Introduction
Tendinopathy is the term used for damage to the tendons, causing pain and if left untreated, serious problems and deformity.
Tendinopathy most commonly develops in and around the ankle and heel. Further down in this section, we describe the different areas where tendinopathy develops. Patients with tendinopathy can normally be seen within our dedicated Heel Pain Clinic, a one-stop service which enables you to have your assessment, all imaging, opinion and first treatment within a single, initial clinic visit.
Tendons and ligaments serve different functions. A tendon connects a muscle to a bone. When the muscle contracts, the tendon pulls on the bone and movement occurs at a joint. Ligaments are not dynamic, and act as check-reins to stop a joint moving too far in a particular direction.
Although tendons can be thought of as ropes, and are not as dynamic as the muscle, they do have a degree of elasticity. Wear and tear (tendinopathy) of the tendon results in thickening, splitting or even tearing of the tendon. When this occurs the whole unit of muscle and tendon loses elasticity and cannot function properly
Tendinopathy Symptoms
Patients may notice pain, swelling, weakness or poor balance. Sometimes neighbouring tendons, ligaments or joints become secondarily problematic.
Tendinopathy Causes
Achilles tendinopathy
Pain and discomfort arises just above the heel bone. This is where it has a poor blood supply. Thickening and tenderness of the tendon causes pain and stiffness and is often worse first thing in the morning.
Insertional tendinopathy
This condition occurs when the back of the heel bone, where the tendon inserts onto the bone, becomes painful and swollen. Normally care with shoes, insoles and some physiotherapy is sufficient to treat the problem, however surgery may be needed for the most severe cases of inflammation (bursitis).
Adult flat-foot – Tibialis Posterior tendinopathy
Not every ‘fallen arch’ or flat foot is due to a tendon problem. However, tendinopathy of the posterior tibial tendon is the most common cause. This tendon runs around the inner ankle bone and attaches to the navicular bone in the instep. It functions like braces to hold up the arch of the foot and if the tendon fails to work effectively, adult flat foot is likely to develop.
Peroneal Tendinopathy
This condition occurs when there is damage to the tendons which run around the outer ankle bone and turn upwards and outwards at the ankle. Pain, swelling and giving-way or ankle instability are the usual complaints from this type of tendon problem.
Diagnosis Tendinopathy
The diagnoses of tendinopathy should be suspected in anybody who complains of pain and swelling in the region of a specific tendon. The pain and swelling often comes on after unaccustomed activity. The pain typically occurs when weight-bearing and using the tendon, but some tendons can hurt even at rest.
The commonest tendons in the foot to be affected by tendinopathy are the Achilles tendon, the tibialis posterior and, less frequently, the peroneal tendons. Tendinopathy of all the other tendons is, in comparison, rare.
Treatment for Tendinopathy
The most important thing to do with tendinopathy is make the diagnosis, as each tendon has a particular way of behaving, i.e. each tendon has a natural history of progression and the treatment for Achilles tendinopathy is in general completely different to that of, say, tibialis posterior tendinopathy.
Whenever tendinopathy is diagnosed the options for a patient are to soldier on, modify footwear and activity, have physiotherapy, medication (rarely an injection), or surgery. In general, treatment in the early stages should be aimed at suppressing the symptoms and avoiding further damage to the tendon. Therefore, non-operative treatment is usually advised in the form of pain relief, splintage and physiotherapy.
Should symptoms deteriorate or fail to improve, surgery often has a lot to offer a patient, but the recovery period is extensive and there is no such thing as a quick fix for any of the tendinopathies. There are some tendinopathies that lend themselves to unconventional treatments such as shockwave therapy, and in the foot the only tendon for which this is appropriate is the Achilles.
