This is big news. Utah Jazz forward Marvin Williams (#2) will undergo Achilles surgery to repair a sore Achilles tendon. His tattoos, reportedly, will still remain intact. Marvin is not a patient of my NYC podiatry practice, and I am not his tattoo artist, but I have a few things to say about Achilles tendonitis, which, as a NYC podiatrist, I often treat.
The Achilles tendon, named for the Greek hero of the Trojan War as represented with such fabulous handsomeness by Brad Pitt, is the longest and strongest tendon in the body. It originates from two muscles around the knee and inserts into the back of the heel. Because it is such an important mover of the foot, and is subject to shoe pressure, painful syndromes affecting this tendon are common, and in my practice I generally see four distinct types of tendonitis:
- This type of tendonitis usually affects the tendon in an area just above the insertion. Usually this is seen in athletes, and involves transient inflammation which resolves with rest, time and stretching.
- An outgrowth of bone that develops on the top of the heel bone and can rub on the front of the Achilles tendon. This is more common in women who wear high heels. Treatment consists of shoe modification, and in some cases, surgery.
- Inflammation of a fluid filled sac that sits between the tendon and the skin, commonly caused by activity or a tight shoe. The area often feels warm and boggy, and can be treated with stretching, use of a high heeled, open back shoe, and occasionally an injection of cortisone. This is a very common condition and also very treatable.
- This is likely the condition for which Marvin is undergoing surgery. In this case, large calcium deposits develop in the back of the heel within the Achilles tendon insertion. Conservative care consists of shoe modification, stretching, and physical therapy. If that fails, surgical management involves removing the calcium deposits, which often requires detaching and reattaching the Achilles tendon to the bone. Although this procedure has advanced remarkably over the past decade due to better hardware systems, it is still a big deal, with a 6-12 month recovery, so it is a last resort option.
So, Marvin, if you’re still looking for a foot surgeon, we have a special spot for you here in NYC. Maybe we can even work out some new ink – I think my face might look good on the back of your heel…
See you in the office.
Dr. Ernest L. Isaacson