Achilles tendon or tendocalcaneus is the longest tendon in the body, connecting muscles of the calf to the foot. 

In humans this tendon passes below the ankle joint. It is the strongest tendon in the body. It can receive 3.9 times weight of the body while walking and 7.7 times while running.

The name comes from Greek mythology. Achilles’ mother Goddess Theti   received a prophecy about her son’s death. To protect him, she dipped his entire body in a river, but kept him held with the heel.

This heel remained vulnerable, while the rest of the body became very strong. Later on in the Trojan war, he was shot in the heel by a poisonous arrow and he died. 

In human beings also, it is a vulnerable part of the body in the sense that due to carrying the entire weight of the body while moving, it is more susceptible to injuries or damage.

Common types of damage which occur in the Achilles tendon are injury, inflammation, undue stretching or tear of the fibres of the tendon or of the muscles attached to it. There may be single or multiple damages present causing pain to the sufferer. 

Any injury to the heel can rupture the fibres of the Achilles heel. Excess   walking or running particularly on rough surface or uphill is a very common cause for damage to the Achilles heel. Because of the excess use of the tendon in   such activities   tendocalcaneus is stressed.

For this reason, football players and athletes are more prone to these problems.  Indulging in sports or vigorous exercise without proper warming up is yet another cause for problems related to Achilles heel.

Misalignment of foot as occurs   in sudden turning, twisting   of foot or extreme pronation, e.t.c. can also lead to damage to the Achilles tendon. 

Wearing ill fitting shoes which are worn out at the sides also make one more vulnerable to Achilles tendonitis or rupture.  Pointed high heeled shoes in women   often causes pain in calf muscles and damage to Achilles tendon, because of the undue stretching of the muscle and resultant stress put on it.

Some drugs like antibiotics of the quinolone group can cause Achilles heel problems as side effects.  

Overuse of the muscles of the foot leads to degenerative changes in this tendon with aging. Thus one may get pain in the foot and heel with advancing age, though there may be no other risk or precipitating factors present.

Whatever may be the cause but damage to Achilles heel causes pain while walking in early stages. Pain is felt in the heel and calf. In severe cases, pain occurs on the slightest movement like when moving   feet while asleep. 

It is important to wear properly fitting shoes at all times to keep the feet evel, to prevent problems like Achilles heel damage or tendonitis.  High heeled shoes are not healthy by any means and should be avoided at all times. 

Warming up before sports is very important to avoid strain on tendocalcaneus. Similarly one should avoid long distance walking or running to which one is not habituated

Treatment of Achilles heel damage consists of pain killer drugs and local injections of cortisone. These drugs indirectly aggravate the problem. Because once somebody has relief in pain, he or she tends to indulge in activities involving overuse of the foot again.

Cold compression by using ice packs is also very useful in reducing the pain. There are shoes available with heel supports which help in relieving the pain and also preventing further aggravation of this problem.

Similarly use of crepe bandage to provide support to the ailing heel is also very useful in keeping the person comfortable.

Acute problems of Achilles heel   improve much with these measures and medications. But chronic problems are more difficult to treat. 

Specific   physiotherapeutic techniques are available to provide relief in such problems.

Regular   stretching and relaxation exercises of the legs and feet are beneficial for preventing Achilles heel related problems.

Dr. Rachna Pande

E-mail –rachna212002@yahoo.co.uk