03/19/2012 03:11 pm ET Updated May 19, 2012

Greek Mythology Isn't the Only Place to Have Achilles Problems

Achilles' tendon problems are all too common in sports, and they couldn't have come at a worse time for Ryan Howard of the Phillies and Tiger Woods. As evidenced by the injuries these athletes suffered, Achilles' tendon problems encompass a spectrum of pathologies ranging from tendinosis (degeneration) in the tendon to frank ruptures. While the treatments for each condition are vastly different, any Achilles' injury can be very debilitating.

The Achilles' tendon is the largest tendon in the body. It is located in the posterior aspect of the lower leg and connects the calf muscles to the heel bone (or calcaneus). The tendon functions to help you stand up on your toes and to push off during walking or running. Injury to the tendon is often due to overuse. Certain foot types, not warming up appropriately and/or being out of shape can all predispose patients to injuring their Achilles'. In the case of high-level athletes, such as Howard or Woods, it is likely due to overuse.

In the case of Woods, it was reported that he withdrew from last week's golf tournament because of Achilles' tendonitis. In these cases, it is often small microtears in the tendon that become painful. The area behind the leg just proximal to the heel bone becomes tender and inflamed. Pushing off, as occurs during the downswing of a golf swing, would be extremely painful. Treatment ranges from rest and anti-inflammatory medications to formal physical therapy to work on stretching and strenghtning. Orthotics may be beneficial to improve foot alignment. It is a frustrating injury for athletes, as it may take weeks or months to completely improve. Returning to sport too soon is a set-up for further injury, and possibly even a complete tear of the tendon.

Baseball player Ryan Howard suffered a more severe Achilles' injury: he tore his tendon in half. This injury is much more debilitating and requires urgent surgery. The surgery is straightforward in the sense that it requires only a small incision and sewing of the torn tendon edges back to each other. Unfortunately, it requires a long recovery and there are potential complications. Even in the best scenarios, the tendon takes about six weeks to heal significantly and it often takes about four to six months before athletes can return to sports. Another problem for patients who require surgery to repair their Achilles' tendon is the risk of wound breakdown and infection due to the poor blood supply in the area and the relatively superficial location of the tendon. Howard, unfortunately, was just diagnosed with an infection after undergoing surgery to repair his tendon. This will clearly have an effect on his recovery, as the infection must be completely eradicated before returning back to baseball activities. And even then, one has to hope that the infection didn't weaken the tendon structure, thereby predisposing him to future problems.

Clearly, Achilles' tendon problems aren't limited to Greek mythology. They affect thousands of athletes every year, even those at the highest level. These injuries must be treated quickly and appropriately or they can severely hinder performance.

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