Understanding Achilles Tendonitis

Achilles tendonitis is a painful and often debilitating inflammation of the Achilles tendon, a cord running down the back of the lower leg and connecting the calf muscles to the heel bone. The Achilles tendon derives its name from the Greek mythological character Achilles, a mighty warrior whose mother Thetis bathed him in the magical waters of the river Styx at birth to make him invulnerable to harm.

According to the legend, as Thetis dipped her son into the mystic river she held him by the heel. The unprotected heel became Achilles' only vulnerability. Many years later, Achilles was mortally wounded when an arrow struck him in the heel.

The Achilles tendon connects the strong leg muscles to the foot and makes it possible to rise up on the toes, facilitating the act of walking. This cord is vital to the ability to walk upright. Inflammation of the Achilles tendon can make walking almost impossible.

Dancers, runners, and baseball, football, and tennis players are particularly at risk for Achilles tendonitis because their activities involve sudden stops and starts. Women who wear heels at work and switch to sneakers for exercise and people with "flat feet" are also susceptible to the condition.
The injury causing Achilles tendonitis occurs at any point along the Achilles tendon from the heel to the calf muscle. It can develop slowly over a period of months or years, or it can strike "weekend warriors" (those who are physically active only on weekends) who fail to warm up before exercise only once. Overdoing exercise at the beginning of a new fitness program is a frequent precipitating event for tendonitis because the muscles are not flexible enough to withstand the new forces being placed upon them.

The Achilles tendon is prone to inflammation be cause of its relatively poor blood supply. When blood circulation to the tendon is not increased gradually through warm-up exercises, the heel releases inflammatory hormones known as bradykinins to dilate the blood vessels and increase the flow of oxygen to the back of the leg.

The lack of circulation to the tendon makes other inflammatory hormones released in response to injury very slow to clear. An injured Achilles tendon can accumulate 100 times the concentration of inflammatory interleukin-6 found in surrounding tissues, and retain this level of the inflammatory chemical for at least 96 hours.

Continuous stress on the Achilles tendon can cause more problems than just pain and inflammation. In severe cases, overstress may cause the rupture of the tendon. Rupture results in severe pain and traumatic damage. Walking may become impossible and the tendon may take a long time to heal, even requiring reparative surgery.

Long-term damage to the Achilles tendon usually occurs when B- and T-lymphocytes from the immune system begin to break down collagen fibers in the tendon itself. The limited circulation to the heel keeps these tissue-destructive white blood cells locked in place, making recovery difficult. In some cases, the action of the immune system can cause the Achilles tendon to rupture even in the absence of trauma or injury to the heel.

Long-term Achilles tendonitis is not an inflammatory condition. Aspirin, NSAIDs, COX-inhibitors, and natural methods of controlling inflammation do not help over the long term, but they do help the first few weeks after injury.

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