TENDONITIS

What is Tendonitis? Tendonitis is inflammation of, or injury to, a tendon, usually at its attachment into the bone. A tendon is specialized tissue at the end of the muscle. Tendons are not elastic (they do not stretch or give) and therefore respond to overuse and excessive stress by tearing of the tendon tissue. The most common areas that get tendonitis in the foot are the base of the 5th metatarsal (Peroneal tendonitis), top of the foot (Anterior Tibial tendonitis) the arch (Posterior Tibial tendonitis), and the back of the heel (Achilles tendonitis).

What Causes Tendonitis?

• Tendonitis in the foot is caused by stress being applied to the tendon which is greater than the tendon can withstand.
• A sudden increase in physical activity such as sports activity, excessive standing or walking, or going without shoes for an extended period
• Trauma (injury) such as twisting of the foot and or ankle.
• The presence of an extra bone in the tendon, called an accessory ossicle.
• Weakening of the tendon itself. For some unexplained reason, some people develop weakening and deterioration of tendons in the foot. This condition is most common in middle aged females and can be related to various types of arthritis.
• Feet that flatten severely with standing are especially susceptible to tendonitis since the flattening of the foot puts an excessive stress on the tendons.

How Is Tendonitis Of The Foot Treated?

• Tendonitis due to a sudden increase in physical activity or due to trauma is treated by ice for the first 24-48 hours, then heat thereafter, rest, and anti-inflammatory medications such as Advil, Nuprin, etc., supportive shoes such as walking or running shoes, and orthotics (custom made supports to go inside the shoe).
• Tendonitis due to weakening of the tendon must have aggressive treatment to prevent the tendon from detaching from the bone. Detachment, or avulsion of the tendon attachment can result in deformity of the foot and a severe limp if left untreated. Treatment begins with a custom made orthotic (arch support), anti-inflammatory medications, rest, and modifying activity to control the progression of the condition.
• Tendonitis of the foot should not be treated with cortisone injections. Cortisone can weaken the tendon causing it to detach from the bone. Some cases require a period of cast immobilization.
• Cases that do not respond to conservative therapy must have surgery to reattach the tendon and remove the accessory ossicle or calcification within the tendon when present.
• Cases where the tendon has been severely or completely torn from its attachment to the bone often require a fusion or other type of stabilizing procedure to prevent reoccurrence of the tendonitis.
• Achilles tendonitis, in addition to the above treatments, responds to the wearing of shoes with a higher than normal heel to relax the excessive pull of the strong Achilles tendon. With Achilles tendonitis, it is especially important not to walk without shoes, or in low heeled, shoes since this severely increases the pull on the Achilles tendon. Persistent cases require the application of a removable cast in order to allow the tendon to heal and reattach itself into the heel bone. Severe cases require surgery to remove calcification of the Achilles tendon, excision of inflamed tissue, and to reattach the tendon into the heel bone.

How Do I Keep From Getting Tendonitis?

• Do not push yourself too hard.
• You should not continue walking, exercising, or working when the symptoms of tendonitis begin.
• Slowly increase your stamina and endurance so your feet and other areas of your body can withstand the stress of the activity, job, sport, or exercise routine.
• Gently stretch the muscles and tendons susceptible to tendonitis, especially before participating in athletic activity, job duties, or exercise programs.
• Wear the proper shoes with the best support possible.
• Feet that tend to flatten excessively must have a custom made support to prevent tendonitis and other conditions that result from flat feet.
  

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