Reprinted from The Medical News, February 18, 1893.] 
ACHILLODYNIA} 
By AUGUSTUS A. ESHNER, M.D., 
CHIEF CLINICAL ASSISTANT, OUT-PATlfiNT MEDICAL DEPARTMENT, 
JEFFERSON MEDICAL COLLEGE, PHILADELPHIA. 
The man whose case I herewith detail presented him- 
self at Jefferson Medical College Hospital, in the service 
of Dr. H. A. Hare (by whose courtesy this report is 
made), complaining of swelling and soreness in the 
region of the heels, that had been present for about four 
weeks. He was twenty-two years old, a car-cleaner by 
occupation, and stated that he had had a similar attack 
three and a half years previously that lasted for about 
fourteen months, and apparently had disappeared spon- 
taneously. The pain appeared after walking, and was 
relieved by rest, either in the sitting or recumbent pos- 
ture. The swelling, however, persisted. There had 
been no traumatism of the parts, and there was no his- 
tory of rheumatism, and none of gout. The man had 
been infected with gonorrhea four years previously (that 
is, half a year preceding the first attack of swelling and 
pain about the heels). The urethritis had never been 
entirely cured, remaining at times latent for months, and 
then breaking out with its former intensity. Within this 
time, he stated, one of the testicles (perhaps it was the epi- 
didymis) had been swollen, and there had been enlarge- 
ment of one or more glands in the right groin. No 
history could be obtained of a sore upon the genitals, of 
1 Read before the Philadelphia County Medical Society, Feb 
ruary 8, 1893. _ 2 
cutaneous eruption, of involvement of the mucous mem- 
branes, of alopecia or of other manifestation suggestive 
of secondary syphilis. There was no heart-lesion, and 
the urine presented no abnormality. There was no his- 
tory of a similar affection in other members of the 
family. 
On examination a firm swelling was found above the 
heels, apparently inseparable from the os calcis, and 
over which passed the tendo Achillis. Manipulation 
induced pain. Station was steady; the knee-jerks were 
preserved; the pupils were equal, regular, and responsive 
to light. I was at a loss to account for the condition, as 
I had never before seen its counterpart; and in the 
absence of more definite information I made a tentative 
diagnosis of syphilis. It was directed that small blisters 
be applied to the heels on either side of the tendo Achillis, 
and potassium iodide was prescribed for use internally. 
The man returned a short time afterward, unimproved. 
A few days days after the case had presented itself I 
came by chance across a note in the Wiener medicinische 
Presse, 1892, No. 2, p. 43, by Professor Albert, of the 
University of Vienna, in which he reports one of a half- 
dozen cases that he has encountered in the course of a 
number of years, characterized by intolerable pain on 
walking or standing, while no discomfort was suffered 
in the sitting or recumbent posture. The pain was ac- 
curately referred to the insertion of the tendo Achillis, in 
which situation there was sometimes also a slight promi- 
nence, as if the tendon were thickened. As a rule the 
parts were not unduly sensitive upon pressure. In 
some cases the bone on either side of the tendinous in- 
sertion appeared to be enlarged. The pain was exceed- 
ingly rebellious and resisted hot applications,cold appli- 
cations, counter-irritation with tincture of iodine and 
inunctions of mercury. Albert was unable to find any 
reference to the subject in literature. He relates that 
Raynal and Kirmisson have described a “ peri-tendinous 3 
cellulitis of the tendo Achillis,” which, however, does not 
agree with the condition under consideration ; and he re- 
fers to a description by Pitha (Pitha-Billroth’s Handbook oj 
General and Special Surgery) of a “ partial rupture of the 
tendo Achillis ” and a “ partial evulsion of the insertion 
of the tendo Achillis,” in which the symptoms recorded 
agree with those here detailed. The opinion is expressed 
that the cases attended with swelling of the tendon are 
described as instances of rupture, while the cases in 
which enlargement of the bone is present are considered 
as instances of evulsion. In one case of Albert’s the pain 
was aggravated by exacerbations of a specific urethritis. 
Kirmisson is also quoted as having noted in one case a 
connection with an attack of gonorrhea. Albert sug- 
gests that the condition may be analogous to a de- 
formity sometimes found in horseback riders, dependent 
upon a hyperplasia of periosteum and bone at the point 
of attachment of the great adductor muscle of the thigh. 
The name achillodynia is proposed for the affection, 
and is sufficiently descriptive, without committing one to 
any view as to its nature, etiology, and pathology. 
Concerning these we can only speculate. To complete 
the analogy with the condition found in riders, there 
should be, as suggested by my friend Dr. J. K. Young, 
a history of some corresponding muscular strain, such 
as standing on the toes for a considerable length of 
time. This was not present in the case here reported. 
The affection should thus be frequently encountered in 
professional dancers. The condition does not seem to 
be an acute inflammation. If the process be at all in- 
flammatory the action is of an exceedingly low grade. 
The condition may be a neurosis, with trophic changes. 
There is one other possibility, and that is that, in some 
cases at least, the condition is a manifestation of an 
intoxication of gonorrheal origin. 
I do not know what importance is to be attached to 
the condition here considered. Possibly it is less un- 4 
common than would appear. I present the case as a 
clinical curiosity. It may prove interesting, perhaps 
instructive to others who may have encountered cases of 
a similar kind. 
The features that seem to me to be of especial interest 
are the circumscribed character and the symmetry of 
involvement; the thickening above the heels; the absence 
of inflammatory symptoms; the presence of the pain only 
after walking; and the apparent spontaneous subsidence 
of the first attack.