Achilles Tendon

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Description

The Achilles' tendon or heel (tendo Achillis) or the calcaneal tendon (tendo calcaneus) is a tendon of              the Posterior leg. It serves to attach the gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone.

Achilles tendonitis is a painful and often debilitating inflammation. The tendon is the largest and strongest tendon in the body. It is located in the back of the lower leg, attaches to the heel bone and connects the leg muscles to the foot. The Achilles tendon gives everyone the ability to rise up on our toes, facilitating the act of walking, and tendonitis can make walking almost impossible.

Achilles' heel is also a common expression for the single vulnerable spot in something or someone (in reference to the Achilles story from Greek Mythology).

Cause & Risk

Athletes are at high risk for developing Achilles tendonitis. Sudden stops and starts and repetitive jumping (e.g., baseball, basketball, football, tennis,) increases the risk. It often develops following sudden changes in activity level or wearing inappropriate footwear.

Symptoms

Symptoms appear gradually. Slight pain in the beginning & pain increasing as activity continues. Continued stress increases the inflammation & if continued may cause the achilles tendon to rupture. Severe pain & inability to walk follows. Recovery is lengthy & dufficuly

Achilles Anatomy

In humans it passes behind the ankle. It is the thickest and strongest tendon in the body. It is about 15 cm long, and begins near the middle of the leg, but receives fleshy fibers on its anterior surface, almost to its lower end. Gradually becoming contracted below, it is inserted into the middle part of the posterior surface of the calcaneus, a bursa being interposed between the tendon and the upper part of this surface. The tendon spreads out somewhat at its lower end, so that its narrowest part is about 4 cm. above its insertion. It is covered by the fascia and the integument, and stands out prominently behind the bone; the gap is filled up with areolar and adipose tissue. Along its lateral side, but superficial to it, is the small saphenous vein.

The use of "Achilles' heel" or "Achilles heel" as an English expression for "area of weakness, vulnerable spot" dates only to 1855 (Merriam-Webster), or, in the form "heel of Achilles," 1810 (OED: Coleridge, "Ireland, that vulnerable heel of the British Achilles".)

The oldest-known written record of the tendon being named for Achilles is in 1693 by the Flemish/Dutch anatomist Philip Verheyen. In his widely used text Corporis Humani Anatomia, Chapter XV, page 328, he described the tendon's location and said that it was commonly called "the cord of Achilles" ("quae vulgo dicitur chorda Achillis").

The name Achilles' heel comes from Greek mythology. His mother, the goddess Thetis, received a prophecy of her son's death. In order to protect him, she dipped him into the river styx, which protected his entire body from harm. However, in order to dip him into the river, she needed to grab onto his heel. During the Trojan War Achilles was struck on his unprotected heel by a poisoned arrow, which killed him.

Role in disease

Achilles tendinitis is inflammation of the tendon, generally due to overuse of the affected limb or as part of a strain injury. Achilles tendon rupture is a partial or complete break in the tendon; it requires immobilisation or surgery. Xanthoma can develop in the Achilles tendon in patients with familial hypercholesterolemia.

Treatment of Achilles tendon damage

Initial treatment of damage to the tendon is generally nonoperative. Orthotics can produce early relief to the tendon by the correction of malalignments, non-steroidal anti-inflammatory drugs (NSAIDs) are generally to be avoided as they make the more-common tendinosis (degenerative) injuries worse^{[citation needed]}; though they may very occasionally be indicated for the rarer tendonitis (inflamatory) injuries. Physiotherapy by eccentric calf stretching under resistance is commonly recommended, usually in conjunction with podiatric insoles or heel cushioning.

Where tendon rupture is concerned, there are three main types of treatment: the open and the percutaneous operative methods, and nonoperative approaches.

Achilles tendon History

Severance of the Achilles tendon is considered by many a particularly unpleasant injury. This has led authors to use it for shock value. Achilles tendons are severed in the horror movies Pet Sematary (1989), Kill Bill (2003), House of Wax and Hostel (2005). In the Gor novels, severing Achilles tendons is a punishment for slaves who try to flee.

The Achilles tendon can withstand 1,000 pounds.