Tendonitis of the Foot and Ankle

Tendons are structures that attach your muscles to your bones, and allow you to move your toes, feet, and ankles in many directions.  In the foot, many tendons and muscles are required to allow you to walk.  These tendons must act against the entire weight of the body almost constantly while you are standing or walking. While running, tendons may act against several times body weight.  For this reason, tendons in the foot and ankle are prone to developing tendonitis, which is inflammation of the tendons, usually due to the excessive stress they are under.

Achilles tendonitis

The Achilles tendon attaches the calf muscles to the heel bone (the calcaneus).  It is the largest and most common tendon to develop inflammation in the foot and ankle.  Achilles tendonitis causes pain at the site where the Achilles attaches to the calcaneus.  The pain commonly occurs when you first get up from sitting, or when you begin vigorous activity.  Once the tendon warms up, the pain often decreases.  It is also common for the calcaneus to develop bone spurs where the Achilles tendon attaches to it, when there has been longstanding inflammation.

Achilles tendonitis responds very well to immobilization in a walking cast.  Usually a period of 4 to 6 weeks is adequate to decrease the pain.  Icing and anti-inflammatory agents are also used to combat the inflammation.  Gentle stretching exercises are helpful, especially in the morning, and before or after exercise.

In cases that do not respond to 6 months of conservative treatment measures, surgery may be recommended.  During surgery, the damaged portion of the tendon is removed.  If a large portion of the achilles is damaged, it may need to be replaced or reinforced with another tendon located next to the Achilles.  If there are any bone spurs on the calcaneus, these are removed during surgery.  Full recovery from Achilles tendon reconstructive surgery is between 3 and 6 months, depending on the extent of damage to the Achilles.

Posterior tibial tendonitis

The posterior tibial tendon runs across the inner portion of the ankle and attaches to the middle part of the foot.  This tendon is a major support structure of the arch of your foot.  Therefore, in advanced stages of posterior tibial tendonitis, your arch begins to collapse.  In earlier stages, pain and swelling occurs over the inner portion of your ankle.

Posterior tibial tendonitis also responds well to immobilization in a walking cast for 4 to 6 weeks.  The cast is usually followed by a type of brace which allows ankle motion but supports the arch.  An exercise program is then initiated which strengthens the foot and ankle.

In cases of posterior tibial tendonitis that doesn’t improve with conservative measures, surgery may be recommended.  The damaged tendon is removed in its entirety, and replaced with a tendon that sits adjacent to it.  If the arch has begun to collapse, the calcaneus bone may be cut and shifted over to offset the collapse.  In longstanding cases of a collapsed arch, a fusion surgery may be necessary to correct the deformity (see arthritis section).  Full recovery from posterior tibial tendon reconstruction is between 4 and 6 months, depending on the type of surgery performed.

Peroneal tendonitis

The 2 peroneal tendons are located over the outer part of the ankle, and run behind the fibula bone (the outer ankle bone).  They enable you to pull your foot and ankle out to the side.  In addition to inflammation (tendonitis), the peroneal tendons are prone to developing tears, or dislocating from behind the fibula.

Once pain and swelling have developed over the peroneal tendons, there is often a tear present.  Initial treatment for peroneal tendonitis consists of immobilization in a walking cast for 4 to 6 weeks. If the symptoms don’t improve, an MRI scan is usually indicated, to assess for a tear of the tendons.  Surgery is necessary if a tear is identified or suspected.

Peroneal tendon dislocation is characterized by a distinct sensation that the tendon is slipping out of place.  Usually there has been an identifiable injury, such as a severe twisting to the ankle, that damaged the tendon sheath that holds the tendons in place.  Cast immobilization within 2 to 3 weeks of the injury may help to fix the problem.  If the dislocations have been going on for longer, then surgical repair of the tendon sheath is necessary to hold the tendon in place.