Tendinopathy Is Caused By Overuse Of The Tendons In The Foot And Ankle

It is an overload or repetitive strain injury in athletes, generating a lot of pain, inflammation, and bone deformities in chronic cases.

Tendinopathy is an overload or repetitive strain injury that affects one or more tendons, causing pain, inflammation, and even bone deformities when chronic. Tendons are anatomical structures that join muscles to bones, giving them movement. Therefore, in everybody, where there is a tendon, there may be tendonitis. Foot and ankle are no different.

This is a common problem among people who train hard, are overloaded with effort, or are athletes who increase intensity or have changed training. Symptoms include pain when mobilizing the foot and ankle, particularly along the course of the tendon. There may be tingling, stinging, or pinching due to inflammation of the surrounding nerve.

Tendinopathy can be described as a spectrum of diagnoses involving lesions in these anatomical structures, such as tendinitis, peritendinitis, and tendinosis. The term tendinitis, for example, is used for acute inflammatory processes involving the tendon sheath (the membrane that surrounds the tendon) and can cause knee pain from running (วิ่ง แล้ว ปวด เข่า which is the term in Thai). At the same time, tendinopathy is the most appropriate term to describe chronic pain in the tendons, accompanied by the signs and symptoms already described above.

Causes

Tendinopathy is caused by ” overuse ” and is more likely to occur when the mode, intensity, or duration of physical activity changes or intensifies in some way other than usual.

Initially, there is irritation of the outer lining of the tendon. This is called peri or paratendinitis. It can then degenerate, making it thicker. The tendon becomes weaker and loses its strength (tendinosis), leading to a complete or partial tear.

It is essential to consider and treat the extrinsic and intrinsic causes of tendon injury. Extrinsic factors include tendon overuse, frequent training errors, smoking, medication abuse, and wearing shoes or other equipment not suitable for the specific activity. Intrinsic factors are tendon flexibility and strength, patient age, anatomical changes, and vascular supply.

How To Avoid

Abnormal foot types (such as flat and cavus feet) and changes in the gait cycle increase the risk of developing tendinopathy. Just a wrong step, shortening and other minor changes that already unbalance the musculature can generate the degenerative process, so, to avoid the injury, it is necessary to acquire a suitable shoe, not to overdo the training, carry out an orthopedic evaluation to see the step and analyze if there is any irregularity in the mechanics.

It is also essential to have a recovery period to meet the increasing demands on tissues; when rest is inadequate, cellular non-recovery occurs and, consequently, inflammation. Therefore, tendon inflammation is a secondary reaction.

Treatment

Treatment should always start with conservative measures, including protection, relative rest, ice, compression, elevation, non-steroidal anti-inflammatory drugs (NSAIDs), and analgesics indicated in the acute phase and rehabilitation exercise modalities (PRICEMM).

The patient should be encouraged to reduce their level of physical activity to decrease repetitive strain on the tendon. Rehabilitation exercises involve a stretching and strengthening program and should be started early. There is a period of immobilization in severe cases to alleviate the pain and inflammation caused by the injury before starting therapy.

Other physical therapy modalities include ultrasound, iontophoresis (electrical charge to direct medication into tissues), and phonophoresis (ultrasound to improve the delivery of topically applied drugs). Still, there is little evidence of its effectiveness in treatment.