Foot & Ankle Tendon Issues

Tendons connect muscles to bones. Your Achilles tendon runs down the back of your lower leg and connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus) and is also called the “heel cord”. The Achilles tendon facilitates walking by raising the heel off the ground. Achilles tendinosis is a condition in which chronic overuse deteriorates the integrity of the tendon, causing pain and stiffness. This is often confused with tendonitis, which presents similarly but has very different causes and treatments. 

Tendinosis can occur in any tendon, but the Achilles is particularly susceptible. Tendons receive poor blood supply and need longer periods of rest to recover after heavy activity. When the tendon is re-stressed too quickly and too often, the structural proteins (collagen) of the tendon begin to break down. Common causes of Achilles tendinosis are intense sports activity, repetitive work duties, untreated tendonitis, and tight calf muscles.

Tendonitis is a general term for inflammation of a tendon. It can occur anywhere in the body, including several places in the feet. Most commonly affected are the Achilles tendon (heel cord), posterior tibial tendon (inner ankle), and peroneal tendon (outer ankle). These tendons will present with pain, swelling, and stiffness which worsens the longer treatment is withheld.

Tendonitis is inflammation of a tendon caused by micro-tears. Both chronic overuse and sudden injury can cause these tears and lead to a weakening of the tendon. Other foot conditions such as flat feet (posterior tibial), high-arched feet called pes cavus (peroneal), and foot and ankle arthritis can contribute to your risk of developing tendonitis.

Tendonitis should be treated with RICE (rest, ice, compression, elevation) at the first sign of pain. Tendonitis left untreated can lead to a torn (ruptured) tendon or tendinosis. Your FAAWC podiatrist may recommend strapping, bracing, or even a cast to immobilize the tendon. Custom molded orthotics may be made to control foot and ankle function and rest the affected area as well as relieve pressure. Anti-inflammatory medications may also be prescribed for swelling and pain management. 

Tendonitis can take weeks or months to heal, but often recovers with proper treatment. Tendonitis leading to a full tendon tear (rupture) would often require surgical intervention to resolve.

A tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. It will be painful at the time of injury and your foot and ankle may become immediately weak and unable to withstand the pressure of walking. Swelling, redness, and warmth at the site of injury are also common.  

Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping. Tendonitis left untreated can result in a partial or complete tear of the foot tendons. Structural conditions such as flat feet or high arches also leave you more prone to a tendon injury and rupture. 

As with most tendon issues, start with RICE (rest, ice, compression, elevation). If you think you have torn or fully ruptured your tendon, you need to see a foot and ankle specialist right away. Keeping pressure off the tendon is critical to helping it heal. Your podiatrist may recommend a boot, brace, soft cast, or even fiberglass cast to support the area during healing. After the tendon strengthens, custom molded orthotics can help keep the foot structure in place to prevent further injury. Other treatment methods that support healing include steroid injections, MLS pain laser therapy, and physical therapy exercises as well as PRP injections (platelet rich plasma).

In certain cases, surgical repair, replacement, or reinforcement of a ruptured tendon may be necessary. Your foot and ankle surgeon may also remove tissue from around the tendon or even reposition the tendon as it connects to the muscle or bone. Talk to your FAAWC provider today to discuss whether your ruptured tendon needs surgery. 

The posterior tibial tendon is a major supporting structure of the foot, helping to support the foot during walking. With posterior tibial tendon dysfunction (PTTD), the tendon structure changes and it can no longer support the arch. This is also known as acquired adult flatfoot because it results in a falling of the arch.

Most often, PTTD is caused by chronic overuse. Symptoms develop over time and build on each other to cause pain. First, there will be localized pain over the posterior tibial tendon (the inside of the foot and ankle). The arch begins to fall and your foot is no longer supported so the ankle begins to roll inward. This affects your gait and puts further stress on the foot, eventually leading to arthritis.

Nonsurgical options for PTTD include immediately reducing stress on the affected area by adding arch support. This may come from a supportive strapping, a brace or a custom molded orthotic combined with a supportive shoe. For moderate and severe cases, full immobilization with a fiberglass cast or cast brace is recommended. Physical therapy and MLS pain laser therapy may also help the tendon strengthen and heal. 

Leaving PTTD untreated for too long can result in major foot deformities and pain that can only be solved with surgery. Early treatment can drastically reduce your need for foot and ankle surgery. Your FAAWC foot and ankle surgeon will discuss your particular need for surgery to repair posterior tibial tendon dysfunction.