By Dr. Lou Pack
Lake Oconee Breeze
LAKE OCONEE — “I ruptured my Achilles tendon. It was surgically repaired but I still have problems. What do you suggest?”
The Achilles tendon attaches the calf muscles (in the back of the leg) to the heel of your foot (calcaneus). It is a major tendon and essential to walking. As a matter of fact, it is so important to proper function that in ancient times it was a prime target during a battle. Some felt it was even better than killing an opponent since it took a number of soldiers to carry a warrior with this injury off the field. The devastating affect of weakening an opponent in this manner has led to the phrase, “Achilles Heel.”
So as you well know, your injury was a major one. In most instances it occurs because the calf muscles are simply too tight, placing a great deal of tension on the tendon’s attachment to the bone. Painful spurs can develop that require surgical removal. And any sudden strain (like running or playing tennis) makes this problem much worse. Like a rubber band, once stretched too far, the tendon simply snaps.
Spontaneous ruptures can also occur without an injury. For example, some arthritic conditions as well as steroid (cortisone) injections can cause this. Conservative treatment with casting may be successful but in severe cases, surgical reattachment may be necessary. But remember, even the best surgery heals with scaring making the tendon even shorter than it was before. Because of this, it is imperative that you do all you can to keep your calf muscles as loose as possible.
Structural problems are most often an underlying cause of injury. For example, individuals with a short leg on one side have a tendency for that calf to tighten more. So equalizing leg lengths is therefore important and a very simple fix. And as I mentioned above, since your injury healed with some shortening, a lift on that side may be even more important for you.
Proper stretching is imperative, and the more active you are, the more you need to stretch. Unfortunately, most people do so improperly. When stretching is too difficult, a trigger point injection to release calf tightness is usually very effective. And no….it doesn’t hurt because a freeze spray can be used to numb the skin first. This injection is also very beneficial after an injury. At times, a fully custom foot orthotic can help too.
As with many medical ailments, this injury can usually be prevented.
— A former reconstructive foot and ankle surgeon and past clinical instructor of Medicine at Emory, Dr. Pack practices at MCG in Greensboro. He works with patients who have arthritis and wish to decrease joint symptoms and remain active without medication or surgery. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist, and helped the UGA Golf Team (2005 NCAA national champions). For further information please see www.drloupack.com, drloupack.blogspot.com or contact him directly at (706) 454-0040.
