Tendonitis of the Foot and Ankle

Overuse injuries to your feet and ankles can sideline you

Achilles tendonitis
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One of the most common causes of foot or ankle pain is tendonitis. The muscles of your leg, foot, and ankle are anchored to the bone by the tendons, which are strong, cord-like structures. Tendonitis is inflammation surrounding a tendon. You will have pain with activity and it usually goes away with rest, only to return again.

The most common types of foot and ankle tendonitis are Achilles tendonitis, posterior tibial tendonitis, peroneal tendinosis, flexor tendonitis, and extensor tendonitis.

Self-care measures will usually heal these injuries over the course of a few weeks. Learn more about what causes them, when to see your doctor, and how to prevent foot and ankle tendonitis.

Causes

  • 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.

    Symptoms

    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.

    You will notice pain, especially when you first start an activity, such as getting up and walking.

    Often, the pain will lessen but then return as you keep walking or doing other activities. You may notice swelling, although this isn't usually an immediate symptom. Often, your foot and ankle will become stiff when you have tendonitis.

    Self-Care

    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.
    • 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.

    When to Seek Medical Attention

    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. Your doctor will take your history and may order X-rays or MRI see whether you have a fracture, calcification, or a tendon rupture, which may require a different form of treatment. 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.

    Treatment

    The general principle for treating foot and ankle tendonitis is to give the injury rest so the body can heal it. This takes time, usually weeks to months. Your doctor may give you a walking boot to keep your foot and ankle immobilized so you aren't using it, or you may be directed to have no weight bearing on the affected foot.

    You are likely to be prescribed nonsteroidal anti-inflammatory drugs. Your doctor may also recommend home treatment with icing, alternating heat and cold, and stretching. You may be referred to physical therapy to learn stretching and strengthening exercises that will help reduce the stress on the affected tendon.

    Prevention

    One of the best ways to prevent tendonitis is to do foot and ankle stretching exercises before activity. Tight muscles put extra strain on your tendons. You also should wear appropriate shoes and avoid worn-out athletic shoes. When you start a new activity or sport, increase your time and intensity gradually.

    Specific Types

    Achilles Tendinitis (Back of 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 1 to 4 inches 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 tendinitis is a common repetitive stress sports injury and can be brought on by any increase in activity or changes in shoes or terrain. Tight calf muscles can also contribute to it. There are some surgical options if your symptoms aren't cleared up in a couple of months.

    Posterior Tibial Tendonitis (Inner Side of Ankle)

    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. You may need a short leg cast or walking boot to give time for the tendon swelling to resolve, then a brace or orthotics.

    Peroneal Tendinosis (Outer Side of Ankle)

    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 tendinosis.

    Flexor Tendonitis (Inner Back of Ankle)

    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.

    Extensor Tendonitis (Top of the Foot)

    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.

    A Word From Verywell

    Pain in your foot or ankle from tendonitis is a signal that you need to take it easy. If the pain continues, see your doctor to get treatment advice. While it may mean weeks away from your favorite activities, the aim is to prevent complications that can sideline you for even longer.

    Sources:

    Achilles Tendinitis. American Academy of Orthopaedic Surgeons. http://www.orthoinfo.aaos.org/topic.cfm?topic=A00147.

    DeLee JC, et al. Tendon injuries of the foot and ankle. In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2015.

    Peroneal Tendinosis. American Orthopaedic Foot & Ankle Society. http://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Peroneal-Tendonitis.aspx.

    Posterior Tibial Dysfunction. American Orthopaedic Foot & Ankle Society. http://orthoinfo.aaos.org/topic.cfm?topic=A00166.

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