Tendonitis is the inflammation of a tendon, the tough, cord-like tissue that connects muscle to bone. The ankle and foot complex is particularly susceptible to this condition because it contains numerous tendons. These tendons are constantly subjected to repetitive stress and motion during daily activities like walking and standing. Due to the high forces placed on the joint, the tendons around the ankle are common sites for irritation and subsequent inflammation.
Key Tendons Susceptible to Inflammation
The ankle joint relies on several tendons for stability and movement, but three groups are most commonly affected by tendonitis. The largest is the Achilles tendon, which connects the calf muscles to the heel bone (calcaneus). This tendon enables the powerful motion of pointing the foot downward. Inflammation here, known as Achilles tendonitis, typically causes pain at the back of the heel, often worsened by activities like running or jumping.
The posterior tibial tendon runs along the inner ankle and attaches to bones in the middle of the foot. This tendon plays a primary role in maintaining the arch of the foot, which is why inflammation can lead to a gradual flattening of the arch over time. Pain from posterior tibial tendonitis is often localized to the inner ankle bone and may worsen with prolonged standing.
The two peroneal tendons are located on the outside of the ankle. They travel down the lower leg and run behind the outer ankle bone (fibula) before attaching to the foot. These tendons stabilize the ankle and foot, helping to prevent sprains during side-to-side movements. Peroneal tendonitis causes pain and tenderness along the outer edge of the ankle, often seen in athletes requiring quick changes in direction.
Identifying the Common Causes
The primary cause of ankle tendonitis is repetitive strain, which results in microscopic tears and irritation of the tendon fibers. This often occurs when individuals significantly and suddenly increase their activity level. For example, a runner may rapidly increase weekly mileage or a person may begin an intense new exercise routine. The constant friction and tension exceed the tendon’s ability to repair itself, leading to inflammation.
Biomechanical irregularities in the foot structure also contribute to the development of tendonitis. Foot conditions like pronation (flat feet) or supination (high arches) alter the alignment of the leg and ankle. This places improper or excessive strain on specific tendons, such as greater stress on the posterior tibial tendon from a collapsed arch.
Wearing unsupportive or worn-out footwear is another common culprit. Shoes that lack proper cushioning or arch support fail to absorb shock and stabilize the foot during impact. This increases the tendons’ workload and susceptibility to injury. Direct trauma, such as an ankle sprain that does not heal completely, can also weaken the surrounding tendons and leave them vulnerable to subsequent inflammation.
Initial Steps for Relief and Recovery
Managing the initial symptoms of ankle tendonitis focuses on reducing inflammation and preventing further damage to the affected tendon. The immediate course of action generally follows the R.I.C.E. protocol: Rest, Ice, Compression, and Elevation. Resting the ankle means avoiding the specific activities that aggravate the pain, often requiring a temporary switch to low-impact exercises like swimming.
Applying ice to the painful area for 15 to 20 minutes several times a day helps constrict blood vessels, reducing swelling and numbing pain signals. Compression, using an elastic bandage or sock, minimizes swelling while providing gentle support to the soft tissues. Elevating the ankle above the level of the heart assists in draining excess fluid and reducing inflammation.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be taken as directed to manage pain and decrease the inflammatory response. Utilizing supportive devices like ankle braces or athletic tape can temporarily stabilize the joint and reduce strain on the injured tendon. In certain cases, a healthcare provider may recommend temporary immobilization with a walking boot to ensure the tendon receives adequate rest.
Once the initial inflammation subsides, recovery involves a gradual transition to physical therapy. This focuses on restoring the tendon’s strength and flexibility. Gentle stretching exercises, such as a towel stretch for the Achilles or ankle rotations, are introduced to improve range of motion. Strengthening exercises, like calf raises, help to build the muscle groups that support the ankle.
If pain persists, worsens, or if you are unable to bear weight on the ankle after a week of conservative home treatment, seek professional medical evaluation. Untreated tendonitis can progress to a more serious condition, like chronic tendinosis or even a tendon tear. A physical therapist or doctor can provide an accurate diagnosis and recommend custom orthotics to correct biomechanical issues. They will also develop a structured rehabilitation plan tailored to the specific affected tendon.