Friday, December 8, 2023

Tendons Of Foot And Ankle

What Are Tendons And Ligaments

Ligaments and Tendons of the Foot

Tendons are tough connective tissues whose main function is to connect muscle to bones. So, when you move around, your muscles contracts, pulls your tendons, which in turn allows movement to occur. Tendons are located on the top, bottom, and sides of the foot.

On the top of the foot are extensor tendons that help move your foot towards the front of the leg There include

  • Extensor digitorum muscle tendon
  • Tendon of the tibialis anterior

On the side of the foot are

  • The posterior tibial tibia tendon located at the inner side of your foot
  • The two peroneal tendons located on the outside of the foot

At the back of the foot is the Achilles tendon that stretches from the posterior part of the leg and gets attached to the heel bone .

Also present at your ankle and foot are ligaments. These ligaments primarily hold bones in shape. If they get injured, you will experience foot pain and swelling.

The Tendons Of Your Feet And What They Do

by Dr. David Watts | Dec 15, 2017 | Foot Health

Your body is an amazing machine made up of many connected parts that work together to allow movement. A tendon, also known as a sinew, is a fibrous tissue that helps to facilitate this movement.1 Tendons join muscles to their corresponding bones. Without tendons, your muscles wouldnt be able to make your bones move.

Tendons are sometimes confused with ligaments. Ligaments and tendons serve similar purposes, but in different ways. While tendons connect muscle to bone, ligaments connect bones to other bones.2

Your feet contain more than 100 muscles, tendons, and ligaments.3 These invisible structures work together to help you do your most important movement walking.

Tendons have different jobs, depending on their location. If you have a foot injury, it can benefit you to know the types of tendons and where they exist in your feet. Injuries to tendons, such as tendinitis and tendinosis, are common, especially for athletes.

Here is an explanation of the types of tendons present in your feet and their purposes.

What Are Foot Tendon Tears

  • Posterior tibial tendon. The posterior tibial tendon attaches the calf muscle to the bones of the inside of the foot. It holds up the arch of the foot and supports the foot during walking. A tear to this tendon is usually from a fall. But it can also be injured from overuse. This is most common in athletes who put a lot of stress on the ankle during sports like basketball or soccer. The anterior tibial tendon runs from the shin to the top of the foot. Injuries to this tendon are much less common than to the posterior tibial tendon.
  • Peroneal tendons. The two peroneal tendons run down the outer part of your lower leg and behind your ankle bone on the outside of the foot. One tendon attaches to the middle of your foot on the outside. The other attaches to the bottom of your foot near the arch. Tears in these tendons are usually caused by an ankle sprain or a blow to the ankle. It can also be caused by overuse, usually in athletes who repeat movements that put stress on the ankle.
  • Achilles tendon. The Achilles tendon connects the calf to the heel bone and is important for walking, running, and jumping. It is the largest tendon in the body. It can tear if sudden high stress is put on it, especially if the calf muscle is stiff or weak and cant take its share of the stress. For example, the Achilles tendon can tear when a sprinter pushes off at the start of a race.

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Risk Factors For Tendonitis Of The Ankle Or Foot

Risk factors for tendonitis in the foot or ankle include:

  • Sports that require repetitive movement
  • Sports that may lead to overuse of the ankle such as running
  • People over 40 are more likely to have tendonitis in the foot or ankle
  • Men are more likely to develop tendonitis in the foot or ankle
  • People who are overweight are more likely to develop tendonitis in the foot or ankle
  • People who wear worn out shoes that do not support the feet are more likely to develop tendonitis in the foot or ankle
  • Previous injuries to the tendons in the foot or ankle

What Is Tendonitis In The Ankle

Arthritis of the Foot and Ankle

Tendons are the cords of tissue that attach your muscles to your bones. When a tendon gets inflamed, you experience tendonitis . Repetitive movements and gradual overuse are common causes, but sometimes a sports injury may cause tendonitis.

Tendonitis can occur anywhere you have tendons. Some common places are:

  • Shoulders
  • Base of the thumb
  • Ankles

The main symptom of ankle tendonitis is pain around the ankle joint, especially when you move the inflamed joint or put weight on it. You may also notice swelling on or around the ankle. The ankle is vulnerable to tendonitis and other injuries because it supports your body weight. Also, as a multi-directional joint, it allows you to point, lift, and rotate your foot.

There are a few common kinds of tendonitis that affect the ankles:

  • Achilles tendonitis refers to inflammation of the Achilles tendon that connects the calf muscles to the ankle. This pain occurs along the back of the ankle.
  • If you feel pain along the outer side of your ankle, you may have peroneal tendonitis.
  • Anterior tibialis tendonitis results in pain down the front of the shin.
  • Posterior tibial tendonitis often presents as pain and swelling along the inner side of the ankle and foot.

Other common ankle ailments include sprains, fractures, and arthritis. Because some of these conditions may share similar symptoms with tendonitis, be sure to see a doctor for a diagnosis.

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Arthritis In The Big Toe Joint

In addition to being the site at which bunions may become apparent, the joint at the base of the big toe can also develop arthritis. When arthritis is present, owing to a loss of cushioning cartilage in the metatarsal phalangeal joint where the metatarsal meets the phalanx bone in the toe stiffness and pain develop. In some cases, the patient also develops a bone spur, or bump on the top of the joint, which can cause additional discomfort. Arthritis in the toe may have a genetic origin, or it may result from an injury.

People who develop this condition, called hallux rigidus, are counseled to wear shoes that have more rigid soles or with rocker bottoms, which are designed to transfer weight, reduce pressure and limit big toe motion. Some running shoes can also provide sufficient support. Going barefoot or wearing a flexible-soled shoe will exacerbate the condition.

Figure 3. Foot anatomy, showing the joint and bones affected by hallux rigidus:The proximal phalanx and metatarsal bone of the big toe are highlighted in yellow.

Until recently, when the arthritis in the big toe progressed to cause all movement in the joint to be painful, surgeons had only two options:

  • Cleaning out the joint , a procedure that potentially restores some comfortable motion in the toe or
  • Fusing the bones together, thereby eliminating joint motion and the pain.
  • Foot And Ankle Tendonitis

    Your feet and ankle bear your complete bodyweight. Feet and ankle are held together by dozens of tendons and ligaments. Tendonitis is a common reason for visits to the podiatrist. The pain tendonitis causes can force you off your feet.

    Tendons and ligaments are strong, fibrous bands of tissue connecting the leg, foot, and bone to muscle. These would give you the power to move your feet. Overuse and inflammation can trigger tendonitis around tendons causing pain. This pain can make walking and standing impossible, and severe cases can cause instability and decreased mobility.

    Tendonitis affects different parts of your foot and ankle including:

    • Back of the ankle or heel extending till calf muscle known as Achilles tendonitis
    • The inner side of the ankle or heel is known as Posterior tibial tendonitis.
    • The outer side of the ankle or heel is known as Peroneal tendonitis.
    • The top of the foot is known as Extensor tendonitis. This is a rare kind of tendonitis.

    Lets learn more about the cause of tendonitis, when to see your podiatrist, and how to prevent it.

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    What Is Foot Tendonitis

    Foot tendonitis is inflammation or irritation of a tendon in your foot. Tendons are strong bands of tissue that connect muscles to bones. Overuse usually causes foot tendonitis, but it can also be the result of an injury.

    Are there different types of foot tendonitis?

    Your feet contain many tendons. Tendonitis can affect any of them, but the most common include:

    • Achilles tendonitis: Affects the tendon connecting your calf muscle and heel bone. This tendon is the strongest tendon in the body. It helps us run, jump, walk and do other activities that require us to rise up on our toes.
    • Extensor tendonitis: Irritation of the tendon that runs along the top of your foot. These tendons attach bones at the front of your leg to your toes.
    • Peroneal tendonitis: Inflammation in either of the two tendons that run along your outer ankle bone. They connect to your midfoot and your arch to help with stability.
    • Posterior tibial tendonitis: Affects the tendon that connects your calf muscle to bones on the inside of your foot. These tendons help hold up the arch of your foot.
    • Plantar fasciitis: Pain at the underside of your heel and within the arch of your foot. While this is technically not a tendon but a ligament, it can produce the same type of painful conditions that present like tendonitis, with similar treatment approaches.

    Can Your Peroneal Tendon Rupture

    Ligaments of the foot (previews) – Human Anatomy | Kenhub

    Left untreated, peroneal tendonitis can progress to a tendon rupture. This occurs if your tendon partially or completely tears. Damaged or weakened tendons can also lead to subluxation, which dislocates the tendons. Ruptures or subluxation can cause:

    • Ankle weakness or instability.
    • Intense pain along the outside of your foot and ankle.
    • Sharp, snapping feeling in your tendons.

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    Treatment Of Foot And Ankle Tendonitis

    Initially, the podiatrist would focus on conservative treatment methods involving non-invasive therapies. Resting the affected area is the basic practice to let the body heal the injured or torn tendons. This usually would take about a few weeks to months. Generally, you may be able to treat tendonitis at home. But if it doesn’t get better within 2-3 weeks, you should see a healthcare provider or podiatrist.

    The treatment plan would include:

    • Self-care: RICE therapy involving rest, ice, compression, and elevation helps in providing maximum benefit initially. The podiatrist would advise:
    • Limiting your activities.
    • Applying cold or ice compression on the affected area to help reduce swelling.
    • Providing compression or pressure using gauze bandage wrap or store-bought ankle support. This also helps reduce swelling and restricts ankle movement.
    • Elevating the affected foot at about the level of your heart.
  • Medication: Medications are prescribed to reduce pain and swelling. These are helpful when pain and swelling do not get better with home care, or after resting. Over-the-counter medicines or Nonsteroidal anti-inflammatory drugs are prescribed by healthcare providers to ease off pain and swelling.
  • Orthotics: These include shoe recommendations by podiatrists such as arch supports or inserts and prescription braces. Orthotics help in decreasing your pain and improve your mobility.
  • Whats The Prognosis For People With Peroneal Tendonitis

    Most people recover fully from this condition in about a month. Talk to your healthcare provider before getting back to full activities or your sport. Your recovery time from peroneal tendonitis will be longer if you have surgery. After surgery, you’ll wear a cast on your lower leg for four to six weeks. You might need crutches for the first few weeks, as well. Your provider can tell you when its safe to put weight on your ankle again. Most people need physical therapy after surgery to regain strength and stability in their ankle.

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    How Is Peroneal Tendonitis Diagnosed

    Peroneal tendonitis can be difficult to diagnose. The symptoms are similar to those of other foot and ankle problems, like sprains, arthritis and fractures. One study suggests that out of 40 people with peroneal tendonitis, about 60% were initially misdiagnosed.

    Your healthcare provider will perform a physical exam and review your symptoms, though. They may palpate on certain parts of your foot and ankle to check for swelling or tenderness. Your provider might also ask you to perform certain ankle movements to evaluate the range of motion in the joint.

    Sometimes imaging is necessary to make sure you dont have a foot fracture, osteoarthritis, cartilage damage or torn tissue. Your provider might recommend an X-ray, MRI, CT scan or ultrasound, as well.

    Treatments For Tendonitis In The Ankle

    Medial Ankle Pain

    Because tendonitis is most commonly the result of overuse, consider altering your work or workouts to be less repetitive and always use good form. Even after recovering from tendonitis, youre still at risk for reinjury.

    Because runners and other athletes are at risk for developing tendonitis, include preventive measures in your fitness routine. Thoroughly warm up before you exercise and allow recovery time between workouts. Consider incorporating strengthening exercises into your fitness routine to stabilize your joints.


    Your doctor may suggest that you take a nonsteroidal anti-inflammatory drug like aspirin, ibuprofen, or naproxen to help reduce the swelling, pain, and inflammation.

    Your doctor may also administer cortisone shots. Cortisone is a type of steroid that helps reduce inflammation. Your doctor will most likely limit the frequency of injections because they may be associated with joint damage over time.

    Home care

    Mild tendonitis may be effectively treated at home with RICE which stands for rest, ice, compression, and elevation.

    Physical therapy

    You may need to seek care from a physical therapist. Depending on your needs, your physical therapist might use ultrasound therapy, massage, or water therapy, or prescribe specialized exercises to build strength and mobility.


    Occasionally, surgery is used to treat severe tendonitis if it doesnt respond to other treatments. If that is the case, your doctor would refer you to an orthopedic surgeon.

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    How To Diagnose Foot And Ankle Tendon Injuries

    At Penn Orthopaedics, our foot and ankle specialists diagnose and treat all types of tendon injuries including:

    • Acute tears: tears that occur suddenly, perhaps while playing a sport or during activity
    • Tendinosis: tears that occur over time as a result of overuse, age or a degenerative condition
    • Tendinitis: inflammation of the tendon that causes pain, redness and warmth to the touch
    • Tendinopathy: the presence of both a tendon tear and tendinitis

    Our orthopaedic specialists perform complete assessments of your foot and ankle to determine the type of tendon injury you have. If needed, a musculoskeletal ultrasound may be done to look closely at all the soft tissues in the foot and ankle, including nerves, tendons, muscles and ligaments.

    Once we come up with an accurate diagnosis and can see exactly how and where your tendon is injured, we can develop a more personalized treatment plan.

    Anatomy Of A Joint Structure

    A joint is a part of a body where two or more bones meet. The ends of these bones are covered by Cartilage. To define, Cartilage is a connective tissue structure that helps provide shock absorbing properties when performing activities. In addition to cartilage, Synovial Fluid presents within each joint space and promotes smooth movement of the joint. There are also important connective tissues called Tendons and Ligaments that make up each body structure. A tendon is a tissue that connects muscle to bone. Similarly, ligaments connect bone to bone.

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    What Is Peroneal Tendonitis

    Peroneal tendonitis is inflammation in the tendons that run along your outer ankle bone and the side of your foot. These tough bands of tissue connect the muscles in your lower leg to the bones in your foot. They help stabilize and balance your foot and ankle, protecting them from injuries.

    This type of foot tendonitis is usually the result of overuse, but it can also happen suddenly if you fall or injure your foot.

    How Is Peroneal Tendonitis Treated

    Foot Anatomy Tutorial (Ligaments)

    Conservative treatments usually help relieve tendon pain and inflammation within three to four weeks. Recovery might take longer if tendonitis is the result of another injury, such as a sprain.

    Common treatments for peroneal tendonitis include:

    • Bracing: An ankle brace can support and stabilize your ankle if you have to perform certain movements, like running or jumping.
    • Immobilization: You might need a soft cast or boot to immobilize your foot and take weight off your tendons so they can heal.
    • Medication:Non-steroidal anti-inflammatory drugs can reduce pain and inflammation. In some cases, your provider might recommend steroid injections around the tendon itself, into the tendon sheath.
    • Physical therapy: Physical therapists guide you through exercises and stretches to regain strength and flexibility in your foot and ankle. Your therapist might also recommend ice, heat or ultrasound therapy.
    • RICE method: You can perform RICE at home. Rest by avoiding strenuous activities. Apply an ice pack or cold compress to your ankle for 20 minutes every two hours. Wrap your ankle in a compression bandage to reduce swelling and keep your ankle elevated, preferably above the level of your heart.

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    Foot & Ankle Ligaments

    Ligaments are strong, thick fibrous bands that connect boneto bone and hold them together. They area really important part of ankle anatomy as they are the primary stabilisers ofthe ankle.

    There are eleven ligaments aroundthe ankle, connecting the various different bones of the hindfoot and midfoot. They work together to control all the different movements in the foot and ankle.

    The most common ankle ligament injury is aligament sprain most commonly of the lateral ligament, aka anterior talofibular ligament. If an ankle sprain is not treated properly, it can cause long-term pain and instability in the ankle and foot.

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