One of the most common places for tendonitis to occur in the body is in the foot and ankle. Tendonitis means inflammation of the tendon. There are many tendons in the foot and ankle. The tendons which tend to develop inflammation are:
- Achilles tendon. It's the largest tendon in the body and attaches the heel to the calf muscle. It helps us walk by raising the heel off the ground.
- Posterior tibial tendon- it attaches the calf muscle to the bones on the inside of the foot. It holds up the arch and supports the foot when you walk.
- Peroneal tendons - we have two of these tendons in the foot. One runs along the outside of the foot and attaches to the baby toe and the other tendon runs along the bottom of the foot and attaches to the inside of the arch.
- Tibialis anterior tendon - runs across the front of the ankle.
- Extensor tendons - one tendon is called the extensor digitorum longos and it runs from the top of the foot to the small toes. The other tendon is called the extensor hallucis longus and it runs from the top of the foot to the big toe.
- Flexor tendons - one tendon is called the flexor digitorum longus and it runs from the bottom of the foot to the small toes. The other tendon is called the flexor hallucis longus and it runs from the bottom of the foot to the big toe.
Types of Tendonitis
- Achilles tendonitis - the most common tendonitis of the lower extremities often caused by repetitive motion such as running.
- Posterior tibial tendon dysfunction - pain can occur anywhere along the tendon, from the bottom of the arch to the inside of the ankle.
- Peroneal tendonitis - pain can occur on backside of the ankle or over the lateral side of the heel.
- Anterior tibial tendonitis - pain occurs on the front of the ankle.
- Extensor tendonitis - pain occurs on the top of the foot where your tendons attach to the toes.
- Flexor tendonitis - pain occur in the back of the ankle, the side of the big toe, or in the foot arch. Common in ballet dancers.
In addition to classifying tendonitis by the type of tendon affected, there are different types of tendon injuries based on severity. This article focuses on tendonitis which is a milder form of tendon injury. Other terminology that describes tendon injuries include tendonosis (tears that occur over time as a result of age or degeneration), tendonopathy (tendon tears accompanied by tendonitis), and acute tears (tears that occur suddenly usually as a result of sports eg. Achilles tendon rupture).
While the most common cause of tendonitis of the foot and ankle is overuse, additional causes include:
- severe high arches or severe flat foot
- Participation in sports
- Unsupportive shoes
- Previous injuries to the foot or ankle
Symptoms and Diagnosis
The most common symptoms are pain, swelling, stiffness, and redness. Particularly after an injury the pain will diminish overtime but return later.
Your podiatrist will do an X-ray and very likely an MRI to determine the extent of the injury.
Conservative treatment for these conditions can often yield relief from pain. These include:
- Icing for acute injuries
- Stopping physical activity
- Anti-inflammatory medication
- Cortisone injection
- MLS laser therapy
- Custom orthotics and bracing
- Walking boot
- Physical therapy
When conservative treatment is not effective, surgery may be necessary to repair the damage.
To prevent these conditions from occurring patients should consider the following:
- replacing athletic shoes every 500 miles or every six months
- ensuring shoes are supportive and appropriate for the sport
- wearing over-the-counter or custom orthotics to correct for flat feet or other foot imbalances
- scanning playfields for divots and other objects to prevent ankle twists and sprains
- gradually building up distance and time spent running or participating in other sports
- stretching before and after sports
- participating in other physical activity to build up core strength