What is tendonitis and how can I treat it?

Tendonitis is inflammation of a tendon, usually at or close to it's insertion. The inflammation results from small micro-tears within the tendon caused by overuse. The three most common types of tendonitis in the foot and ankle are Achilles tendonitis, peroneal tendonitis and posterior tibial tendonitis.

Achilles tendonitis
Achilles tendonitis can occur at the insertion of the achilles tendon on the heel bone, called insertional achilles tendonitis, or behind the ankle, about 2 inches above the insertion. The pain occur in the back of the heel and can be accompanied by a lump in the tendon. The pain is typically the worst at the first step in the morning and is usually described as sharp and stiff with walking and achy at rest.

Achilles tendonitis is common in athletes, especially in runners who change their routine. Incorporating hills or stairs into a training regimen may lead to Achilles tendonitis. The tendonitis can also develop in weight lifter overdoing calf exercises or performing squats incorrectly. Backpacking with a heavy pack, hiking steep hills or uneven terrain, cycling long distances and even simple activities like gardening can cause tendonitis. About 10% of all lower extremity pain in athletes is due to Achilles tendonitis.

Achilles tendonitis is treated by eliminating aggravating activities, icing the heel 20 minutes each evening, adding heel lifts or heel cups to the shoes, and stretching the calf and achilles with daily stretches or night splints.

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Peroneal tendonitis
The peroneal tendons are located on the outside of the ankle. These tendons function to balance and stabilize the foot while walking. These tendons are the most common tendons to flare due to compensation from another injury. For example: when an individual has plantar fasciitis, their gait is altered and they switch their weight from their painful heel, to the outside of their foot. This places undue stress on the peroneal tendons and causes small micro-tears and inflammation, resulting in pain and swelling on the outside of the foot and ankle.

The treatment for peroneal tendonitis is very similar to the treatment for Achilles tendonitis. A heel lift is not necessary for this type of tendonitis, but an orthotic may help. Identifying the cause of the tendonitis is important and it's essential to eliminate aggravating activities like walking on uneven terrain or walking in worn out shoes. Daily icing, contrasting between hot and cold water for 20-30 minutes a day and stretching exercises may help.

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Posterior tibial tendonitis
The posterior tibial tendon start in the calf and travels down to the inside of the arch. This tendon holds up 30% of the arch. Posterior tibial tendonitis develops most commonly in those individuals with flatfeet. The excess stress from the collapsing arch causes micro-tears in the tendon, typically as it inserts into the bone, and results in pain and inflammation.

The most important treatment for individuals with flatfeet and posterior tibial tendonitis is orthotics. Although pre-fabricated orthotics may help, custom made orthotics which can be done through a podiatrist may be necessary.

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Disclaimer: The advice on this website is not intended to substitute for a visit to your health care provider. We will not be held liable for any diagnosis made or treatment recommended. Consult your doctor if you feel you have a medical problem.