Foot Tendonitits

Overview

What is foot tendonitis?

Foot tendonitis (tendinitis) is inflammation or irritation of a tendon in your foot. Tendons are strong bands of tissue that connect muscles to bones. Overuse usually causes foot tendonitis, but it can also be the result of an injury.

Are there different types of foot tendonitis?

Your feet contain many tendons. Tendonitis can affect any of them, but the most common include:

  • Achilles tendonitis: Affects the tendon connecting your calf muscle and heel bone. This tendon is the strongest tendon in the body. It helps us run, jump, walk and do other activities that require us to rise up on our toes.
  • Extensor tendonitis: Irritation of the tendon that runs along the top of your foot. These tendons attach bones at the front of your leg to your toes.
  • Peroneal tendonitis: Inflammation in either of the two tendons that run along your outer ankle bone. They connect to your midfoot and your arch to help with stability.
  • Posterior tibial tendonitis: Affects the tendon that connects your calf muscle to bones on the inside of your foot. These tendons help hold up the arch of your foot.
  • Plantar fasciitis: Pain at the underside of your heel and within the arch of your foot. While this is technically not a tendon but a ligament, it can produce the same type of painful conditions that present like tendonitis, with similar treatment approaches.

Who gets foot tendonitis?

Anyone can get foot tendonitis, but it’s more common in athletes or very active individuals who overuse the tendons. You’re also more likely to develop foot tendonitis if you:

  • Are overweight.
  • Don’t stretch before physical activity.
  • Don’t stretch after physical activity.
  • Have certain health conditions, such as arthritis, gout, thyroid disease or diabetes.
  • Have flat feet.
  • Have had previous tendon injuries.
  • Have tight tendons and muscles in your legs.
  • Smoke or use tobacco products.

How common is foot tendonitis?

Achilles tendonitis is the most common type of foot tendonitis. Studies suggest it affects anywhere from 1% to 9% of elite and recreational athletes.

Symptoms and Causes

What causes foot tendonitis?

Foot tendonitis is usually chronic, meaning it develops over time when you put repeated stress on the tendons in your foot. But tendonitis can also happen suddenly if you overstretch the tendon, over-rotate your ankle or use improper technique when running, jumping or playing sports.

What are the symptoms of foot tendonitis?

Symptoms vary depending on which tendon you injure, but may include:

  • Bone spurs (small formations of extra bone near the tendon).
  • Pain along the length of the tendon or where the tendon attaches to the bone.
  • Pain that gets worse with physical activity.
  • Stiffness in the tendon after periods of inactivity, such as first thing in the morning.
  • Swelling, redness or warmth around the tendon.
  • Thickening of the tendon.

Can foot tendonitis lead to a tendon rupture?

Severely overstretching or a sudden injury to a tendon can lead to a rupture, causing the tendon to partially or fully break. A tendon rupture in your foot needs medical attention. Talk to your healthcare provider if you:

  • Can’t put weight on your foot.
  • Can’t move your foot in a certain direction.
  • Have severe foot pain.
  • Noticed a snapping or popping sensation in your foot at the time of injury.

Diagnosis and Tests

How is foot tendonitis diagnosed?

Your healthcare provider will perform a physical exam and review your symptoms. They may palpate (press) on certain parts of your foot, ankle or calf. They’re checking for areas of swelling and tenderness. Your provider may also ask you to perform certain movements to assess your range of motion, strength and the severity of your pain.

If your provider suspects you may have a foot fracture or a torn tendon, they may recommend imaging exams such as an X-ray, MRI, CT scan or ultrasound.

For many of the tendons in your foot, if not torn, an ultrasound is often the test of choice to see how the tendon moves and what types of injury or degenerative changes are causing your pain.

Management and Treatment

How is foot tendonitis treated?

In most cases, your healthcare provider will recommend at-home treatments such as RICE to manage foot tendon pain:

  • Rest: Stop physical activity to avoid further damaging the tendons in your foot.
  • Ice: Put an ice pack or cold compress on your foot for up to 20 minutes at a time. Don’t apply ice directly to your skin.
  • Compression: Reduce swelling by applying a compression bandage or wrap around the injured tendon.
  • Elevation: Lift your foot into an elevated position, preferably above the level of your heart.

Once your healthcare provider diagnoses your injury, they may recommend additional treatments such as:

  • Calf stretches or exercises.
  • Orthotics (special shoe inserts) to reduce pain and support your foot as you get back to physical activity.
  • Non-narcotic pain relievers.
  • Physical therapy to regain range of motion, strength, stability and flexibility in your foot, ankle and calf.
  • Soft cast or boot to immobilize your foot and let the tendons heal.

Will I need surgery for foot tendonitis?

Most people don’t need surgery for foot tendonitis. But your healthcare provider may recommend surgery if your injury hasn’t improved after six months of nonsurgical treatments. Surgical treatments may include:

  • Gastrocnemius recession: This procedure surgically lengthens your calf muscle. It may help people with flat feet or relieve stress on the Achilles tendon.
  • Tenosynovectomy: This surgery debrides (cleans) a damaged tendon. A surgeon removes damaged tissue and stitches the healthy tissues back together.
  • Tendon transfer: If your tendon is severely injured, you may need a tendon transfer. A surgeon removes most of the damaged tendon, then takes a healthy tendon from elsewhere in your foot and attaches it to the remaining part of the original tendon.
  • Ultrasound-Guided Hydroresection (TenJet): If your tendon isn’t torn, but contains a degenerative material called tendinosis, your provider may recommend an office-based procedure to debride that degenerative tissue. This is performed under ultrasound guidance in the office.

Prevention

How can I prevent foot tendonitis?

You can reduce your risk of foot tendonitis by:

  • Not pushing through pain. Let pain be your guide.
  • Gradually working up to intense physical activity.
  • Maintaining a healthy body weight.
  • Not overworking your tendons.
  • Not smoking or using tobacco products.
  • Resting between workouts.
  • Stretching before physical activity.
  • Stretching after physical activity.
  • Using proper technique when playing sports.
  • Wearing supportive shoes that fit, including orthotics if recommended by your healthcare provider.

Outlook / Prognosis

What’s the prognosis (outlook) for people with foot tendonitis?

Most people recover fully from foot tendonitis without any permanent damage. You can expect tendon injuries to heal with conservative treatments within a few months. If you have surgery, your recovery period could take from six to 12 months. Most people need physical therapy following surgery.

Once you’ve had a foot tendon injury, you’re at a higher risk for future injuries in that area. Take extra measures to prevent reinjury when playing sports or exercising.

Living With

When should I contact my doctor?

Contact your doctor if you:

  • Are unable to walk or bear weight on your foot.
  • Can’t bend or flex your toes or ankle.
  • Feel or hear a snapping or popping sensation or sound in your foot or ankle.
  • Have severe pain in your foot, ankle or calf.
  • Notice swelling in your foot, ankle or calf.

A note from Cleveland Clinic

Foot tendonitis occurs when you overstretch the tough bands of connective tissue in your foot. It’s a fairly common overuse injury in athletes, but it can also affect older individuals with conditions like flat feet or arthritis. For most people, it’s an injury that heals on its own with a combination of conservative treatments such as rest, ice, stretching or physical therapy. In rare cases, foot tendonitis requires surgery.

Last reviewed by a Cleveland Clinic medical professional on 10/26/2021.

References

  • American Academy of Orthopaedic Surgeons. Achilles Tendinitis. (https://orthoinfo.aaos.org/en/diseases--conditions/achilles-tendinitis/) Accessed 11/2/2021.
  • American Academy of Orthopaedic Surgeons. Posterior Tibial Tendon Dysfunction. (https://orthoinfo.aaos.org/en/diseases--conditions/posterior-tibial-tendon-dysfunction/) Accessed 11/2/2021.
  • American Academy of Orthopaedic Surgeons. Smoking and Musculoskeletal Health. (https://orthoinfo.aaos.org/en/staying-healthy/smoking-and-musculoskeletal-health/) Accessed 11/2/2021.
  • American Podiatric Medical Association (APMA). Tendinitis. (https://www.apma.org/tendinitis) Accessed 11/2/2021.
  • Foot Health Facts. American College of Foot and Ankle Surgeons. Peroneal Tendon Injuries. (https://www.foothealthfacts.org/conditions/peroneal-tendon-injuries) Accessed 11/2/2021.
  • Pabón MAM, Naqvi U. Achilles Tendonitis. (https://www.ncbi.nlm.nih.gov/books/NBK538149/) [Updated 2020 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 11/2/2021.

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