Dear GeezerJock Doc:

Can you tell me about the treatment and prevention of Achilles tendon injuries?

The GeezerJock Doc responds:

How did a simple part of the human body, the Achilles tendon that runs down the back of the leg, become associated with a mythological Greek warrior? According to myth, the infant Achilles was dipped into the River Styx, which would make him invincible. Unfortunately, his mother held her son by the heel, which subsequently didn't have the same protection as the rest of his body. In the Trojan War, an arrow struck Achilles in the heel, near the tendon area, and the great warrior died.

Now that's pretty exciting stuff. Here's the real story about the Achilles tendon. It is the end of the primary calf muscle, which is called the gastrocnemius. This muscle is responsible for moving the foot at the ankle in a downward direction. This muscle is also responsible for people's ability to stand on their toes.

The gastrocnemius muscle is actually two muscles that form a common tendon at the level above the heel and insert into the bone at the heel. There are two other muscles in the back of the calf (the soleus and the plantaris) that can be also suffer injury, but damage to these muscles is not as common as to the Achilles tendon. There are a number of Achilles tendon injuries; the most common are listed below:

Tendon Rupture
A rupture of the Achilles tendon is usually a very obvious event. Often those suffering this injury will swear they felt like they were shot (by an arrow)? Most athletes will first feel this injury when they are running and push off from the ground. Injured athletes will have a very difficult time walking and will not be able to point their foot. There will be tenderness and swelling above the heel bone in the back of the leg. Treatment is surgical or cast immobilization. In the active population, surgery is the preferred treatment option. There is a lower re-rupture rate with surgical treatment. Post surgery, the time back to playing a sport can range from about three to nine months.

Partial Tendon Rupture
A partial tendon rupture can be more subtle than a full tendon rupture -- but sometimes even a partial rupture can feel like a full rupture. Treatment may entail immobilization in a cast boot, physical therapy and rest. Partial ruptures of the Achilles tendon can potentially heal without an operation. However, persistent weakness and pain may be a surgical indication.

Achilles Tendinitis
Achilles tendinitis is an inflammation around the tendon or the sheath that surrounds the tendon. The condition may be caused by repetitive and accumulative overuse. In such cases, there may be swelling and sometimes a palpable nodule. There often is pain and weakness. Treatment is similar to partial tears: rest, physical therapy and anti inflammatory medications. Cortisone injections are almost never used, because they may further weaken the tendon and lead to tearing. Two other treatments that are often employed are night splints and orthotics. Night splint enable the tendon to rest in an elongated position. Orthotics may correct a foot deformity that can lead to tendinitis.

Prevention
Sometimes, athletes have some warning signs prior to an Achilles tendon rupture. They may feel a tightness that cannot be stretched out. If you have tight calves, it's very important to warm up and stretch prior to exercise. Other causes of this injury are poor footwear, changes in training conditions and tendon overload. The best way to deal with this is to do everything possible to avoid injury. Strengthen and stretch your Achilles tendon and make sure your footwear is right for you.

The FDA has recently approved a topical anti-inflammatory cream available in Europe for more than 20 years. It's great for tendinitis -- in the Achilles and elsewhere -- and other muscular problems. Speak with your physician for further information.

Ask the Doctor Written by Pittsburgh-based orthopedic surgeon and Masters sprinter Allan Tissenbaum, M.D., GeezerJock Doc is a forum for your questions about injuries, exercise and getting older. Submit questions to geezerjockdoc@masters-athlete.com. Or mail to GeezerJock Doc, 2033 W. Hutchinson St., Chicago, IL 60618.