Ankle tendonitis is a common cause of ankle pain. The muscles of the ankle are anchored to the bone by tendons, which as tight cord-like fibrous tissues. Tendonitis is inflammation surrounding a tendon, which is usually due to overuse or an injury such as ankle sprain. The pain usually dissipates with rest, only to return. Common symptoms of ankle tendonitis include pain and swelling.

Ankle Anatomy

ankle anatomy

 

Common types of ankle tendonitis

  • Achilles tendonitis (back of the ankle): Achilles tendonitis is characterized by pain within 1 to 4 inches above where the tendon connects to the heel bone in the back of the leg. Achilles tendonitis is a common repetitive stress injury that can be brought about sports, poorly-fitted shoes, or thigh calf muscles. Achilles tendonitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs.
  • Posterior tibial tendonitis (inner side of the ankle): Pain along the inside of the foot and ankle, where the tendon lies. When the foot collapses, however, the heel bone may shift to a new position outwards, and this can put pressure on the outside ankle bone. Patients may occasionally also experience an unsteady gait. Pain worsens with high-intensity or high-impact activities, such as running. As the condition progresses, the arch of the foot can flatten, and the toes begin to point outwards. This is the result of the posterior tibial tendon not doing its job to support the arch of the foot. The inflammation of the posterior tibial tendon is usually associated with flat feet – an abnormal foot position where the toes splay outward around the rear of the foot. You may need walking boots or a short leg cast to ease the swelling. Alternatively, you may consider a brace or orthotics if necessary.
  • Peroneal tendonitis (outer side of the ankle): Peroneal tendons stabilize the foot and ankle to protect from sprains. Peroneal tendonitis may be due to high-arched feet and a history of the recurring ankle. They most commonly occur in physically active individuals who participate in sports that involve repetitive ankle motion.

 

Causes

  • Overuse: Overstretching of the tendon may occur as a result of repetitive or extreme activity, such as competitive sports.
  • Abnormal foot structure: High arch or flat feet can create muscular imbalances that put stress on your tendons.
  • Trauma: An ankle or foot injury can occur with a sudden, jolting motion like jumping. Another form of shock is constant rubbing against a shoe, which most often happens at the top of the heel or foot, resulting in tendonitis in those areas.
  • Medical conditions: Inflammatory diseases such as reactive arthritis, rheumatoid arthritis, gout, and spondyloarthropathy can cause ankle and foot tendonitis.

 

Treatment

  • Rest – Decrease activity so that your body can heal it. Avoid aggravating activities for some time, usually weeks to months. Refrain from athletic participation when the tendon is still inflamed, as there is a significant risk of rupturing or tearing the tendon, especially in the Achilles area, with continued athletic activity. You may be able to start some low-impact exercises, such as cycling or swimming, within a week. While you are healing, your doctor may give you a walking boot to keep your foot and ankle immobilized, or you may be directed to reduce weight bearing on the affected foot.
  • Ice and heat– Apply ice or cold compression for 20 minutes at a time. You may also alternate with heat.
  • Compression – Apply an ACE wrap or other ankle supports. Shoe insoles and inserts can also be used to provide padding and support for the foot, taking any undue tension off the tendons.
  • Exercise – Incorporate stretching and strength exercises to regain tendon strength and flexibility, as well as a healthy range of motion. Depending on the severity, physical therapy treatments such as ultrasound may be necessary to help heal your tendons.

Non-steroidal anti-inflammatory medicines such as ibuprofen can decrease pain and inflammation. A steroid injection can also be given to help reduce the swelling. These injections can weaken the tendons temporarily, so care must be taken to prevent the risk of re-injury.

If the pain fails to settle, extracorporeal shockwave therapy, physical therapy, or surgery may be recommended to repair severely injured tendons.

 

Prevention

Stretch your foot and ankle before strenuous activity to loosen your tendons.

Healthy feet also rely on properly-fitted shoes that provide orthotic support. Use shoes for the designated activity – if you run, invest in a good pair of running shoes.

Gradually increase your time and intensity if you are starting with a new physical activity.

 

The Bottom Line

Tendonitis in your foot or ankle is a sign that you need to take it easy. If the pain persists, consult your doctor. While resting may mean time away from your hobbies, the aim is to avoid complications that can sideline you for even longer.