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Achilles tendon

The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body.[1][2][3][4][5][6] It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone. These muscles, acting via the tendon, cause plantar flexion of the foot at the ankle joint, and (except the soleus) flexion at the knee.

Not to be confused with Achilles' heel.

Achilles tendon

Back of the lower leg

tendo calcaneus, tendo Achillis

Abnormalities of the Achilles tendon include inflammation (Achilles tendinitis), degeneration, rupture, and becoming embedded with cholesterol deposits (xanthomas).


The Achilles tendon was named in 1693 after the Greek hero Achilles.[7]

History[edit]

The oldest-known written record of the tendon being named for Achilles is in 1693 by the Flemish/Dutch anatomist Philip Verheyen. In his widely used text Corporis Humani Anatomia he described the tendon's location and said that it was commonly called "the cord of Achilles."[8][9] The tendon has been described as early as the time of Hippocrates, who described it as the "tendo magnus" (Latin for "great tendon") and by subsequent anatomists prior to Verheyen as "chorda Hippocratis" (Latin for "Hippocrates' string").[9]


Verheyen referred to the mythological account of Achilles being held by the heel by his mother Thetis when she dipped him in the River Styx as a baby to render his body invulnerable. As the heel by which she held him was not touched by the water, it was his one vulnerable spot (hence the expression "Achilles' heel") and he was eventually killed by a poison dart to the heel. The name thus also refers to the particularly disabling and painful effect of an injury to this tendon.[9] The first closed rupture was described by Ambroise Pare in the sixteenth century.[9]


The Achilles tendon is also known as the "tendo calcaneus" (Latin for "calcaneal tendon").[9] Because eponyms (names relating to people) have no relationship to the subject matter, most anatomical eponyms also have scientifically descriptive terms. The term calcaneal comes from the Latin calcaneum, meaning heel.

Function[edit]

Acting via the Achilles tendon, the gastrocnemius and soleus muscles cause plantar flexion of the foot at the ankle. This action brings the sole of the foot closer to the back of the leg. The gastrocnemius also flexes the leg at the knee. Both muscles are innervated by the tibial nerve.[14] Because the fibres of the tendon spiral about 90 degrees, fibres from the gastrocnemius tend to attach to the outer part of the bone, whereas fibres from the soleus tend to attach closer to the midline.[11]


Vibration of the tendon without vision has a major impact on postural orientation.[15] Vibration of the tendon causes movement backwards and the illusion of a forward body tilt in standing subjects.[16] This is because vibrations stimulate muscle spindles in the calf muscles. The muscle spindles alert the brain that the body is moving forward, so the central nervous system compensates by moving the body backwards.

Paratendinopathy: The inflammation of a connective tissue sleeve which surrounds the tendon and protects it from friction, irritation, and repeated trauma

Insertional: Eminently overuse-injury which frequently occurs in running and jumping athletes. Patients affected by insertional Achilles tendinopathy complain of pain on the posterior aspect of the heel and may have morning stiffness, swelling with activity and tenderness at the tendon insertion level. If this condition becomes chronic, calcific deposits at the Achilles insertional level may be developed (due to microfractures and healing of the osteotendinous union) which can degenerate, if it persists over time, in the abnormal bony prominence on the posterior aspect of heel, condition known as Haglund deformity,[36] which can be painful and difficult close-shoes fitting due to friction and irritation.

[35]

Mid-portion: Occurs approximately 2–7 cm proximal from the Achilles insertion into the calcaneus. Characterized by a combination of pain and swelling at this level. It has associated a remarkable impaired performance.

[37]

Other animals[edit]

The Achilles tendon is short or absent in great apes, but long in arboreal gibbons and humans.[38] It provides elastic energy storage in hopping,[39] walking, and running.[38] Computer models suggest this energy storage Achilles tendon increases top running speed by >80% and reduces running costs by more than three-quarters.[38] It has been suggested that the "absence of a well-developed Achilles tendon in the nonhuman African apes would preclude them from effective running, both at high speeds and over extended distances."[38]

Heel lifts

Media related to Achilles tendon at Wikimedia Commons