Foot & Ankle Tendonitis

Written By: Chloe Wilson - BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

Foot and ankle tendonitis is a common cause of foot pain.

Tendonitis occurs when there is inflammation or irritation of the tendons, which is usually due to overuse from repetitive movements or stretching, or an injury such as an ankle sprain.

Symptoms of foot tendonitis typically consist of pain, swelling and stiffness. It usually takes two to three months to recover from tendonitis, but it can take much longer without the proper treatment so early diagnosis and treatment is essential.

Foot and ankle tendonitis can affect any of the tendons in the foot. 

Here we will look at how tendons get damaged and what the effects of that damage is. We will then go on to look at the most common types of foot and ankle tendonitis including the symptoms and treatment options for each. 

What is Tendonitis?

Foot Tendon Diagram. Ankle tendonitis develops when there is inflammation in the tendons from overuse

Tendons are the strong, cord-like bands of connective tissue that link muscles to bone. There are lots of different tendons around the foot that work hard whenever we are on our feet.

If a tendon is made to work too hard, for too long or in the wrong way, damage and tiny tears develop in the tendon.  This is accompanied by inflammation which is the tell-tale sign of the condition. 

The body’s normal response to an injury is to send extra red blood cells carrying the oxygen and nutrients required for healing and white cells to fight off possible infection.  Waste products such as inflammatory chemicals are then carried away. 

All of this helps speed up healing but should only last for a few days.  If an area is repeatedly irritated, the process keeps going resulting in the continued inflammation described as tendonitis. 

Common Causes

There are four main causes of foot and ankle tendonitis:

  • Overuse:  It most commonly occurs when the tendon is repeatedly overloaded i.e. being asked to work too hard, or it is repeatedly over-stretched
  • Abnormal Foot Structure: If your foot is an abnormal shape e.g. flat foot or high arches, it can put more stress on the tendons resulting in the condition
  • Injury: It can develop after any foot or ankle injury e.g. ligament sprain, or from repetitive friction on the tendon e.g. from a shoe rubbing
  • Medical Conditions: Some inflammatory conditions such as gout and rheumatoid arthritis can cause foot tendonitis

Symptoms of Foot Tendonitis

The symptoms of foot and ankle tendonitis will vary according to the location, severity and stage of the tendonitis.  The most common symptoms are:

  • Foot Pain: Pain is usually the first sign that there is a problem.  There tends to be a sharp and/or burning pain, usually localised to the area of the tendon at first but as the condition worsens, can spread wider.

    Pain is usually worse with initial movement, settles down after a minute or so, but then returns as you do more. For example, your first few steps when you get out of bed will really hurt, but the pain will then ease up.  But as you are on your feet for longer, the pain will return
  • Swelling: It usually takes a while for swelling to develop with the condition.  After a few weeks of minor symptoms, you may notice a soft lump forming over the tendon, which is often tender to touch.  This is most common in Achilles Tendonitis.
Flat feet can cause ankle tendonitis as it places extra strain on the foot tendons
  • Abnormal Foot Shape: Flat feet are often the result of a problem with the tibialis posterior. The tendon provides a majority of the support and stability for the inner foot arch.

    When posterior tibial tendonitis develops, then the foot arch gradually collapses down. This then puts strain on other tendons in the foot so can cause inflammation and degeneration in those too

  • Stiffness: The foot and ankle often becomes stiff as a result of ankle tendonitis limiting the amount of pain-free movement.

Types of Foot and Ankle Tendonitis

Tendonitis can occur in a number of places around the foot and each will present with different symptoms.

Achilles Tendonitis

Achilles tendonitis is a common problem

This causes heel and calf pain and is probably the most well known type of foot tendonitis. 

The Achilles tendon joins the two calf muscles to the heel.  Pain is usually felt when walking/running and can occur anywhere from the back of the heel up to the middle of the calf. Find out more in the achilles tendonitis section.

Peroneal Tendonitis

This causes pain on the back and outer side of your ankle/foot. The peroneal tendons run down the outer side of the ankle across the bottom of the foot.  

Pain from peroneal tendonitis is usually felt when standing or pushing off through your foot. You can find out more in the peroneal tendonitis section.

Posterior Tibial Tendonitis

This causes pain on the inner side of the foot. The posterior tibial tendon runs along the inside of the foot and ankle.  

Pain is usually felt when you start to push off through your foot. Over time, the foot arch will gradually collapse resulting in flat feet. The classic sign of posterior tibial tendonitis is an inability to stand on tiptoes. Find out more in the posterior tibial tendonitis section.

Extensor Tendonitis

This causes pain on the top of the foot. The extensor tendons pull the toes up.  

Pain from extensor tendonitis is often worse when running.  This is one of the more rare types of ankle tendonitis. You can find out loads more in the extensor tendonitis section.

Anterior Tibial Tendonitis

This results in pain at the front of your foot. The Anterior Tibial Tendon controls the movement at the front of your foot.  

Pain is usually felt when coming down stairs or when walking/running on sloped surfaces e.g. hills.  Again, this is one of the less common places to get the condition.

Treatment Options

There are two aims of treatment for ankle tendonitis.  The first is to reduce the pain, swelling and dysfunction associated with the problem.  The second is to address any aggravating factors that can be avoided to prevent the problem from returning such as abnormal foot shapes or muscle weakness and tightness. 

With any type of ankle tendonitis, it is vital to rest the foot to prevent further damage and to allow recovery.  Any activity that increases pain should be avoided if possible.  PRICE principles should be followed (protect, rest, ice, compression and elevation) and anti-inflammatory medication may help.

What Else Can Help?

Recovery from any type of foot and ankle tendonitis tends to be slow and can take anything from weeks to months. The earlier treatment is started, the better the likely outcome.

For more in-depth information and specific treatment advice for each type of tendonitis, visit the appropriate section choosing from Achilles Tendonitis, Peroneal Tendonitis, Posterior Tibial Tendonitis or Extensor Tendonitis

Go to Common Causes of Foot Pain or Foot Pain Guide

Page Last Updated: 11/12/18
Next Review Due: 11/12/20


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