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The term tendinitis is commonly used to refer to a chronic condition of tendon pain due to excessive and repetitive stress placed on the tendon. Tendinitis is generally considered an overuse injury, and is a very common condition that is brought to the attention of a podiatrist. The “-itis” at the end of the term implies inflammation, which is actually not present in most chronic conditions. Because of this misnomer, tendinitis is commonly referred to in scientific literature as tendinosis.
The foot and ankle is a common sight for tendinitis to occur, partially due to the fact that the tendons in the leg that control the motion of the foot have to bend through the narrower ankle to enter the foot. This places extra stress on the tendons, and injury is commonly seen at the bend in the tendon. The tibialis posterior and peroneal tendons (peroneus longus and peroneus brevis) are of the most common tendons affected.
The Achilles tendon does not fit this description of a tendon that bends to enter the foot, but is nevertheless one of the most common muscles to be effected by tendinitis.
Tendons are composed primarily of collagen, a protein found in abundance throughout the body. Through overuse, the collagen in the tendons can become fibrotic, or thickened and stiff. This can lead to pain, particularly during strenuous activities. It can also progress to partial or complete tears of the tendon, or total ruptures.
The goal of treatment is to prevent the progression of the tendinitis, alleviate the pain associated with use, and to correct biomechanical dysfunction that may be contributing to the problem. Preventing biomechanical dysfunction would include things like taping, bracing, and the use of orthotics.
The progression of tendinitis can lead to a more chronic problem if not addressed. Arthritis forms in the ankle and subtalar joint because of dysfunction of the tibialis posterior muscle. The peroneus brevis may be seen as split on magnetic resonance imaging (MRI) around the peroneus longus tendon following injury. Achilles tendon ruptures are fairly common, and are usually seen in individuals aged 30-40 with a history of an acute increase in activity.
For the acute condition involving swelling and pain, symptoms can be addressed with PRICE therapy (Protection, Rest, Ice, Compression, and Elevation). This is usually sufficient to alleviate any pain, though some may also use medications such as NSAIDs or other anti-inflammatory medications.
There are a variety of things that can go wrong with the tendons of the foot and ankle, most of which are due to overuse. The thorough clinical evaluation and technical imaging are essential to diagnosis.
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