TENDON INJURIES IN FOOT AND ANKLE
There are several groups of tendons in the foot and ankle that are susceptible to injury. Persistent overuse of the tibialis anterior (in front of the ankle) and posterior (at the back of the ankle) tendons causes tibialis anterior or posterior tendinopathy. Overuse of the extensor tendons that run along the top of the foot and straighten the toes, and/or the flexor tendons, along the bottom of the foot, causes tendonitis. The peroneal muscles lie on the outer side of the ankle and act to plantar flex (point), evert (point outwards), and stabilize the foot and ankle. Overuse of the peroneal tendons leads to peroneal tendonitis, as can a tendency to roll the foot outwards when running.
TIBIALIS POSTERIOR TENDINOPATHY
EXTENSOR AND FLEXOR TENDONITIS
WHAT ARE THE SYMPTOMS?
Gradual onset of pain either in the front of your ankle or towards the back of your ankle on the inner side could be tendonitis in the tibialis anterior or posterior tendons. Pain and swelling on the top of your foot can be a symptom of inflamed extensor tendons. Tenderness across the underside of your foot, and a stabbing pain in the arch of your foot, especially when you stand on tiptoe, indicates possible inflamed flexor tendons. Swelling and nodules (small lumps) may appear on your foot. If the arch of your foot collapses completely, you will be unable to bear pressure on the sole of your foot. Pain or soreness on the outer side of the ankle indicates possible inflammation of the peroneal tendons. Peroneal tendonitis commonly worsens with running and eases with rest. Tendon injuries are often accompanied by swelling and the skin around the affected area will feel hot.
WHAT IS THE TREATMENT?
Stop any activity that causes pain, follow the RICE procedure and seek medical advice. Your doctor will diagnose you with a physical examination and possibly an X-ray or ultrasound scan to eliminate stress fracture or other injuries. Initial treatment will be rest and pain-relief medication, followed by treatments with physical therapist. Persistent (chronic) tendinopathy is a sign that the tendons are failing to heal properly. The condition is difficult to manage and there is a risk that the tendons will eventually rupture. This may require surgery, followed by a longer period of rehabilitation.
WHEN CAN I RETURN TO RUNNING?
Depending on the severity of the injury, you should be able to return to training a few weeks after peroneal tendonitis; it will be six weeks if surgery is required. Recovery from tibialis anterior or posterior tendonitis will take about three months. Extensor or flexor tendonitis will heal in six to 12 weeks. If you have to have surgery, full recovery can take up to a year.
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