This section of Damhsóir features articles written for us by Hullachan designer Craig Coussins on protecting your feet, toes, arches and heels.

Dance Injury & Prevention: The Achilles Tendon
by Craig Coussins

Craig Coussins started training as a dancer in his mother’s school in the West of Scotland well over 50 years ago. He started fitting and designing shoes made by the UK’s oldest dance shoemakers 30 years ago and has designed many award winning sports and dance shoes. He retired in 1995 to develop shoes closer to his Celtic roots, including shoes for Irish and Highland dancers.

The Achilles Tendon

When I speak to dancers that have serious injury, it is usually the Achilles tendon around the back of the heel that seems to be the most common of these. Around 18% of dancers get this painful condition at the back of their heels. It was called the Achilles tendon from the Greek legend of Achilles.

I know we are talking about this part of the body but I thought you would like to hear the background to this myth. It was not always Achilles’ heel that was his weak point.

Thetis dips Achilles into the Styx, holding him by the heels. Engraving-etching by Johann Balthasar Probst, 18th Century.

Thetis was Achilles mother. She wanted him to be immortal so holding him by the heel; she dipped him into the river that runs into the underworld, The Styx. The legend goes; she held him down once and forgot to immerse him a second time holding the other heel so the magical waters of the Styx did not cover the heel. That part then stayed vulnerable and not immortal. Since the 15th century, from writers on medicine such as Ambroise Pare and others, the term, Achilles Heel, referred to a weak point, not only physically, but also mentally.

Writer, Michael Macrone, in his excellent book called, It’s Greek to Me, (Harper Collins, New York, 1991) explained that Achilles did not always have a vulnerable heel. Certainly, he had a weak spot, but according to the original story about Achilles, Homer, in the Iliad, said it was his pride.

Later versions indicate his weakness was his love for the Trojan princess Polyxena. In his Metamorphoses, Ovid suggested that Achilles had a vulnerable spot on his body; but the Roman poet, Statius (c. A.D. 45-96), was the first to imply in a poem that it was his heel.

Back to the actual problem.

What is the Achilles Tendon?

The Achilles is connected to one of the strongest groups of muscles in the leg. Huge pressures build up in this area and athletes are very prone to damage in this area. The tendon we are discussing is attached to three muscles. The tendon itself is the end part of that muscle group. These are the gastrocnemius, (gast) which has two ends and the soleus muscles.

The problem is that the gast muscle crosses over three main joints. The knee, the ankle and the subtalar joint. Please let me explain a little anatomy as this really does affect you when you do Irish Dance.

The foot is divided into three sections. The forefoot, the back, or hind foot and the mid foot. The back foot is the anklebone or talar joint, and the calcaneus or heel bone. The subtalar (or subtalus) joint is formed by these two main bones and why it is important for you as an Irish dancer is that it is responsible for its amazing flexibility. When you do a rocking side-to-side movement with your ankles, it is the subtalar joint that allows this.

The major part of the Achilles is in the lower part of the leg near the foot and attached to the heel bone or calcaneus. See the drawing. Unlike other most other tendons, the Achilles is not inside a sheath and does not have a rich blood supply of its own.

Symptoms

• A sharp pain; painful heel up the back of the leg when you start to dance. The pain can subside during dancing and then return before you finish. This is the problem. You are lulled into a sense of false security. Just grin and bear it... work through the pain... deal with it?, I don’t think so!

Causes

• Achilles tendonitis can be caused by a number of factors. These can include simply ignoring any pain at the back of the leg of heel, extra classes preparing for a Championship, such as dancing twice a week and suddenly practicing five times a week. Breaking in a new shoe that is far too stiff, and not warming up, or cooling down properly. Fortunately, you are a body and not a machine, however, machines break and so can bodies. Be sensible and warm up correctly.
• Shoe pressure at the back of the foot, tying laces around the mid foot which stops the full functionality of the foot joints, getting kicked or damaging the tendon at the heel or just above the heel area.

Treatment for Achilles Tendonitis

• I coveredR.I.C.E treatment in the article on heels: Rest, Ice, Compression and Elevation. Please get that into play immediately to reduce the problem and do it at least three times a day over three or four days.
• See a doctor as soon as you can. If your Achilles is getting less painful still continue treatment of R.I.C.E. for the next two to four weeks or until it is healed.Reduce practice of course to about half of that you normally do.
• Avoid too much stretching. However saying that use correct stretching and if you do get an attack of Achilles tendonitis from your dancing, do not stretch too enthusiastically, but continue to stretch gently or if attending a doctor, follow their advice. Avoid stair, wall, incline and towel stretches.
• Try not contract the muscles in the initial period of pain.If this does not show positive results, use a firm heel support or lift of no more than a quarter inch or half a centimetre.
• Do not use flat shoes in day-to-day use such as trainers. The idea is to relieve the pressure on the tendon so that it does not stretch too much. A good preventative part of your general warm up should be gentle calf stretches.
• Do not use overly cushioned insoles that are too soft.
  

Avoid all trainers/dance sneakers when practising if you get Achilles tendonitis.

Other problems in this area

Heel Bumps: A heel bump may be diagnosed as Haglund’s Deformity. It can possibly indicate that the tendon is pulling away from the heel bone, or that a bony growth is caused by pressure at the back of the heel. Ascertain if there is any pain while you are barefoot and while you are wearing a shoe. The Achilles Tendon problem will be painful while you are barefoot. Haglund’s is painful while wearing a shoe but, normally, not barefoot. Heel bump, while in some cases, not too serious or indeed even painful can cause shoe fitting problems and this could mean you buying a shoe that is not the right overall fit. Width is probably the answer here. I have an answer for this but will discuss this later on.

Achilles, who can not be killed except through his heel, dies of an arrow. Engraving-etching by Johann Balthasar Probst, 18th Century.

The articles on this website have been written by Craig Coussins and edited for the web by Damhsóir. Questions regarding article content should be directed to Mr. Coussins or visit or Hullachan Pro.com .

Advice given here is just that -- advice. If you are suffering from an Irish dance injury, please see your doctor for treatment.

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