"I felt tightness in my left Achilles warming up this morning, and it continued to get progressively worse," Woods said in a statement. "After hitting my tee shot at 12, I decided it was necessary to withdraw. In the past, I may have tried to continue to play, but this time, I decided to do what I thought was necessary." He had been changing shoes through the game, and was lifting his left leg, flexing the ankle. Woods was walking with a noticeable limp.
Woods' next engagement is in two weeks at Bay Hill, his last tournament before the Masters.
Achilles tendonitis is a fairly common foot injury. A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the "heel cord", the Achilles tendon facilitates walking by helping raise the heel off the ground.
Two common disorders that occur in the heel cord are Achilles tendonitis and Achilles tendonosis.
Achilles tendonitis is an inflammation of the Achilles tendon. This inflammation is typically short-lived. Over time, if not resolved, the condition may progress to a degeneration of the tendon (Achilles tendonosis), in which the tendon loses its organized structure and is likely to develop microscopic tears. Sometimes the degeneration involves the site where the Achilles tendon attaches the the heel bone. In rare cases, chronic degeneration with our without pain may result in rupture of the tendon.
As "overuse" disorders, Achilles tendonitis and tendonosis are usually caused by a sudden increase of a repetitive activity involving the Achilles tendon. Such activity puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ongoing stress on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered, resulting in continued pain.
Athletes are at high risk for developing disorders of the Achilles tendon. Achilles tendonitis and tendonosis are also common in individuals whose work puts stress on their ankles and feet, such as laborers, as well as in "weekend warriors"- those who are less conditioned and participate in athletic only on weekends or infrequently.
In addition, people with excessive pronation (flattening of the arch) have a tendency to develop Achilles tendonitis and tendonosis due to the greater demands placed on the tendon when walking. If these individuals wear shoes without adequate stability, their over-pronation could further aggravate the Achilles tendon.
The symptoms associated with Achilles tendonitis and tendonosis include:
- Pain- aching, stiffness, soreness, or tenderness- within the tendon. This may occur anywhere along the tendon's path, beginning with the tendon's attachment directly above the heel upward to the region just below the calf muscle. Often pain appears upon rising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity.
- Tenderness, or sometimes intense pain, when the sides of the tendon are squeezed. There is less tenderness, however, when pressing directly on the back of the tendon.
- When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.
Treatment approaches for Achilles tendonitis or tendonosis are selected on the basis of how long the injury has been present and the degree of damage to the tendon. In the early stage, when there is sudden (acute) inflammation, one or more of the following options may be recommended:
- Immobilization. Immobilization may involve the use of a cast or removable walking boot to reduce forces through the Achilles tendon and promote healing.
- Ice. To reduce swelling due to inflammation, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
- Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibruprofen, may be helpful in reducing the pain and inflammation in the early stage of the condition.
- Orthotics. For those with over-pronation or gait abnormalities, custom orthotic devices may be prescribed.
- Night splints. Night splints help to maintain a stretch in the Achilles tendon during sleep.
- Physical therapy. Physical therapy may include strengthening exercises, soft-tissue massage/mobilization, gait and running re-education, stretching, and ultrasound therapy.
Craig M. Kaufman, DPM
Connecticut Foot Care Centers
Sports Podiatrist in Newington CT
Foot Doctor in Newington and Kensington CT
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