The beauty of golf is its accessibility to people of all ages and fitness levels. Although less physically demanding than many other sports, orthopedic specialists at Hospital for Special Surgery (HSS) have seen their share of injuries among golfers. While many involve the back, shoulder or hip, another painful condition can sneak up on players and make it difficult to enjoy the game — Achilles tendonitis.
The Achilles is the largest and strongest tendon in the human body, connecting the calf muscles to the heel bone. It comes into play when we walk, run, and jump. Remember Achilles, the hero in Greek mythology who was only vulnerable to injury at his heel? Technically called the calcaneal tendon, Dutch surgeon Philip Verheyen coined the term “Achilles” in his book on anatomy back in 1693.
Achilles tendonitis, also known as tendinopathy or tendinosis, refers to an irritation, degeneration or inflammation of the tendon. It causes pain, and sometimes swelling, in the back of the leg near the heel.
Good foot and ankle health are essential for athletic activities such as golf, providing stability, strength, and the ability to adapt to changing terrain. Our feet absorb the impact of every step we take, and walking the golf course requires substantial support from the Achilles tendon. Players may walk more than six miles on an average 18-hole round. All that walking — uphill, downhill, on sand — can lead to foot and ankle problems.
Tendonitis often results from overuse — doing too much of an activity too often without adequate rest. Footwear that does not provide good support is another culprit. Tight calf muscles that put excessive strain on the tendon during the golf swing or while walking a long distance can also lead to tendonitis. It can make walking the course more difficult or even painful, limit range of motion, and reduce power in the golfer’s drive.
HSS experts advise anyone experiencing pain or stiffness in the back of their leg to take a break. For discomfort that doesn’t improve with rest, a consultation with a medical professional may be in order. In addition to activity modification, treatment may include ice, physical therapy, and a shoe insert to raise the heel and take pressure off the tendon.
Taking preventive steps and treating pain early are essential to maintain performance and comfort on the golf course. Here is a roundup of the best advice from HSS:
- Avoid doing too much, too soon. If you’ve been inactive for a while, gradually increase the amount of time you play.
- Choose proper, well-fitting footwear. Your feet shouldn’t slide inside your shoes as you swing.
- Warm up for 5 to 10 minutes before playing with a light jog, mini-squats or heel raises.
- If you have tight calf muscles, consider consulting a sports medicine specialist, physical therapist or athletic trainer for advice on when and how to stretch. Stretching when you reach the ninth hole or after a round of golf may lessen the amount of stress the calf muscles put on the tendon.
- Before beginning your game, take a few slow practice swings to roll through your feet and ankles.
- If you injure your foot or ankle during the game, stop playing. Don’t resume golf until the pain resolves.
- Consider heel lifts or cushions for temporary pain relief.
- When hitting on uneven terrain or out of the sand, make sure your feet make solid contact with the ground by bending at your knees or hinging at your hips.
- If you have a foot problem that is exacerbated by walking, consider using a golf cart.
- Stay hydrated. Drinking plenty of water is important when engaging in any sport, especially when playing in hot weather and strong sunlight. Inadequate fluid intake can lead to dehydration, which can cause muscle cramping in the calves and affect the Achilles tendon.
- Try to stay in good physical condition overall to avoid an overuse injury and to have the energy to walk to the 18th hole.
- If consuming an alcoholic beverage before or during the game, be mindful of the effect it can have on your body. It may be OK to enjoy a cocktail during a lunch break, but it’s important to drink responsibly. Too many drinks could not only affect your game, but also lead to injury.
- If you are taking a fluoroquinolone antibiotic such as Ciprofloxacin, you may want to modify your activity. This class of medication has been linked to tendonitis and even tendon tears.
The HSS experts say simple measures such as gradually increasing play time and listening to your body will help ensure a safe and enjoyable golf season.
Andrew P. Creighton, DO, physiatrist at HSS in New York City; Mark C. Drakos, MD, orthopedic foot and ankle surgeon at HSS in New York City and Medical Director at HSS Long Island; and David A. Wang, MD, sports medicine physician at HSS in New York City and HSS Paramus, were interviewed for this article.