Foot Tendonitis: Causes, Symptoms and Treatments

Foot tendonitis affects the posterior tibial tendon which travels down the side of the ankle to attach to the underside of the foot. It helps to support the arch on the inner edge and to prevent the foot from rolling inwards. The tendon becomes inflamed due to over-use or an injury, which causes pain.

Cause of Foot Tendonitis

When excess strain or stress is placed on the foot, tissues can be strained or tiny tears can occur, resulting in inflammation and pain.

Excess stress is placed on the tendons of the foot in several ways, the most common being:

  • Walking or running on uneven ground
  • Walking or running up steep inclines
  • Wearing ill-fitting shoes
  • Wearing the wrong type of shoes for the physical activity involved in
  • Having flat feet or overly high arches
  • Standing for long periods
  • Symptoms of Foot Tendonitis

Inflammation of the tendon causes pain in the arch of the foot. Some swelling and redness is also likely to occur. The ankle joint and the foot will probably be stiff and normal movement could be restricted. The arch of the foot may feel hot.

The pain may start as an isolated tender spot in the middle or front part of the arch but will increase in intensity if not treated. Pain is often worse during physical activity and at night. Standing on the toes will produce a sharp, stabbing-like pain in the arch of the foot.

Types of Foot Tendonitis

1. Achilles Tendonitis

Achilles tendonitis is inflammation of the Achilles tendon found at the back of the heel and ankle. The Achilles tendon is the strongest and largest tendon in the body, running down the back of the lower leg to join the calf muscles to the heel bone. It helps the calf muscles lift the heel off the ground and so is needed during walking and running.

Risks and Causes of Achilles Tendonitis

Those who play sports that involve sudden changes of direction, stops and starts are at risk of developing Achilles tendonitis. These sports include tennis, squash, netball, football and basketball. Uneven ground, incorrect or ill-fitting footwear and inadequate preparation and training add to this risk. A single incident can cause the irritation or, more commonly, consistent stressful movement. Injuries more often occur after a period of inactivity when the tendon is stiff and inflexible.

It isn’t only sports players who are at risk of developing Achilles tendonitis. Women who frequently wear high heeled shoes are also at risk because the height of the heel actually has the effect of shortening the Achilles tendon.

This means that when she wears flatter-heeled shoes, the tendon has to over-stretch and tears can occur, which causes inflammation and pain. People who don’t exercise often and then play a high-risk sport or suddenly start intense exercise are also at risk of Achilles damage.

Some people have a congenital condition of a short Achilles tendon which makes them more prone to Achilles tendonitis than the general population.

Symptoms of Achilles Tendonitis

Tendonitis symptoms often develop gradually with only moderate pain at first. If left untreated and the activity which caused the pain is continued, more serious damage can occur. You might experience one or more of the following symptoms:

  • Pain in the Achilles area during or after activity.
  • Swelling around the tendon
  • Pain when walking or running, especially on an upward incline like a hill or treadmill.
  • Stiffness and pain when stretching the tendon
  • Early morning stiffness of the Achilles

Prevention of Achilles Tendonitis

Achilles tendonitis can be prevented by ensuring a complete warm-up and stretching program is followed before any strenuous sport or exercise is started. If you have had Achilles tendonitis before, pay particular attention to stretching the heel, ankle, and calf muscles. Warm up the feet and ankles with light jogging on the spot, lunges, and small spot jumping.

Wearing the correct shoes for the activity you are engaged in is vital to preventing Achilles tendonitis. Go to a specialist sports shoe store to be correctly fitted for the right shoes for your sport and for your individual feet. Even if you are just into walking for exercise and fitness, the correct shoes are important to avoid injury which will interfere with your activity. Achilles tendonitis shoes need to have a cushioned heel, a heel cup and good heel support.

If you know that you are prone to tendonitis, avoid pushing yourself. If you experience any pain, stop and apply the RICE treatment. Focus your training and preparation on strengthening your ankles and having a flexible Achilles tendon.

If you love to wear high heels, take a few minutes before you put them on, and throughout the day, to gently stretch your Achilles tendon by flexing your foot up and down and drawing imaginary large circles in the air with your toes.

2. Extensor Tendonitis

Tendons attach muscles to the bone to form an anchor and to assist in the muscle’s action. Extensor tendons are so-called because they assist muscles to extend a joint. There are extensor tendons in the feet, hands, wrist, knee, and elbow. Extensor tendonitis is inflammation of a tendon, or the protective sheath surrounding a tendon, caused by forceful or repetitive movement.

Extensor tendons in the hand and the foot are similar in that they divide and spread over the back of the hand or the top of the foot to join onto the fingers or toes. In the feet, they help the muscles pull the foot up and are needed for walking and running.

Extensor tendonitis in the feet is a common injury among runners and those who play fast running sports. In the hands, the extensor tendons help to do several movements of the hand, wrist and thumb like grasping, twisting and extending.

While there are extensor tendons in the knee and elbow joints, which also have the similar function of extension of the joint, most cases of extensor tendonitis occur in the wrists, hands or feet.

Cause of Extensor Tendonitis

Extensor tendonitis is caused by over-use of an extensor tendon or by sudden force applied to the tendon or muscle. Sports or workplace activities that involve repetitive movements of extensor tendons are the most common causes although unaccustomed activity involving an extensor tendon can also lead to tendonitis.

Specific risk factors include:

  • Runners and soccer players are prone to extensor tendonitis of the foot.
  • Ill-fitting shoes or wearing shoes that are not specifically designed for the activity.
  • Running or walking uphill, on uneven ground or slippery surfaces.
  • Workers who do repetitive tasks especially if weight or force is involved.
  • An activity that holds the hands or wrist in the same position for lengths of time.
  • Unaccustomed use of the hands or wrists, particularly if force or weight is required.

Symptoms of Extensor Tendonitis

Swelling or redness at the site of the tendon. This is due to inflammation of the tendon.
Pain is usually worse with movement.
In the foot, the pain and swelling will be along the top of the foot.
The classic test for foot extensor tendonitis is to try and pull the foot up against resistance, which will cause pain along the top of the foot.
In the wrist and hand, the pain and swelling will be along the thumb side or the back of the hand, depending on the tendons affected.
Pain usually develops gradually.
A snapping sound or sensation may occur when the joint is extended.
Stiffness and reduced movement is often experienced.

Prevention of Extensor Tendonitis

There are preventative measures that you can take to avoid extensor tendonitis and to prevent the condition from returning. The most important is to work within the limitations of your own body; only ever increase distance and intensity gradually and exercise to your own pace.

The following strategies will also help you prevent extensor tendonitis:

Make sure you wear the correct shoes for the activity you are doing. Have them properly fitted by a trained sports shoe specialist.
Avoid tying shoelaces too tight as this pressure can irritate the extensor tendons in the foot.
Alternate activities and use some non-weight-bearing exercise to rest the tendons.
Wear cushioned shoes when you are going to be standing or walking all day at work.
Always warm up and stretch before you start any exercise activity. Pay special attention to stretching the extensor tendons and muscles.
Take regular breaks when doing anything that involves repetitive actions of the hands or wrists. Change or alternate activities regularly, to avoid injury.
When doing repetitive tasks, try to keep the wrist in a neutral position.

2. Posterior Tibial Tendonitis

The posterior tibial tendon runs down the back of the lower leg, connecting the posterior tibial muscle to the inside bones of the foot near the arch. This tendon helps to support the arch of the foot as well as assisting the action of the posterior tibial muscle.

This part of the foot has a limited blood supply, due to the anatomy of the area, causing problems in healing conditions like posterior tibial tendonitis. Tendonitis is inflammation of a tendon, usually caused by the over-use of a joint.

The Cause of Posterior Tibial Tendonitis

Over-use of the ankle, particularly in activities like dance, swimming, walking, and running. Sports and activities that require lots of sudden changes of direction also increase the risk of posterior tibial tendonitis.
Anatomical weakness or poor support causes the foot and ankle to roll inwards, putting extra strain on the posterior tibial tendon.
Trauma to the foot or ankle either by striking or sudden movement.
Wearing poorly-fitting footwear that allows or encourages an inward rolling of the feet.
The Symptoms of Posterior Tibial Tendonitis

Pain felt on the inside of the ankle or foot, initially after physical activity.
Bruising or swelling on the inside of the ankle and/or the inside of the arch of the foot.
Extending the foot upwards and standing on the toes will produce stronger pain.
Pain will get worse if the tendonitis is not treated and will be felt at other times, especially early morning and evening.
If left untreated, the arch will be affected. The arch will become lower and the toes will point more outwards, because the posterior tibial tendon is not capable of supporting it properly. Just putting weight on the foot will be painful.

The Treatment of Posterior Tibial Tendonitis

Rest and immobilization are necessary to allow the tendon to heal. Keeping the foot elevated will help ease pain and swelling.
Apply ice packs every hour or two for the first few days to relieve pain and reduce swelling.
Take anti-inflammatory medication to reduce the inflammation. Over-the-counter preparations containing ibuprofen or aspirin are easily available or a doctor can prescribe something stronger for you if necessary.
Expect to be out of action for several weeks as tendons are notoriously slow to heal. Once the pain and swelling have diminished, you might be able to move around by wearing a splint or a brace for support. Avoid all movements which increase the pain.
Your doctor may suggest physical therapy to help you stretch and strengthen the ankle joint again and correct any inward roll of your feet.
When you do return to full activity, start off very gradually to avoid exacerbating the injury.
Wearing arch support in your shoes will protect and support the arches of your feet.
Surgery is only considered if these treatment options are not effective.

The Prevention of Posterior Tibial Tendonitis

You want to avoid a recurrence of this condition because every time it returns, the tendon becomes weaker. These important strategies for the prevention of posterior tibial tendonitis will help you recover fully and avoid a recurrence.

It is really important to wear appropriate shoes for any activity or exercise that you do. Specialized sports shoes are made for most sports and these are the best to wear. Sports shoes have adequate cushioning for the heel, good support for the foot and ankle, and arch support to protect you from posterior tibial tendonitis.

They prevent the foot from rolling inward but if this is a problem you have, you might consider custom orthotics, made specifically for your feet. Avoid wearing slippers or badly-fitting shoes, high-heeled shoes, or going barefoot.

Always warm up thoroughly before any exercise. This involves raising your core temperature and stretching the tendons and muscles you are going to be using. After exercising, cool down with stretches again to avoid muscle soreness.

Treatment of Foot Tendonitis

The best treatment for foot tendonitis is rest. This means that you need to discontinue the activity that caused the injury, sit or lie down and raise the foot.

Rest is the first part of the R.I.C.E treatment method for injuries; this is a good method to use when treating foot tendonitis.

Ice the arch of the foot every 2 to 3 hours, for several days, until the pain subsides. Ice packs help to reduce inflammation and relieve pain.

Compression of the foot with an elastic bandage or tape helps to isolate the injury, reduce swelling and avoid movements that could make it worse.

Elevate the foot to above heart height to help reduce inflammation and swelling.

Anti-inflammatory drugs can help relieve both the pain and the inflammation. Over-the-counter ibuprofen or aspirin are readily available; if these aren’t effective, your doctor can prescribe stronger medication.

Treatment needs to continue until the symptoms have completely gone; this could take several weeks. After a week or two, when the pain has eased, start doing simple, gentle flexing, extending, and circling of the foot and ankle to prevent the joint from becoming too stiff. If this hurts, stop and wait another few days before trying them again.

If these conservative methods of treatment are not effective, or the foot tendonitis recurs, consult your doctor. There are additional treatments that can be tried.

Prevention of Foot Tendonitis

You can apply this preventative measure to help avoid tendonitis recurring. Once you have had foot tendonitis, it is important to stretch the tendons in the foot properly before any physical activity and even first thing in the morning. If your work requirements caused the tendonitis, do some stretching exercises before you start and after you have a break.

Take care to warm up and cool down before and after exercising, paying special attention to the feet and ankles.
When you return to normal activities after a break, do so gradually and ice the arch of the foot after your exercise session or workday.

Wear properly fitting shoes that are appropriate for the activity you are doing. Specialist sports shoes are available that have been designed for most sports; wear the ones designed for your sport or activity.
Arch supports can be fitted inside your shoes to give added support to your feet.
Alternate different exercise and training methods to avoid excess stress being placed on the feet. Integrate some non-weight-bearing activities.

Try to avoid running and walking on hard surfaces, uneven ground, slippery surfaces and steep hills.
If you need to stand for your work, get a thick rubber mat to put under your feet and take regular breaks to stretch and move your feet.
These tips for preventing foot tendonitis will help you continue your exercise, sport and work without pain or discomfort.


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