One of the most common causes of foot or ankle pain is tendonitis. Tendonitis is inflammation surrounding a tendon, which is a strong, cord-like structure that anchors a muscle to bone. The characteristic symptoms of tendonitis include pain and, occasionally, swelling during activity or with stretching of the affected tendon. The pain is usually relieved by rest, although the affected tendon may be painful to the touch.
Most Common Types of Tendonitis that Affect the Foot and Ankle
The Achilles tendon is the large tendon that attaches the calf muscles to the back of the heel. Achilles tendonitis is characterized by pain that is located two to six centimeters above the area where the tendon attaches to the heel bone. This is the weakest part of the tendon and is usually the spot where tendon tears occur. Achilles tendonitis is a common sports injury and can be brought on by any increase in activity or changes in shoes or terrain.
Posterior Tibial Tendonitis
Posterior tibial tendonitis is usually associated with flat feet. The tendon of the tibialis posterior muscle wraps around the inside (big toe side) of the ankle (medial malleolus) and instep of the foot. That area is the usual site of pain and swelling. Flat feet usually show the "too-many-toes" sign, an abnormal foot position where the toes splay outward in relation to the rear of the foot. The foot often continues to flatten and splay outward if posterior tibial tendonitis becomes a chronic, recurring problem.
The tendons of the peroneal muscles wrap around the outside (little toe side) of the ankle (lateral malleolus). Pain and possibly swelling occur in this area of the ankle and in the area just below and above it. High-arched feet and a history of recurring ankle sprains are sometimes associated with peroneal tendonitis.
Flexor tendonitis has characteristic pain deep in the back of the ankle, on the big toe side. This type of tendonitis is usually seen in dancers or with activities that require a lot of toe balancing.
Tendonitis affecting the extensor tendons on the top of the foot is usually caused by the foot rubbing against the shoe or, less frequently, inflammatory conditions such as rheumatoid arthritis. High-arched feet are more susceptible to the shoe friction that causes this type of tendonitis.
Conditions that Can Cause Tendonitis:
- Overuse - The most common cause of tendonitis is overuse, which means a tendon is overly stretched and possibly experiencing a small degree of pulling apart or tearing. This occurs when there is an increase in activity, which can include anything from walking to participating in competitive sports.
- Abnormal foot structure - Problems such as flat feet or high arches can create muscular imbalances that put stress on one or more tendons.
- Trauma - A foot or ankle injury can cause tendonitis. This can occur with a sudden, powerful motion like jumping. Another form of trauma is chronic rubbing against a shoe, which most often occurs at the top of the foot or heel, resulting in tendonitis in those areas.
- Medical Conditions - Certain medical conditions that cause general inflammation can lead to tendonitis. Inflammatory conditions such as rheumatoid arthritis, gout and spondyloarthropathy can cause Achilles tendonitis or posterior tibial tendonitis.
Treatment of Tendonitis
One of the best ways to prevent tendonitis is to do foot- and ankle-stretching exercises before activity.
When tendonitis symptoms occur, the first thing to do is R.I.C.E, which stands for rest, ice, compression and elevation. Decrease activity as much as possible and apply ice or cold compresses for 20 minutes at a time. While cold compresses and ice are helpful for swelling, recent medical studies have shown that applying heat to sore areas is equally therapeutic for soreness. Compression can mean applying an ACE wrap or other store-bought ankle support if necessary. Anti-inflammatory medicines such as ibuprofen can also be taken to help decrease pain and swelling.
If pain and swelling worsen, are not relieved with home care, or occur while at rest, it is best to seek medical attention as soon as possible. Sometimes a tendon rupture, or complete tear, may be the cause. A torn tendon requires immobilization with a cast or boot and may even require surgery.
If you frequently experience tendonitis symptoms, a podiatric evaluation can help identify foot abnormalities that may be causing them. Shoe recommendations, arch supports or orthotics and prescription braces are possible treatments options to manage and prevent tendonitis.
Sammarco MD, James G. and Cooper MD, Paul S (Eds.), Foot and Ankle Manual, 2nd ed. Williams and Wilkins, 1998. pps. 331-339.
Klippel, MD, John H. (Ed.), Weyand MD, PhD, Cornelia M., Wortmann, MD, Robert L. (Assoc. Eds.). Primer on the Rheumatic Diseases, 11th ed. Atlanta: Arthritis Foundation, 1997. pps. 285-286.