Tendon Problems

What are tendon problems?

The most common foot tendon to tear include the posterior tibial tendon, the peroneal tendons and the Achilles tendon.

Tibialis posterior dysfunction

The posterior tibial tendon links the calf muscle to the bones inside the foot. It is a vital tendon in the leg, because it holds up the foot’s arch and supports it during walking.

Seen more frequently in women, tibialis posterior tendon dysfunction occurs as a result of the posterior tibial tendon becoming torn or swollen. This can lead to a flat foot because the tendon is no longer able to sustain the stability of the foot’s arch. Arthritis can also be a consequence of these kind of changes in the foot’s shape.

What causes tibialis posterior tendon dysfunction?

The tendon can be damaged due to an injury from a fall, for example, or can result from repetitive strain, typically arising from playing a sport like tennis. Should inflammation occur in the tendon, the arch will gradually start to fall.

You are more likely to suffer from tibialis posterior tendon dysfunction if:

• You are over 40
• You have weight problems
• You suffer from high blood pressure or diabetes

What are the symptoms of tibialis posterior tendon dysfunction?

Pain will be experienced on the inside of the foot and ankle, which is exacerbated by activity. Consequently, running and other sports will become problematic.

As the arch begins to fall, the heel bone may shift outwards, pressurising the outer ankle bone.

How is tibialis posterior tendon dysfunction diagnosed?

At your initial meeting, your consultant will discuss your symptoms and advise you on the most suitable treatment. X-rays to assess any arthritic damage, together with an MRI or ultrasound scan to study the tendon and surrounding tissue in greater detail, may also be organised.

How is tibialis posterior tendon dysfunction treated?

Suffering from tibialis posterior tendon dysfunction doesn’t mean you will need surgery. The application of ice packs, rest, taking anti-inflammatory painkillers under your doctor’s direction, together with wearing a specially supportive medical boot or shoe can be enough to hold up the arch of the foot and ease your pain. It may be that your consultant will also recommend a personal plan of physiotherapy to further improve the tendon’s strength. Should your symptoms prove resistant to the non-surgical treatments outlined however, your consultant may indicate that flat foot surgery is your best option.

Peroneal tendon problems (peroneal tendinopathy or tendonitis)

The two peroneal tendons run side by side from the outside of the leg below the knee, behind the outer ankle bone to the foot. These tendons are used to keep the ankle stable when running or walking and enable the foot to roll outwards.

What cause peroneal tendon problems?

Peroneal tendon issues are usually caused by overuse, notably an abrupt increase in sporting activity or high-intensity training sessions. Wearing inappropriate footwear or running on bumpy terrain are other significant causes. Football and gymnastics see a high rate of these issues because the foot is frequently sharply pivoted.

The peroneal tendons may also be injured due to being torn or stretched, when you suffer an ankle sprain. Repetitive strain or embarking on a new activity can also lead to inflammation, causing tendinitis. A previous injury can result in long-term tendon degeneration, known as tendinosis.

What are the symptoms of peroneal tendon problems?

• An inflamed and painful ankle
• A sensation of the tendon ‘snapping’ or ‘popping’
• Should the sheath surrounding the tendons be affected, tendons can dislocate leading to weakness and an unpleasant ‘clicking’ on movement of the ankle
• Ankle instability and pain when running or walking
• Without treatment, the tendon can rupture, so try to consult a doctor at an early stage

How are peroneal tendon problems diagnosed?

When you first meet, you will be invited to describe your symptoms to your consultant, who will guide you towards the right treatment for you. Often, he will suggest taking anti-inflammatory painkillers. The type of tendon problem you have will dictate the nature of your treatment and your consultant will direct you with this too.

How are peroneal tendon problems treated?

Depending on the nature of your injury, resting the foot occasionally, above the level of your heart, together with the application of an ice pack and the use of compression or support bandages may prove effective. Anti-inflammatory painkillers may also be recommended. Your consultant may also advise that you to undergo a rehabilitation programme of physiotherapy to improve the calf and peroneal muscles’ flexibility and strength. Some patients have found that wearing inserts in their shoes can cut pain levels too.

Your consultant can, in certain cases, perform surgery either to solely repair the tendon or to take away injured tissue from around the tendon area as well, with the aim of reducing any pain.