One of the most common causes of foot or ankle pain is tendonitis. The muscles of the lower leg, foot, and ankle are attached to the bone by tendons, which are strong tissues that resemble the umbilical cord.
Tendonitis is a swelling around a tendon . This causes pain with activity, which usually goes away with rest but then returns.
Learn more about what causes tendonitis, when to see your doctor, and how to prevent it.
Types of tendonitis
Tendonitis can affect different parts of the foot and ankle. These different areas include:
- Back of the ankle
- Inner ankle
- Outer ankle
- Outer back of the ankle
- Top of the foot
Rest and home care usually heal these injuries within a few weeks. Below are the common types of foot and ankle tendonitis.
Achilles tendonitis (back of the ankle)
The Achilles tendon is a large tendon that attaches the calf muscles to the back of the heel. With Achilles tendonitis, the pain is 1 to 4 inches above the insertion of the tendon into the heel bone. This is the weakest part of the tendon and is usually the site of the tendon rupture.
Achilles tendonitis is a common sports injury . This can happen if your activity level has recently increased, you have started a new sport, or you have started wearing new shoes. Also, tight calf muscles can exacerbate the problem.
If your symptoms persist after a couple of months, surgery can help.
Posterior tibial tendonitis (inner ankle)
The posterior tibial tendon (the deepest muscle at the back of the lower leg) wraps around the inside (from the side of the big toe) of the ankle and instep. This is the area where the pain occurs with this type of tendonitis.
Posterior tibial tendinitis is often associated with flat feet . Flat feet often show the "too many toes" sign when you can see all four toes from behind the heel. As the condition worsens, the foot flattens and the toes extend outward.
If you have this type of tendonitis, you may need a short leg band or walking boots. This helps reduce tendon swelling. After that, you may need to wear a brace or orthotics (shoe inserts that better support your foot).
Peroneal tendonitis (outside the ankle)
The tendons of the peroneal muscles bend around the ankle from the outside (from the side of the little finger). With peroneal tendonitis, pain and possibly swelling occurs around the outside of the ankle and just below and above it.
If you have a high arched foot and a history of ankle sprains, you may be at risk for this type of tendonitis.
Flexor tendonitis (inner back of the ankle)
With flexor tendonitis, people feel deep pain in the back of the ankle, on the side of the big toe. This type of tendinitis is commonly seen in dancers or those who play sports that require a lot of balance on the toes.
Extensor tendonitis (top of the foot)
Tendinitis, which affects the extensor tendons on the top of the foot, is usually caused by the foot rubbing against the shoes. Less commonly, it can be caused by diseases that cause general edema, such as rheumatoid arthritis .
High arched feet are more likely to cause shoe friction, leading to this type of tendonitis.
Symptoms of tendonitis.
With tendinitis, you will notice pain, especially when you first start an activity, such as getting up and walking. The pain may go away for a while, but then return when you continue to walk or do other activities. The main symptoms of tendonitis include:
- Pain near the ankle
- Swelling when you use, move, or stretch the affected tendon
Rest usually relieves pain, although it can still be painful to touch the affected tendon. Swelling is not usually an immediate symptom, but it can appear later. Often the foot and ankle become stiff due to tendonitis.
Tendonitis can be due to a number of reasons. You have more control over some reasons than others. For example, you can stretch gently and not overextend your muscles. However, you cannot control the structure of your foot or the development of certain diseases.
Causes of tendonitis include:
- Overuse : The most common cause of tendonitis is overuse. This usually means that the tendon is overstretched. When this happens, the tendon can tear or break. This can happen when you walk, run, or exercise more or more often.
- Abnormal foot structure : Flat feet or high arches of the foot can lead to imbalances in certain muscles. This can put pressure on one or more tendons.
- Trauma : Trauma to the foot or ankle can cause tendonitis. This injury can occur from sudden and forceful movements, such as jumping. It can also happen if your foot constantly rubs against your shoes. Most of the time, the lesions are on the top of the foot or on the heel.
- Medical Conditions: Certain medical conditions that cause general inflammation can lead to tendonitis. Rheumatoid arthritis , gout , and spondyloarthropathy are examples of conditions that can cause Achilles tendonitis or posterior tibial tendonitis.
Your healthcare provider will review your medical history and may order an X-ray or MRI . These tests will help your healthcare provider determine if you have a broken bone, calcium build-up in your tendons (called calcification), or a tendon rupture.
Knowing the source of your pain will help your doctor determine how to treat it. For example, a torn tendon must be held still in a cast or shoe, and surgery may even be necessary.
If you frequently experience symptoms of tendonitis, you may be evaluated by a podiatrist (a healthcare provider who specializes in feet and ankles). They can help identify foot abnormalities that may be causing your problem.
The general idea behind treating foot and ankle tendonitis is to give the injury some rest so the body can heal. This takes time, usually several weeks to months. You may be able to treat tendonitis at home, but if you don't feel better, you should see your doctor.
When tendonitis symptoms appear, the first thing to do is treat it with RISA , which stands for rest, ice, constriction, and elevation. To process rice, do the following:
- Limit your activity as much as possible.
- Apply ice or a cold pack for 20 minutes at a time. While the cold washcloth and ice can help with swelling, recent medical research has shown that applying heat to sore areas can also help with pain.
- Provide compression (or pressure) with a gauze bandage or store-bought ankle support. This can reduce swelling and prevent the ankle from moving too much.
- If possible, try to keep your foot elevated approximately to the level of your heart, for example, when watching television.
If pain and swelling get worse, do not go away with home care, or occur during rest, it is best to seek medical attention as soon as possible. In addition to rest, your healthcare provider may suggest other treatments, such as:
- Walking Boots – Will keep your foot and ankle stationary so they don't need to be worn. Or your healthcare provider may ask you not to load the affected foot.
- Orthopedics – This may include shoe recommendations, arch supports or inserts, and prescription braces.
- Non-steroidal anti-inflammatory drugs : This can include prescription or over-the-counter medications such as Advil (ibuprofen) .
- Home treatments : Home treatments can include icing, alternating hot and cold, and stretching.
- Physical therapy : Stretching and strengthening exercises can help reduce stress on the affected tendon.
One of the best ways to prevent tendonitis is to stretch your feet and ankles before exercising. Tight muscles put extra stress on tendons.
You should also wear shoes that provide good support and avoid worn sneakers. Finally, when starting a new activity or sport, gradually increase the time and intensity.
Tendonitis causes pain and swelling of the tendons in the foot and ankle. There are several types of tendonitis, each of which affects a different part of the ankle or foot.
Tendonitis can be caused by overuse, trauma, foot problems, and certain medical conditions. The first line of treatment is ankle support. Your healthcare provider may also recommend shoe inserts or other orthopedic, anti-inflammatory, or physical therapy products.
Stretching your muscles before exercising is a good way to prevent tendonitis. Wearing proper footwear with the proper support and gradually increasing your activity level can also help prevent tendonitis.
Get the word of drug information
Foot or ankle pain from tendonitis is a sign that you need to relax. However, if pain persists despite resting, see your doctor. They will help you find the right treatment plan for you. While this may mean that you can give up your favorite activities for several weeks, the goal is to avoid complications that could further distract you.
Frequently asked questions
The pain and stiffness of tendonitis depend on physical activity. The pain is usually most severe when you start walking on it. As you begin to move, the pain usually goes away a bit and then returns if overdone. Rest usually helps relieve pain, but it can be painful to the touch.
Depending on the extent and cause of your injury, tendonitis can heal in weeks or months. In some cases of tendonitis, physical therapy will be required to make a full recovery. Talk to your doctor if you have any concerns.
With peroneal tendonitis, the pain occurs on the outside of the ankle. Swelling can occur above and below the ankle. Fibula tendinitis is more common in people with high arches or frequent ankle sprains.
Yes, people with flat feet are more prone to posterior tibial tendonitis. The posterior tibial tendon attaches the calf muscle to the sole of the foot. Runs along the inside of the ankle and arch. Shoe braces are often used to prevent and treat posterior tibial tendonitis.
Flexor tendonitis, which is felt on the back of the inner ankle, is common in ballet dancers. It can also be caused by other activities that require balancing on your toes.