Tendonitis fundamentals
Tendons are fibrous cords that attach muscle to bone. It is through tendons that the muscles of the foot and ankle allow us to perform the different motions necessary for walking. Tendonitis is inflammation or irritation of a tendon. Tendons can become irritated quickly, as in acute tendonitis. Or, they can become irritated after repetitive injuries, termed chronic tendonitis or overuse syndrome.
What causes tendonitis?
Injuries to tendons usually start with an inflammation of the lining around the tendon that eventually leads to inflammation within the tendon (tendonitis). Both of these conditions are caused by overuse of, or increased stress on, the tendon. The inflamed tissues are painful. Tendonitis may be associated with other diseases such as arthritis, diabetes, and thyroid disease. If left untreated, tendonitis can lead to a tear within the tendon or a complete rupture of the tendon.
Incorrect posture at work or home, or poor stretching or conditioning before exercising or playing sports, also increase a person's risk. Other risk factors for tendonitis include:
- An abnormal or poorly placed bone or joint (such as length differences in your legs or arthritis in a joint) that stresses soft-tissue structures.
- Stresses from other conditions, such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders, or unusual medication reactions.
What are the benefits of treatment?
If properly treated early with rest, activity modifications, physical therapy, and appropriate medication, the problem can be resolved completely. If left untreated, in addition to pain, long-term structural abnormalities, such as flat foot, can result. Occasionally, surgery may be necessary in order to regain the normal pain-free function.
Treatment options include the following:
- Refrain from activity that caused the inflammation, or modify your workout.
- Splint the affected area.
- Apply ice or heat.
- Take anti-inflammatory medications to reduce inflammation and pain.
- Perform stretching/strengthening exercises in physical therapy.
What are the risks of treatment?
There are very few risks in treating tendonitis non-surgically. When surgically treated, tendons can heal but re-tear in the future. Risks include nerve injury, infection, and stiffness.
How do I prepare for surgery?
Tendonitis surgery often is done on an emergency or urgent basis, so preparation is not always possible. However, the following steps should be followed if time permits:
- Complete any preoperative tests or lab work prescribed by your doctor.
- Arrange to have someone drive you home from the hospital.
- Do not eat or drink after midnight the night before surgery.
What do I need to do the day of surgery?
- If you currently take any medications, take them the day of your surgery with just a sip of water.
- Refrain from taking diabetic pills or insulin.
- Do not wear any jewelry, body piercings, makeup, nail polish, hairpins, or contacts.
- Leave valuables and money at home.
What happens during surgery?
You will be initialized in the preoperative area by a member of the surgical team. In the operating room, you will be met by a nursing team and the anesthesia team. There are several anesthetic options:
- General: Completely asleep and breathing through a tube.
- Epidural/Spinal: Numb from the waist down.
- Local: Numbing medicine just above the surgical site.
Epidural/Spinal and Local are usually combined with sedative medication so you can rest comfortably during the procedure.
The lining around the tendon is opened and the inflammatory tissue is removed. The tendon is inspected for tears and, if found, they are repaired. Occasionally, a tendon will need to be lengthened or shortened, depending upon the preoperative problem.
