Foot tendonitis affects the 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 prevent the foot from rolling inwards. The tendon becomes inflamed due to overuse or an injury, which causes pain.
Tendon Terms & Anatomy
Tendon: a band of connective tissue that connects muscle to the bone that functions to transmit force created in the muscle to the bone and allow for joint movement. Paratenon: a fragile outer layer of the tendon, which functions as an elastic sleeve. Not all tendons have a paratenon.
Tendon sheath: A canal-like structure surrounds the tendon and creates a lubricated low-friction environment for the tendon to glide. The tendon sheaths are mostly grouped around the ankle and may partially or surround the tendon.
Tendinopathy: a general term used to describe a painful, overuse tendon injury. Tendinitis: painful inflammation of the tendon, generally associated with microscopic tearing and subsequent degeneration within the tendon.
Tendonitis is the inflammation of a tendon resulting from small microscopic tears caused by chronic overuse within the tendon. The small tears weaken the area and cause inflammation. Swelling may be noticeable, and the area is typically painful and weak. Common symptoms with tendonitis:
- Dull achy pain and soreness at restSharp pain with certain activitiesTenderness to the touch and swelling pain and stiffness in the morning Inflammation and swelling generally characterize the initial stages of tendonitis.
Tendonitis will last about 2-4 weeks. Tendonitis progress to tendonosis sometime between 1 – and three months. The exact period of time is not well defined and may vary by individual.
Tendinosis is the non-inflammatory degeneration of a tendon that may or may not be painful. Tendinosis is the degeneration (deterioration) of the tendon. The collagen fibers which make up the tendon become disorganized and infiltrated with small blood vessels, which results in a weakened tendon. Tendinosis is not an inflammatory condition; it is a degenerative condition.
Paratenonitis: an inflammatory process with associated thickening of the paratenon. This process may constrict the underlying tendon and prevent gliding. This condition commonly occurs in areas where the tendon changes direction or lies over a bony prominence. Also known are peritendinitis or tenosynovitis.
Cause of Foot Tendonitis
When excess strain or stress is placed on the foot, the stress can strain tissues, 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 inclinesWearing 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 are 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 the 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 foot’s arch.
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 is needed during walking and running.
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 foot’s arch and assists the action of the posterior tibial muscle.
This part of the foot has a limited blood supply due to the area’s anatomy, causing problems in healing conditions like posterior tibial tendonitis. Tendonitis is inflammation of a tendon, usually caused by the over-use of a joint.
3. Peroneal Tendonitis
Peroneal tendonitis is another common tendonitis in the foot. The peroneal tendons are located on the outside of the ankle and attached to the midfoot. These tendons function to balance and stabilize the foot while walking. The most common type of pain is dull pain on the outside of the foot.
Many will notice what they think is a lump. It is actually the bone that one of the peroneal tendons attaches, called the styloid process, located at the base of the 5th metatarsal.
Related: How to treat a foot blister.
Treating Foot Tendonitis
It is important to recognize the aggravating activity to be eliminated during the healing process. Recognizing the problem and treating the tendonitis as soon as it develops will prevent progression to tendon degeneration. The initial treatments focus on taking the stress off of the tendon, resting, and decreasing inflammation.
1. Eliminate the aggravating activity: If you are a runner or a walker, switch to biking or swimming for 2-4 weeks during the healing process. If you are a cyclist, avoid hills and steep climbs, and don’t drop your heel while pedaling.
2. Ice massage: Ice the back of the heel and tendon for at least 20 minutes twice a day (3-4 times a day if possible). The most effective icing method is to place ice directly on the heel and massage the heel with the ice for 20 minutes. This will cause discomfort and possibly some pain but should eventually lead to some numbness.
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Extended periods with ice directly on the skin could result in mild frostbite, so always keep the ice moving and don’t leave the ice directly on the skin for long periods of time. If the direct ice massage is too painful, rest your heel directly on an ice pack or a bag of frozen peas.
3. Wear shoes with a proper heel: The best shoes to take the stress off of the tendon are a shoe with a wedge or heel (1 inch), a rigid midsole, and a rocker on the bottom. The best example of this shoe is a Dansko. Those with insertional Achilles tendonitis may find the rigid heel counter on the Dansko shoe uncomfortable.
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This is not the only acceptable shoe, but the Dansko shoe is a good example. A true rocker bottom sole is unnecessary, but a rocker at the toe area, as demonstrated in this picture, helps with push-off during walking and decreases the stress on the Achilles tendon. Avoid flexible, soft shoes, and don’t go barefoot.
4. Try heel lifts: Heel lifts can be placed in any shoe and lift the heel, effectively taking stress off the Achilles tendon. The concept is the same as wearing a shoe with a wedged heel.
Look at the above images to better understand the concept behind heel lifts. The tendon is placed on stretch when the foot is forced up at the ankle (when walking uphill). There is considerable tension in the calf muscle and the Achilles tendon. It’s like taking a cord and pulling it at both ends until it becomes taut.
When the foot flexes down at the ankle (plantar flexion), the tendon and the calf muscle take the tension off. It would be like giving the cord in the example above more slack.
The less tension and less stress on the tendon, the faster the tendon will heal. A heel lift is used, or a wedged heel shoe takes stress off the Achilles tendon.
5. Calf Stretching: Start with gentle stretching during the initial stages of tendonitis. When seated, take a belt or a towel and place it around the ball of your foot. Keep the knee extended and gently pull the foot towards you. You should start to feel a stretch in the calf muscle.
Continue to gently pull the foot toward you until you feel some pain. Back off a little and then hold the stretch for 60 seconds.
Repeat this stretch ten times, twice a day. Try to stretch before getting out of bed in the morning or before you get up after long periods of rest. This stretch should not be painful. Aggressive stretching during the initial phases of tendonitis can aggravate the condition.
6. Take anti-inflammatory medications: Ibuprofen and Naproxen are two common anti-inflammatory medications you can buy over the counter. They will reduce pain and decrease inflammation.
Used in combination with the other treatments mentioned, they can be an effective therapy. But, it is also important to realize that they can mask the pain, and they are not addressing the cause of the problem.
Prevention of Foot Tendonitis
1. 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 starting and after a break.
2. 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 foot’s arch after your exercise session or workday.
3. Wear properly fitting shoes that are appropriate for your activity. Specialist sports shoes are available that have been designed for most sports; wear the ones designed for your sport or activity. To support your feet, use arch supports inside your shoes.
4. Alternate different exercise and training methods to avoid excess stress on the feet. Integrate some non-weight-bearing activities.
5. 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 under your feet and take regular breaks to stretch and move your feet.
Hopefully, these tips for preventing foot tendonitis will help you continue your exercise, sport, and work without pain or discomfort.
If the tendonitis has not improved within 2 – 4 weeks, an appointment with your doctor is recommended. After four weeks, the condition has most likely progressed to tendinosis. At this point, the treatment regimen will change slightly, and a referral to physical therapy is recommended.
Icing will help decrease the number of new blood vessels formed within the area and act as an analgesic. But, it is no longer necessary as an anti-inflammatory.
Anti-inflammatory medications are not necessary either, although they can help reduce the pain. This is something to be discussed with your doctor and may vary individually.