Tendinopathy

Tendinitis or Tendinosis

Tendinits Tendonitis

Tendinits or Tendonitis

Tendinitis or Tendonitis is the inflammation of the tendon and results from micro-tears that happen when a tendon is acutely overloaded/stretched or utilized in excess. When overuse is continued without giving the tendon time to heal and rest, such as with repetitive strain injury, Tendinosis results.

The term Tendinopathy has been advocated to describe the variety of painful conditions that develop in and around tendons in response to overuse or acute injury.

Tendinosis

Tendinosis is a degeneration of the tendon’s collagen in response to chronic overuse. Scarring of the tendon and increased vascularity within the tendon will often cause a thickening of the tendon in the case of tendinosis.

Causes of tendinopathy may include an injury or repetitive activities such as running. Groups at risk include people who do manual labor, musicians, and athletes. Less common causes include infection, arthritis, gout, thyroid disease, and diabetes. Quinolone antibiotics (e.g. Levaquin, Ciprofloxacin) are also associated with increased risk of tendinitis and tendon rupture.

In the foot and ankle, as with the rest of the body, there is potential for tendinopathy in ANY tendon. Generally, however, the Achilles, Tibialis Anterior, Tibialis Posterior and Peroneal (i.e. Peroneus Longus and Brevis) tendons are those that are most afflicted.

Achilles Tendinitis

Tends to happen in the back of the leg/heel with a sudden push off against the ground in the propulsive phase of gait or when jumping/reaching. Repetitive motion that occurs with running, jumping or pivoting can also lead to the condition.

Tibialis Anterior Tendinitis

Is an irritation and swelling on the front of the leg in one of the main tendons that lifts the foot up. This conditiontypically occurs due to activities such as fast walking or running (especially up or downhill or on hard or uneven surfaces) or sporting activity (such as running or cross country skiing/snowshoeing).

Tibialis Posterior Tendinitis

Involves pain/tenderness on the inside of the shin, ankle or foot. The posterior tibial tendon provides support to the arch of the foot and gives stability when walking. As the foot pronates in the midstance phase of gait, the tendon is under load. With high load over a short time or with extended repetition, the tendon can suffer microtearing. Overuse may be caused by walking, running, hiking, stair-climbing or high-impact sports, such as tennis and basketball.

Peroneal Tendinitis

Occurs when the tendons adjacent to the bump that is on the outside of the ankle or outer foot become inflamed. This condition is very common after ankle sprains as the tendons become overstretched as the foot rolls inward. More typically, it is caused by overuse, a sudden increase in training, improper training techniques, inadequate or unsupportive footwear, walking/running on slanted surfaces (foot rolls outward).

Symptoms of Tendinopathy include tenderness at or near a joint, stiffness/pain restricts the movement of the joint involved, mild swelling of the tendon near the joint. 

Call your doctor about Tendinitis if: 

  • Your pain doesn’t ease up in seven to 10 days; or, 
  • Your pain is extremely severe and accompanied by swelling and a marked loss of motion – you may have a ruptured tendon, which requires immediate medical attention.

Most often, the diagnosis of tendinopathy is made by the physical exam and imaging done by an experienced medical professional. Tissue/structural changes associated with tendinopathy that are often visible on ultrasound include degeneration and disorganization of collagen fibers and increased cellularity. Plain x-rays of the foot and ankle are often negative as this is a problem involving a tendon which will not usually be seen on plain x-rays. An MRI of this area will reveal swelling and inflammation of the lining of the tendon sheath surrounding the tendon.

Fludid Tendon Around

Treatment

There will often be fluid around this tendon, and there may be signs of degenerative change within the tendon itself.

Treatment may involve any of the following alone or in combination: 

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