What is the difference between Tendonitis and Tendinosis?

Have you ever felt that nagging pain in your ankle or foot and wondered what on earth is going on? You’re definitely not alone! Many of our patients come to us saying things like “My Achilles tendon is killing me” or “I think I have tendonitis.” Here’s the thing that might surprise you though:  it might not actually be tendonitis at all! 

These two conditions masquerade as each other, but they’re actually quite different. Understanding the difference between these two properly means you’ll get the right help and feel better faster. 

What Are Tendons?

Think of tendons as your body’s super-strong cables that connect your muscles to your bones. These amazing structures are what let you point your toes, push off when you walk, or dance. In your feet and ankles, you’ve got some real importance like your Achilles tendon (the thick one at the back of your ankle) and several others that work together like a well-oiled machine.

These tendons are made mostly of something called collagen, which you can think of as nature’s rope fibres all bundled together. When everything’s working perfectly, these “ropes” are incredibly strong and can handle tremendous pressure. But just like any rope, they can get frayed, overstretched, or worn out over time.

Some parts of your tendons get lots of blood flowing through them , while other spots don’t get as much love from your circulation system. This uneven blood supply is actually pretty important because it affects how well and how quickly these areas can heal when something goes wrong.

Understanding Tendonitis

Tendonitis is your body’s inflammatory response to tendon injury or irritation. This condition typically develops when something sudden happens to stress your tendon beyond its normal capacity. Common triggers include suddenly increasing your activity level, starting a new sport, or experiencing direct trauma to the area.

When tendonitis occurs, your body activates its natural healing response. Blood flow increases to the affected area, bringing healing cells and nutrients. This process causes the characteristic signs you’ll notice like  swelling, warmth, and tenderness around the tendon.

The key feature of tendonitis is its sudden onset. You can usually pinpoint when the pain started, often within days or weeks of the triggering event. The affected area will typically appear swollen, feel warm to the touch, and cause significant discomfort when you try to use it. The encouraging news is that tendonitis generally responds well to appropriate care, including rest and anti-inflammatory treatments.

Understanding Tendinosis

Tendinosis presents a completely different picture from tendonitis. While tendonitis involves acute inflammation, tendinosis is characterised by chronic degenerative changes within the tendon structure. This condition develops gradually over time, often without the obvious inflammatory signs we see with tendonitis.

The underlying problem in tendinosis involves the breakdown and disorganisation of the tendon’s collagen fibres. Instead of sudden damage, this represents accumulated wear and tear that occurs when repetitive stress exceeds the tendon’s ability to repair itself effectively.

This condition typically develops in people who perform repetitive activities over extended periods. Long-distance runners, workers who perform repetitive motions, or athletes who train intensively may gradually develop tendinosis. The tendon attempts to heal itself continuously, but the repair process becomes inefficient over time.

One of the most challenging aspects of tendinosis is its gradual onset. Many people find it difficult to remember exactly when their symptoms began. The pain often develops so slowly that it becomes noticeable only when it starts interfering with daily activities or exercise.

Spotting the Differences 

These two conditions are alike from a distance but are quite different up close. With tendonitis, the pain shows up suddenly, usually after you can pinpoint exactly what triggered it. The pain tends to follow rules, it hurts more when you use it and feels better when you rest. 

Tendinosis, on the other hand, can be a little harder to figure out. You might have no idea when this started, but your ankle could be hurting me for months. This pain doesn’t always make sense and sometimes it feels better after you start moving around, but then gets worse if you keep going. Rest might also not help much, which can be quite frustrating because that’s usually the go-to solution for pain.

When you look at the affected area, tendonitis can be spotted through obvious swelling, redness, and heat. Tendinosis is more subtle where an area feels a bit thick or different, but it’s not always easily identifiable. 

Treatment & Solutions

This is where knowing the difference between tendonitis and tendinosis becomes absolutely crucial. 

For tendonitis , the approach is pretty straightforward. Since it’s all about inflammation, the aim is to calm things down. Rest, ice and anti-inflammatory medications can all actively help recovery. Sometimes a doctor might suggest a steroid injection if things are really heated up. 

However, tendinosis isn’t about inflammation, so anti-inflammatory treatments wouldn’t always be helpful. Instead, we need to help your tendon rebuild and reorganise those messy fibres we talked about.

For tendinosis, we often use something called eccentric exercises, which is really just a specific way of strengthening that helps remodel the tendon tissue. Think of it as helping your tendon learn how to organise its fibres properly again. Controlled, progressive exercise is often way more helpful than complete rest. It sounds a little counterintuitive, using a painful tendon to help it heal, but the key is doing it in just the right way with proper guidance.

We also have tools now to see exactly what’s happening inside your tendon. Ultrasounds can show us the difference between inflamed tissue and degenerative changes in real-time. 

Get Help Today

Both of these conditions are totally treatable, but the sooner you get the right help, the faster your recovery will be. If you have sudden, severe pain, don’t try to live with it for weeks. And if you have that nagging, persistent pain, you shouldn’t learn to live with that either.

The key to being pain-free is finding a doctor who understands the difference and can guide you toward the right treatment. If you’re tired of guessing what’s causing your foot or ankle pain, our friendly team at London Foot and Ankle Centre specialises in getting to the bottom of tendon troubles and creating treatment plans that actually work for your specific situation.

We use the latest diagnostic tools and treatment approaches to help you feel better faster. Don’t keep yourself in pain, get in touch and let’s get you back to full health.