Article written by:    Maria Kasper, D.P.M. and Sonam Ruit, D.P.M.

For all you Jeopardy fans, we have a few answers:

Question 1:  It is a large ropelike band of tissue that connects the calf muscle to the back of the heel.

 Answer 1:  What is the achilles tendon?

Question 2:  He is now called the "destroyer of evil" after injuring his leg while chasing a burgler from his hotel room.

   Answer 2: Who is Alex Trebek?

That is correct.....on Tues, the 71 yo Trebek chased a burgler from his San Franscio hotel room after she allegedly stole cash and jewlery from him.  Trebek was staying with his wife in the hotel room while hosting the National Geographic Geography Bee.  Unfortunately, during the incident, while chasing the burgler down the hall Trebeck snapped his Achilles tendon. 

He is likely to require surgery to repair the tendon.

Achilles tendonitis is a painful and often debilitating inflammation of the Achilles tendon (heel cord).  It is located in the back of the lower leg, attaches to the heel bone (calcaneus),  and connects the leg muscles to the foot. The Achilles tendon gives us the ability to rise up on our toes, facilitating the act of walking.  Achilles tendonitis can make walking almost impossible due to the pain associated with it.

            Who is more prone to Achilles tendon injuries or tendonitis?

Poorly conditioned athletes are at the highest risk for developing Achilles tendonitis. Participating in activities that involve sudden stops and starts and repetitive jumping (e.g., basketball, tennis, dancing) increases the risk for the condition. It often develops following sudden changes in activity level, training on poor surfaces, or wearing inappropriate footwear. Achilles tendonitis may be caused by a single incident of overstressing the tendon, or it may result from a series of stresses that produce small tears over time (overuse).

The condition also may develop in people who exercise infrequently and in those who are just beginning an exercise program.    It is important for people who are just starting to exercise to stretch properly, start slowly, and increase gradually.

Women who wear high-heeled shoes often and switch to sneakers for exercise also can develop Achilles tendonitis.  High heels have allowed the Achilles tendon and lower leg muscles to gradually adapt to a shortened and contracted position.  When this happens, wearing sneakers or flat shoes forces the Achilles tendon to stretch further than it is accustomed to, causing inflammation.  If high heels are worn every day, stretching should be done every morning and night to keep the Achilles tendon lengthened.

The symptoms associated with Achilles tendonitis and tendonosis include:

• Pain—aching, stiffness, soreness, or tenderness—within the tendon. This may occur anywhere along the tendon’s path, beginning with the narrow area directly above the heel upward to the region just below the calf muscle. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity.
• Tenderness , or sometimes intense pain, when the sides of the tendon are squeezed.  There is less tenderness, however, when pressing directly on the back of the tendon.
• When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.

If damage to the tendon is minor, the injury may respond to a simple course of treatment known as RICE (rest, ice, compression, elevation).

Patients are advised to:

• RESTthe tendon by keeping off their feet as much as possible;
• Apply ICE packs for 20 minutes at a time every hour for a day or two to reduce swelling;
• COMPRESS the ankle and foot with a firmly (not tightly) wrapped elastic bandage; and
• ELEVATEthe foot whenever possible to minimize swelling.

A nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used to reduce pain, swelling, and inflammation. if mild Achilles tendonitis does not respond to basic treatment, or if symptoms return with the resumption of physical activity, a flexible cast may be used to immobilize the foot and reduce swelling, and crutches may be used to keep weight off the foot. This treatment may be necessary for up to 6-8 weeks .  Martin Foot and Ankle can provide Physical therapy and rehabilitation, which is also very essential in the treatment and management of Achilles tendonitis, to gradually stretch the tendon before full activity is resumed. 

When conservative therapy fails for severe Achilles tendonitis, Martin Foot and Ankle may recommend surgery at their surgical center located on S. Queen St. in York, PA. Surgery involves removing the tendon's inflamed outer covering and reattaching the torn tissues. Following surgery, the patient is immobilized in a cast or splint for 2-3 weeks, and then undergoes passive range of motion physical therapy and progressive strengthening exercises for the next 4-6wks. Most activities can be resumed in 6–10 weeks and competitive sports usually can be resumed after 3–6 months.

How can we prevent such problems?

Proper conditioningand appropriate footwear are the best defense against Achilles tendonitis. People who engage in physical activity should always warm up and stretch properly before beginning the activity. If discomfort occurs, the activity should be discontinued immediately and ice should be applied to the affected area to relieve inflammation. If the problem persists or recurs, medical evaluation by a foot and ankle specialist is necessary. It may be advisable to consult a physical trainer to determine whether a flaw in technique is contributing to the problem as well.

Martin Foot and Ankle,

Podiatrist in Lancaster, PA, York, PA, Hanover, PA and Shrewsbury, PA