Their Achilles’ heel

A cluster of stars from the baseball diamond to the silver screen have discovered lately the vulnerability of a mythic point on the human body, the Achilles tendon.

Already this season, three Major League Baseball players -- Nomar Garciaparra of the Boston Red Sox and Mark Prior and Mark Grudzielanek, both of the Cubs -- have been benched for several weeks with strains or partial tears to the Achilles tendon.

Meanwhile, Los Angeles Laker Gary Payton has been slowed with a sore Achilles, and actor Brad Pitt, ironically, while playing the Greek warrior Achilles, injured his left tendon during the filming of “Troy.”

The body’s longest tendon, connecting the calf muscle to the heel bone, the Achilles is particularly susceptible to injury. Once damaged, it can take months to heal properly.

Sports medicine experts say that part-time athletes in their 30s and 40s, not physically fit professional athletes or movie stars, are most vulnerable to Achilles’ heel injuries. Age, increasing body weight and loss of flexibility, they say, are the main reasons for this group’s vulnerability.

Furthermore, men are hobbled by Achilles problems at more than 10 times the rate of women. Part of the reason, sports medicine physicians say, is that men tend to play sports with a higher risk for Achilles injuries. But even that doesn’t account for all the disparity.

“The middle-aged guys who are out there playing basketball or tennis are the ones who really have to be careful,” said Dr. Robert Sallis, an assistant clinical professor at UC Riverside with the American College of Sports Medicine’s team physician’s program. “Because they can be suddenly racing for a ball -- and pop!”

That “pop” is the sensation of the most serious type of injury, a complete rupture, usually triggered by the first few steps of a sprint or a harsh landing after a jump. A complete tear can leave the victim unable to walk unassisted or even to get off the field under his own power.

Strains or small tears often happen gradually and begin with tendinitis, a chronic inflammation that, if untreated, increases the chance of ruptures. After age, overuse is one of the chief causes of strains and tears. The symptoms are usually pain and stiffness near the heel.

Sports medicine experts are divided over how to treat a rupture in nonprofessional athletes. Some doctors, usually surgeons, urge patients with a torn Achilles to have it surgically reconnected, ensuring that the tendon is properly realigned. Such an operation offers the best chance of restoring the tendon to its original strength, they add, and preventing a future tear.

Other physicians believe that simply putting the injured person in a walking boot for eight weeks and letting the tendon naturally reattach itself is the best route. The treatment avoids possible complications from surgery and lets most people return to work within a couple days. Surgery usually requires up to a week off. In either case, recovery time is roughly the same: six months to a year.

“The decision to operate really has to be individualized,” said Margot Putukian, director of athletic medicine at Princeton University in Princeton, N.J. “Taking into consideration their age, their sport and where they are in their season, some athletes do as well without surgery as with it.”

For professional athletes, however, most experts recommend surgery to repair the ruptured tendon.

“It’s an explosive injury. I mean it can look like a mop end,” said Dr. Tom Vangsness, a professor of orthopedic surgery at USC. “To me, there’s little doubt that in a high-profile athlete, you open them up. The flavor of the literature says the tendon will be stronger.”

Treatment for less serious injuries, including those of the three baseball players injured this season, is more straightforward for both professionals and weekend warriors. Primarily, rest is the key to recovery, which usually means suspending the activity that caused the injury for six to 12 weeks. Other treatments include anti-inflammatory medication, massage, stretching and strengthening exercises.

To stay in shape, professional athletes frequently train temporarily in another sport, such as swimming, that doesn’t aggravate the condition. Elite athletes usually opt for physical therapy and are sometimes fitted with shoe orthotics in an effort expedite the healing process.

Even with the relatively aggressive treatments pro athletes receive, healing can still be a very slow process. For instance, Prior is not expected to resume pitching until early June.

It’s not known whether Achilles injuries can be effectively prevented through exercises, stretching or even scaling back an activity, say physicians. Short of stopping activities that require quick bursts of speed, there may be little way to eliminate such injuries.

Most physicians do recommend, however, that all athletes stretch the tendon regularly and perform strengthening exercises, such as calf raises. Staying in good overall physical condition also seems to help, physicians say.

“The Achilles is still somewhat perplexing,” Vangsness said. “There’s a lot more we need to know.”