how foot tendonitis is treatedAthletes and non-athletes can develop foot tendonitis (tendinitis). Tendons are strong, thick cords of tissue that connect muscle to bone. When these tendons become inflamed, tendonitis develops.

While athletes are most likely to develop foot tendonitis through overuse or injury, anyone can fall or twist their foot or ankle causing this condition to develop.

Other factors that increase your risk for tendonitis are:

  • Flat feet
  • Tight calf muscles
  • Improper stretching before and after exercising
  • Poor form during exercise
  • Improper footwear
  • Health conditions such as arthritis, thyroid disease, gout, or diabetes
  • Overweight
  • Experienced previous injuries to a tendon
  • Smoking

Symptoms of Foot Tendonitis

You may have developed foot or ankle tendonitis if you notice any of the following symptoms:

  • Swelling, redness, or warmth near the tendon
  • Pain along the length of the tendon or where the tendon connects to the bone
  • Ankle pain felt on the inner or back of the ankle
  • Tendon stiffness following periods of inactivity, particularly in the morning
  • Ankle snapping noises or sensations
  • Physical exercise causes pain to worsen.

Are There Different Types of  Foot Tendonitis?

Because your feet have five tendons, you can develop different types of foot tendonitis depending on which ones are affected. The types of tendonitis you can develop are:

  • Achilles tendonitis
  • Posterior tibial tendonitis
  • Extensor tendonitis
  • Peroneal tendonitis
  • Anterior tibial tendonitis
  • Flexor tendonitis

Let’s go over each one.

Achilles tendonitis

The Achilles tendon is the largest tendon in the foot and body. Because it runs along the back of the foot that’s where you’ll most often feel the pain. In addition, to the risk factors above, Achilles tendonitis can develop because of hill running or stair climbing and resuming exercise too early after a period of inactivity. The Achilles tendon can also rupture when too much force is applied. Learn more about Achilles tendonitis and its treatment here!

 

 

Posterior Tibial Tendonitis

The posterior tibial tendon supports the arch when you move. When this condition develops you’ll feel pain along the inside of the foot or ankle. Early treatment is critical to prevent progression to Posterior Tibial Tendon Dysfunction (PTTD). In the latter condition, the foot flattens causing significant pain, deformity, and loss of function.

Learn more about Posterior Tibial Tendonitis and PTTD here!

Extensor Tendonitis

The extensor tendons are responsible for lifting your foot when you walk or run. When this condition develops, you’ll feel pain over the top of the foot or ankle. It’s mostly found in dancers, skiers, and figure skaters. In addition to the other risk factors listed above it can also be caused by running up and down hills and spending too much time on your feet.

Learn more about treatment and prevention of Extensor Tendonitis here!

Peroneal Tendonitis

The peroneal tendons do a lot of different tasks. They assist with transferring your weight from the outer foot to the great toe during push-off, aid your calf muscles in foot flexion, and maintain ankle stability when you run or jump. You’ll feel pain along the outside of the foot or ankle. In addition to the other causes mentioned above peroneal tendonitis is also caused by chronic ankle sprains resulting from a high-arched foot.

Learn more about the symptoms and treatment of Peroneal Tendonitis here!

Anterior Tibial Tendonitis

The anterior tibial tendon pulls the foot up, lifts the foot up when in motion, and turns the foot inward. People most at risk are athletes involved in sudden, repetitive jumping and quick starts, those who run hills and long distances, have poor physical conditioning, and those with flat feet.

Symptoms

  • Pain and swelling in front of the ankle where it joins the foot.
  • Pain that worsens with increased activity
  • Redness on the front of the ankle
  • Pain and weakness when the foot is pulled up.
  • Cracking sound when the tendon is moved or touched

Flexor Hallucis Longus Tendonitis

The flexor tendon helps you flex your big toe and stand on the tips of your toes. It extends from the calf muscle, past the side of the ankle, and to the big toe. Flexor Hallucis Longus Tendonitis is caused by repeated push-off from the big toe.

Risk Factors

  • Found most often in gymnasts and dancers
  • Inadequate warm-up before exercise
  • Poor technique
  • Not fully rehabbing previous injury
  • Flat feet
  • Poor flexibility
  • Inappropriate footwear

Symptoms

  • The pain develops slowly and over time and is felt on the bottom of the foot or the inside of the ankle.
  • Pain is worse when pushing off the toes.
  • A clicking sensation can be felt when flexing the big toe.
  • Stiffness after rest
  • Pain when touching the tendon

Treatment of Foot Tendonitis

Foot tendonitis will not typically go away on its own. If you develop this condition, it’s important to suspend all physical activities, and elevate and ice the area, particularly in the beginning stages and before you see a podiatrist. Taking an anti-inflammatory medication can also help as long as they are recommended by your physician. These steps will help decrease inflammation and pain.

Other potential therapies depending on the type of injury you have can include:

  • Immobilization with a walking boot or brace
  • Custom orthotics – these are recommended when patients have poor foot mechanics like flat feet.
  • Stretching for tight calf muscles
  • MLS laser therapy – this non-invasive treatment can help reduce pain and inflammation and increase the bodies ability to heal itself at the cellular level.
  • Cortisone injection – a guided ultrasound injection of cortisone may be needed to more quickly reduce inflammation
  • Physical therapy - can improve flexibility and strength in the affected area
  • Wearing supportive shoes – supportive shoes are essential. If you’re an athlete you should wear shoes specifically designed for your sport.
  • Surgery – while our office focuses on conservative treatment, sometimes surgery is necessary to help you more fully recover from your tendonitis.

Prevention of Foot Tendonitis

To prevent a recurrence of foot tendonitis, follow these measures.

  • Wear Your Custom Orthotics At All Times - to prevent a recurrence of foot tendonitis it’s important to wear your custom orthotics all the time, not just when you’re exercising.
  • Continue to Stretch Your Calf Muscles - stretching your calf muscles will help greatly in preventing tendonitis. Use dynamic stretching before you work out and static stretches afterwards.
  • Gradually Increase Your Training Time - your body needs time to recover from your workouts. Don’t increase your training time by more than 10% a week.
  • Vary Your Terrain – consider changing up the terrain you run or workout on. For example, don’t run hills every day as this can be a factor in developing foot tendonitis.
  • Replace Your Shoes. if you’re an athlete you may have to replace your shoes every 6 months to ensure they are still providing proper support for your sport. To find out if your shoes are worn out, turn them over and examine the treads. 
Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.