Foot and Ankle Tendonitis 

What is Tendonitis?

Foot and ankle tendonitis is a common cause of foot pain, occurring when there is inflammation or irritation of the tendons, usually due to overuse or injury.

Symptoms of Foot Tendonitis

1) Pain Pain is usually the first sign that there is a problem and it tends to be a sharp and/or burning sensation. The pain is usually localised to the area of the tendon at first but as the condition worsens, can spread wider.  Pain is typically worse with initial movement, settles down after a minute or so, but then returns as you do more activity. For example, your first few steps when you get out of bed will be painful, but the pain will ease up as the day goes on. However, the pain will return the longer you’re on your feet.

2) Swelling Swelling usually takes a while to develop with the condition.  After a few weeks of minor symptoms, you may notice a soft lump forming over the tendon, which is often tender to touch.

3) StiffnessThe foot and ankle often becomes stiff as a result of ankle tendonitis thus limiting the amount of pain-free movement.

TYPES OF FOOT AND ANKLE TENDONITIS 

EXTENSOR TENDONITIS

(PAIN ON THE TOP OF YOUR FOOT)

This form of foot tendonitis is caused by inflammation or irritation of the tendons that pull the toes up, usually from repeated friction or compression from a poorly fitting shoe.

It tends to affect people who spend long periods on their feet, people walking or running on uneven surfaces or up and down hills and people who lace their shoes too tightly.

Swelling can often occur and it’s very likely you see a large bump or nodule somewhere on the tendon itself.

Treatment and Prevention

The most effective treatment is to change your shoe lacing pattern and loosen your laces slightly, especially while you’re bothered by the pain. You can use a ladder-lacing pattern, which reduces pressure on the top of the foot by not allowing the laces to cross over the middle of the metatarsals. Alternatively, you can also use shoes with Velcro straps and stretch material as pictured below.

 

 

 

ACHILLES TENDONITIS

Achilles tendonitis is an inflammatory condition that involves the Achilles tendon and/or its tendon sheath.

The Achilles tendons are located on the back of your legs, connecting the calf muscle to your heel bone (Calcaneus).

There are three main symptoms most commonly associated with the condition:

1) Pain: This tends to be over the problem area and sometimes radiates out to the calf region and heel.  It is usually worst first thing in the morning or after prolonged rest.

2) Thickening: You can often feel a lump in the affected area of the tendon which can be painful to touch.  This varies in size depending on the severity of the tendonitis and the location.

3) Stiffness: The ankle and calf often become tight and stiff, limiting foot movement.  Again, this tends to be worst after prolonged rest and eases with gentle movement.

Footwear and Achilles tendon injuries

Achilles tendon injuries and footwear are related in three ways: correctly fitting footwear can be a major factor in preventing Achilles tendon injuries, recovering from Achilles tendon injuries, and preventing the re-occurrence of Achilles tendon injuries. Unfortunately, the reverse is just as true: incorrect footwear can increase the likelihood of Achilles tendon injuries, delay recovery, and increase the chance of a re-occurrence.

An Achilles tendon injury is usually a sign that footwear changes should be made.  Better fitting shoes and sports shoes often make a huge difference to the Achilles tendons.  A good fit means a lot more than just the right shoe size and width; it means the correct arch, cushioning, firmness, height, and heel height.  Keep shoes that fit well and get rid of old worn out shoes and shoes that do not have a good fit.

 

PERONEAL TENDONITIS

What is peroneal tendonitis?

The peroneal tendons run on the outside of the ankle just behind the bone called the fibula. Tendonitis implies that there is inflammation in the tendon. This usually occurs in the setting of overuse, meaning a patient does a repetitive activity that irritates the tendon over long periods of time.​

What are the symptoms of peroneal tendonitis?

Patients will usually present with pain right around the back of the ankle, swelling and tenderness.

What causes peroneal tendonitis?

This most commonly occurs in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. Improper training or rapid increases in training and poor shoe wear can lead to peroneal tendonitis.  The harder the tendons work, the more likely they are to develop tendonitis.

What are treatment options?

The vast majority of peroneal tendinitis will heal without surgery. This is because it is an overuse injury and can heal with rest. This usually takes several weeks. Long-term treatment includes regular calf muscle stretching and an orthotic that tilts the ankle to the opposite side to help to offload the tendons.

Medical grade shoes in this case would be beneficial. Wearing a stiff soled shoe with a wide base and a high toe box would help you through the healing process by taking a lot of stress off the peroneal tendons.

POSTERIOR TIBIAL TENDONITIS

This causes pain on the inner side of the foot.  The posterior tibial tendon runs along the inside of the foot and ankle.  Pain is usually felt when you start to push off through your foot.

The main function of the tendon is to hold up the arch and support the foot when walking. When the tendon becomes inflamed or torn, it may not be able to provide stability and support for the arch of the foot, resulting in flatfoot. Most patients can be treated without surgery, using orthotics, braces and medical grade shoes.

TREATMENT

Immobilization

A short leg cast or walking boot may be used for 6 to 8 weeks. This allows the tendon to rest and the swelling to go down. However, a cast causes the other muscles of the leg to atrophy (decrease in strength) and thus is only used if no other conservative treatment works.

Orthotics

Most people can be helped with orthotics and braces. An orthotic is a shoe insert. It is the most common nonsurgical treatment for a flatfoot. A custom orthotic is required in patients who have moderate to severe changes in the shape of the foot.

Braces

A lace-up ankle brace may help mild to moderate flatfoot. The brace would support the joints of the back of the foot and take tension off of the tendon. A custom-moulded leather brace is needed in severe flatfoot that is stiff or arthritic. The brace can help some patients avoid surgery.

What to look for when buying the best shoes for posterior tibial tendonitis:

  • A shoe where the mid-sole area is firm and cannot be easily twisted or rotated.

  • A shoe that provides good heel support, also to stop pronation.

  • The shoe offers good cushioning inside.

  • Shoes that allow you to use your own orthotics if needed.

  • A shoe that has “motion control” or “maximum stability” features as these prevent midsole twisting and pronation.