Tendinitis is a commonly seen ankle injury, particularly in
athletes such as runners. Characterized
by inflammation of the tendons, it can lead to symptoms such as stiffness,
swelling, and pain. Below are several of
the details patients should know regarding ankle tendinitis, how it occurs, and
its various forms:
What is a Tendon?
Before diving into tendinitis itself, let’s begin at the
source: tendons. Tendons are ropes that
originate from a muscle and attach to a bone. They are dynamic, mobile, and can
stretch and glide. When a skeletal muscle contracts, it pulls on a tendon which
then moves a bone or a joint. An example is the Achilles tendon. This tendon
originates from the calf muscle and attaches to the back of the heel bone. When
the calf muscle contracts, the Achilles tendon pulls, the foot pushes downward,
and the body moves forward.
What is Ankle Tendinitis?
The suffix “-itis” indicates inflammation. Ankle tendinitis
is the inflammation of one or more the tendons crossing the ankle joint. This
can be from an acute injury (fall, twist, sprain
) or from overuse. It can also
be caused by poor conditioning and increase in activity that occurs too quickly.
Although there are numerous tendons that support and stabilize the ankle joint,
there are a few tendons that account for the majority of ankle tendinitis
injuries: the posterior tibial tendon, the peroneal tendons and the Achilles
tendon.
Posterior
Tibial Tendinitis -
This is a big name for a common problem. The strange
sounding name is just a geographic term. Anterior means front of the body, and
posterior means back of the body. The tibia is the big leg bone on the inside
of the ankle. And, tendinitis is inflammation of one of the supporting
structures of the ankle. So, posterior tibial tendinitis is inflammation of the
supporting tendon that originates from the back of the lower leg or tibia. This
tendon is one of the most important stabilizers of the arch. Posterior tibial
tendinitis is most common in patients with low arches or flexible flatfeet.
Flattening of the arch places increased pull and strain along this tendon.
Rapid increasing in certain activities, generalized wear and tear, and poor
shoe selection are frequent culprits for posterior tibial tendinitis, which is
also called Posterior Tibial Tendon Dysfunction (or PTTD). This condition is
not usually an acute injury from a fall, twist or sprain.
Peroneal
Tendinitis -
Everyone has a pair of tendons on the outside of the ankle called
the peroneal tendons. These tendons run along the outside of the ankle and
support the ankle from rolling inward. In chronic overuse instances, these
tendons are affected by a high-arched (Cavus) foot type. Unlike the posterior
tibial tendon, the peroneal tendons are frequently injured in acute sprains,
falls or stepping in a hole.
Achilles
Tendinitis -
The Achilles tendon is under significant stress and tension
during physical activities. This can be chronic, longstanding overuse or a
sudden increase in physical activity. This tendinitis can range from mild to
severe. Firm arch support combined with calf and hamstring stretching are good
first-line options for this condition. Physical therapy, anti-inflammatory
medications, and immobilization in a walking boot can be helpful in
recalcitrant cases of Achilles tendinitis.
These conditions are very treatable, often with non-surgical
methods. The best treatment will depend on the patient’s foot type, the cause
of the condition, and the patient’s long-term functional goals. Treatment
begins with a foot and ankle examination by an expert
in ankle tendinitis.
X-rays do not actually show tendons but are often helpful with ankle tendinitis
because they show bony detail and alignment. In some cases, specialized studies
such as an MRI are utilized to confirm diagnosis and the extent of the injury.
If
you fear that you may have injured an ankle tendon, contact my office
to request a consultation
. Once a diagnosis
has been confirmed, we can determine the most appropriate treatment approach to
help your ankle heal quickly.
