Take Steps to Address Your Foot and Ankle Pain

Have pain in your foot or ankle when you’re walking or running? Rest and it goes away? Notice your foot changing shape or losing your arches? One of the most common causes for this type of pain is tendonitis.

Tendons are strong, cord-like structures that anchor the muscles in your leg, foot and ankle to the bone, explains Dr. Jim Lachman, an orthopedic surgeon at St. Luke’s University Health Network. Tendonitis is inflammation of these tendons.

Dr. Lachman says foot and ankle tendonitis has a number of causes:

• Overuse. This is the most common cause. It occurs when you have an increase in activity and the tendon becomes inflamed or can even tear slightly.
• Trauma. An injury also can cause tendonitis in your foot or ankle.
• Medical conditions. Some diseases such as rheumatoid arthritis and gout can cause inflammation of the joints that can lead to tendonitis.
• Foot structure. Some people have problems such as high arches or flat feet that can put extra stress on their tendons. The tendonitis itself also may be the cause of these deformities.

“We tend to see it more in middle-aged women, but tendonitis can be seen in anyone and at any age,” Dr. Lachman says.

The most common symptoms of tendonitis are pain and discomfort with activity. Typically, the pain subsides when you rest but it can return even then, Dr. Lachman says.  More severe tendonitis that has been present for years can lead to foot deformities including flat feet.

Conservative Treatments First

Conservative treatments include: 

• Non-steroidal anti-inflammatory drugs such as ibuprofen, although Dr. Lachman says, they may not be that helpful for tendonitis.
• Bracing and orthotics can be helpful for many types of tendonitis. Sometimes a cast or walking boot is necessary if symptoms warrant.
• Activity modification or avoiding activities that irritate or cause the discomfort.

It can take weeks to months for your tendonitis to heal, Dr. Lachman says.

If these treatments don’t provide relief, surgery is an option. Surgery is usually done when the tendon is torn or damaged and the pain just doesn’t get better with prolonged rest, Dr. Lachman  says. If your tendonitis is caused by an injury, it may be best to have surgery sooner rather than later, he says. Also, if your tendinitis has been present for a long time, you may have developed bone spurs in the tendon, in which case surgery may be necessary, he adds.

Surgery for tendonitis is typically a same-day procedure done as an outpatient, Dr. Lachman says.  During surgery, the tendon can be reconstructed or repaired depending on the severity of the damage. If you don’t have enough healthy tendon, you may need a tendon graft from another part of your body or a tissue bank, Dr. Lachman says. Surgery also may be needed to remove the bone spurs.

“The surgery itself takes about an hour,” Dr. Lachman says, “and the recovery is pretty structured.”

After surgery, you need to immobilize your foot with a splint or cast to give your tendons time to heal. After a while, you can switch to a walking boot, Dr. Lachman says. It will take up to 12 weeks for your tendon to heal but usually takes longer before returning to daily activities without discomfort. Physical and occupational therapy can help you regain movement and reduce stiffness.