T he legend ofGreek warriorAchilles is well

known. As the storygoes, Achilles wasdipped into the riverStyx by his motherwhen he was an infant.The river shielded Achilles from injury, but hismother’s hands prevented the waters of the Styxfrom touching Achilles’ heel, rendering thatpart of his body vulnerable. According to themyth, Achilles was killed during the Trojan Warwhen an arrow was shot through the only sus-ceptible area of his body. The moral: the Achillestendon, otherwise known as the Achilles heel,is a vulnerable area of the body.

Many years later, Robert, a 37-year-oldtriathlete, comes into my office. “Doc, it hurtsright here in my Achilles. I’m having troublerunning and biking,” he says.

“Robert,” I tell him, “you need to remem-ber your Greek mythology.”

“Doc, have you lost your marbles?” he asks. The Achilles is a thick tendon that connects

the gastrocnemius and soleus muscles to theirinsertion point at the heel bone. Achillesinjuries can occur in several places. Occasion-ally they occur in the muscle, in which casethey are referred to as strains; however, theseinjuries tend to heal relatively quickly due tothe abundant blood flow to the muscle.

Indeed, a more common place for Achillesinjuries is at the muscle-tendon junction—thearea where the muscles converge into the ten-don. This spot is visible about halfway downthe back of the leg where the muscles form aletter “V.” Injuries in this area tend to heal spon-taneously, though they do so more slowly thaninjuries in the muscular area of the leg, sincethe blood supply isn’t as good.

Unfortunately, however, Robert comes inwith the most serious of Achilles afflictions, aninjury to the tendon itself. The Achilles ten-don is about 10 centimeters long and formsthe thick, rope-like structure at the back of theleg. Irritation of a tendon, tendonitis and chron-ic irritation of a tendon with fluid build-up,tendonosis, are both common Achilles injuries.

When persistent Achilles tendon pain is notgiven proper attention, chronic tendonitis canlead to a degenerative tear in the tendon, oftencharacterized by a lump on the side of the ten-don. When this is present, there is risk of eitherchronic, career-threatening Achilles pain orpossibly Achilles tendon rupture.

GETTING YOUR R & RSo, what should you do when the Achilles

is sore? A day or two of discomfort is fine, butpain that lasts for more than several days or,more importantly, pain that results in limp-

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TRAINING DOCTOR’S ORDERS

Achilles agonyDon’t ignore a recalcitrant Achilles tendon

By Dr. Jordan D. Metz l , MD

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ing or altered gait needs to be checked out.In rehabilitation, a therapist or athletic train-er will use ultrasound, electrical stimulation,ice and, eventually, a combination of stretch-ing and strengthening to fix the problem.

As is the case with many injuries, keeping fitduring the process of healing and rehabilita-tion is crucial. In general, swimming is finewhile recovering from an Achilles injury, andbiking is acceptable, too, if it can be done pain-free. The no-no is running, which can quick-ly make a painful Achilles injury even worse.

The location of the Achilles injury is thekey. Again, high, muscular calf strains tend toheal relatively quickly. Muscle-tendon junc-tion strains heal a little more slowly, andinjuries in the tendon itself can become life-long problems if not allowed time to heal.

With Robert, his Achilles had a smalllump and was painful, so I sent him for anMRI, which showed a small, partial tear in

the tendon. I put him in a walking boot castfor several weeks. When he was pain-free, Istarted him in physical therapy so he couldbegin to regain his strength and remedy theunderlying lack of flexibility that caused theinjury in the first place. His foot mechanicswere also corrected through the use of anorthotic, which helped prevent the pronation(rolling in of the foot) that contributed tohis problem. His injury took three monthsto fully heal, but now he is better and goingstrong.

So, listen up and remember your mythol-ogy. There’s a little Achilles in all of us. s

Jordan D. Metzl, MD, is a nationally recog-nized sports-medicine specialist at Hospital forSpecial Surgery in New York City. In addition,Dr. Metzl is a 25-time marathon runner andnow a four-time Ironman finisher.

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