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Inflammation of the achules tendon and its peritenon is an important source of disability, restricting both performance and endurance. Impact sports and systemic diseases can cause achules tendonitis. There are numerous classifications and treatments of pain about and in the achules tendon. Almost all treatment schemes rely on decreasing inflammation.
The achules tendon is named after the Greek chieftain, Achilles. Achilles had been made invulnerable by his mother, Thetis, who dipped him in the river Styx by holding him by his heel. As an adult, he was mortally wounded during the Trojan War by an arrow that struck his unprotected heel.
ANATOMY
The achules tendon is the largest tendon in me body and is approximately 6 cm long. It receives fibers from the gastrocnemius and soleus muscles. The two heads of the gastrocnemius and soleus make the triceps surae. The gastrocnemius crosses both the knee and ankle joints and is most effective as a plantar flexor when the knee is extended. The soleus crosses only the ankle joint. When the ankle is plantarflexed and the knee is flexed, the soleus is a more effective plantar flexor than the gastrocnemius. The plantaris tendon runs between the gastrocnemius and soleus muscles. It has its own insertion on the calcaneus, separate from the achules tendon and just medial to it. The plantaris is analogous to the palmaris longus muscle.1 All muscles of the posterior calf are innervated by the tibial nerve and comprise the superficial compartment of the posterior calf.
The achules tendon becomes rounder as it approaches its insertion into the posterior surface of the calcaneus, where it expands slightly. Most of the fibers from the gastrocnemius insert laterally to the posterior aspect of the calcaneus, while those fibers from the soleus insert medially. The tendon twists 90° laterally as it descends; most rotation occurs 2 cm to 5 cm above the tendinous insertion. This is me area of poorest blood supply and the most common site of tendonitis.2 The twisting of the tendon may cause a "sawing" action of one part of the tendon on the other.3
The tendon is covered its entire length by paratenon of variable thickness, which blends proximally with the muscle fascia and distally with the periosteum.4 The peritenon acts as...