exertion.
There are numerous reasons why an Achilles tendon gets into trouble. For example:
- Repetitive overexertion
- Wrong foot position
- Acute (partial) rupture
- Overexertion happens a lot when people start a sport without knowledge or built-up (running, gym). Repetitive straining damages the matrix and texture of the tendon, and results in a thickened and less dense quality of the Achilles (tendinopathy). This can be made visible by Ultrasound scanning (echography). Treatment has to contain two things: repair by Shockwave treatment and start of a 12 week program of ‘eccentric loading’. This program will create new, healthy tissue. After 12 weeks one can return to a gradual built-up in intensity to return to normal activity (image 1).
- Wrong positioning of the foot leads to several problems: falling of the medial arch which will cause fasciitis plantaris or heel spur, but also a strain of the (medial) side of the Achilles. A reactive tendinopathy shows itself by acute swelling of the sheath (not the tendon!). Treatment is rather simple: correction of the foot position (insole) and relative resting + ice. In most cases no further treatment is necessary (image 2).
- A (partial) rupture of the Achilles is dramatic in most cases: an acute tear of the tendon leads to a long-term treatment program. A complete tear needs surgery straight away. If not, the tendon will retract and connecting the ends will be quite impossible. A partial tear can be treated conservatively. Six weeks cast or boot in a plantar position and afterwards gradually stretching of the tendon. In this case no certainty that the tendon comes back to normal levels though… (image 3).
Treatment without knowledge can lead to dramatic mistakes of strategy.
And once again: NO cortisones. It will lead to weakening of tissue and can induce a rupture.
And finally: a certain group of antibiotics (fluorchinolones) can cause sudden ruptures of large tendons (i.e. biceps and Achilles).
Be safe: when you have (chronic) Achilles problems, do not experiment but see a qualified therapist to determine the origin of your trouble.