Tendonitis

Description

Tendonitis is an inflammation of a tendon caused by an injury. It is most often an overuse injury. Often people begin a new activity or exercise that causes the tendon to become irritated. Tendon problems are most common in the 40-60 year old age range. Tendons are not as elastic and forgiving as they might be in younger people. Occasionally, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.

Muscles end as tendons, and it is the tendons that allow muscles to attach to the bones or joints of the body. You can easily see tendons on the back of the hand, or top of the foot, by moving a finger or toe. The tendon moves back and forth as you move the finger or toe. Most of the tendons in the feet, especially those on the top, are very close to the skin and are not well protected. Thus, they can easily be injured.

Injuries that frequently cause tendonitis include:

  1. Twisting injuries of the foot and ankle.
  2. Dropping an object on the foot (it does not have to be a heavy object; all it has to do is hit the tendon directly).
  3. Tight shoes.
  4. Tying shoelaces too tightly.
  5. High heel shoes (especially if you are not used to wearing them).
  6. Overdoing any weight-bearing activity, such as running too far.

If there is a cut or break in the skin associated with a tendon injury, see a doctor immediately.Tendons have few blood vessels, and an open wound down to the tendon can cause a severe infection. Tendons usually have an area of poor blood supply that leads to tissue damage and poor healing response. This area of a tendon that is prone to injury is called a “watershed zone,” an area when the blood supply to the tendon is weakest. In these watershed zones, the body has a hard time delivering oxygen and nutrients necessary for tendon healing.


Treatment

The Main tendon problems that affect your foot and leg are:

  1. Achilles tendonitis causes pain and swelling in the back of the heel. Understanding this common problem can help with treatment and help to avoid serious complications such as Achilles tendon rupture.
  2. Posterior Tibial Tendonitis: Occurring near Achilles tendonitis, posterior tibial tendonitis is less common, but should be considered in people with symptoms on the inner side of the ankle. Left untreated, posterior tibial tendonitis can result in a flat foot.
  3. Patellar (Kneecap) Tendonitis, or inflammation of the patellar tendon, is a condition often called Jumper’s Knee. Treatment of patellar tendonitis usually consists of rest and anti-inflammatory medication.

Self Treatment should begin immediately after the injury, with a careful examination of the foot.

  1. Make sure that the tendon is not torn through and through. If it is severed, you must see a doctor immediately so that the tendon can be repaired. Severe injuries can sever a tendon, without a skin laceration being present. Testing involves moving the toes and foot to see if the tendon moves. If the tendon does not appear to move, it may be severed (comparing the injured tendon and its movement to the same tendon on the un-injured foot may help).
  2. If there is extreme swelling and pain (out of proportion to the amount of trauma received), you may have sustained a vascular injury. A doctor must see this type of injury immediately. If you are not sure, see a doctor.
  3. If you have multiple injured areas see a doctor immediately, in order to prevent excessive swelling and pain.
  4. The sooner you begin to treat your injury by following “R.I.C.E.”, the better you will feel:a. Rest is very important. Take off your shoe, get off your feet, and relax.

    b. Ice should be applied as soon as possible. Never apply ice directly on the injured area, as the cold may make the pain worse. Ice should be applied close to the injured site, between the heart and the injury, so that as the blood flows under the ice, it will be cooled. This cool blood flowing into the injured area will help to reduce the swelling and pain. Apply the ice, wrapped in a cloth or over an elastic bandage, to the foot for 30 minutes, every 2 hours, for the first 3 days after an injury. Do not apply ice on the toes. If the ice is uncomfortable, or causes increased pain, do not continue to use it, and see a doctor immediately. If you have poor circulation do not use ice, as this may cause a serious problem.

    c. Compression is used to limit swelling, and to give support to the injured area. Compression should be applied to the entire foot, starting first at the toes and working back to the ankle. If it is applied just to the injured area, increased swelling will occur in front and behind the wrapping. Compression should be applied with a 3-inch elastic bandage, beginning around all the toes, and then going around the foot and ankle. Compression reduces motion in the injured area and foot, and this decreases the pain, and allows for quicker healing. The bandage should not be so tight that it causes increased pain or throbbing in the toes or foot. It should be comfortable! Do not remove the elastic bandage for the first 12 hours, unless it becomes to tight, or the pain increases, or the toes become pale, blue, or cool. If any of these things happen, immediately remove all bandages, and leave them off for several hours. The normal color and temperature of the toes should return immediately. If not, see a doctor immediately! Continue until the swelling and pain subsides; it could take from several days to several weeks.

    d. Elevation of the leg will aid in reducing swelling and pain. Blood rushes to an injured area to bring increased blood cells that aid in healing. Gravity will also force blood to the injured area. Too many cells and too much fluid will apply pressure to the injured nerves and tissues, and cause increased pain and delayed healing. Keep your foot elevated so that it is at least parallel to the ground, or higher if it is comfortable. Do this for at least 48 hours, or until the throbbing subsides, when you lower the leg.

    5. Healing will occur more quickly if there is no pressure on the injured tendon, and if the foot is at least partially immobilized. Our Injury Shoe is designed to keep all pressure off of the toes and foot, and allows you to walk without bending the foot. This will partially immobilize the injured tendon, allowing it to heal more quickly. This shoe will decrease healing time and pain. In 30 years of private practice, I have found that this shoe will reduce healing time by half, and allow you to be more comfortable while healing is occurring. We will ship this shoe to you by Priority Mail at no additional charge.

    6. Do the above for at least 3 days. If there is no improvement, or if the symptoms become worse, see a foot and ankle specialist immediately. If you see gradual improvement, it is suggested that you continue the above course of treatment until the pain and swelling are gone. It can take inflamed tendons 2 to 4 weeks to heal, so be patient!