Tendon Pathology and Injury

May 11, 2021

Whenever you need to stand up, sit down, run, jump, play, or do literally anything that involves locomotion, the many tendons of your feet and ankles have important roles to play.

Tendons are the key tissues that connect muscles to bones, and thus translate the flexing and lengthening of individual muscle pairs into precise, controlled motion of feet, limbs, and joints. You have a ton of them in your body—around 4,000!—and as you can imagine, you want them to be as strong and healthy as possible so you can get where you need to go!

Unfortunately, a lot of things can go wrong with foot and ankle tendons, including overstretching, degeneration of the fibers, and even traumatic ruptures. When that happens, it’s important to get a comprehensive evaluation, diagnosis, and personalized treatment options from experts like the team at Lakes Foot & Ankle Associates. Otherwise, you run the risk of doing even greater and more lasting damage to your tendons.

Foot and Ankle Tendons: A Lot More Than Just the Achilles

The Achilles tendons, also known as the heel cords, are often the first ones that come to mind when you think of tendons and tendon injuries. That’s not surprising—they’re the biggest, thickest, and most frequently injured.

But they’re also part of a “family” of tendons that all work in cooperation to manipulate the ankle, and any one of which could be injured or damaged. In general, we can categorize these tendons into four “quadrant” groups:

  • Posterior (back side) is home to the Achilles tendon, which connects the largest calf muscle to the heel bone.
  • Medial (inside) is home to the posterior tibial tendon, which connects a calf muscle to the bones of the inner foot, and the two long flexor tendons, which run from the leg muscles to the toes.
  • Anterior (front) is home to the tibialis anterior tendon, which lies on the inner front of the ankle and aids in flexing the foot upward, and the two long extensor tendons, which connect to the toes and work opposite the long flexor tendons.
  • Lateral (outside) is home to the two peroneal tendons, which lie behind the outer ankle bone.

Depending on which tendons are injured, and how severely, different symptoms can result—everything from mild swelling and tenderness in a particular spot, to difficulty moving your foot in a specific direction, or even collapsed arches.

Achilles Tendinitis, Injury after exercising and running. Need to see doctor for treatment 

Types of Foot and Ankle Tendon Injuries

While “tendinitis” is the most familiar term when referring to tendon injuries (especially when the Achilles is involved), it does not properly describe all forms of tendon pain.

Sources of tendon pain can be divided into three main categories: tendinitis, tendinosis, and tendon tears/ruptures. Each has its own unique defining factors that guide us toward the best forms of treatment.


Tendinitis refers to the inflammation of a tendon. (Anything you see with the suffix “-itis” refers to inflammation in some way.)

In most cases, the tendon has become irritated by an acute injury that has overstretched or overworked the tissue, causing it to grow inflamed and painful. A common real-world example is overdoing it during a weekend pick-up basketball game, especially if you stormed the court and didn’t take time to warm up beforehand.

The inflammation of tendinitis can occur within the body of a tendon or its sheath (a layer of membrane around the tendon). It can also occur where the tendon connects or “inserts” into a bone. 

Common symptoms may include:

  • Pain both during and after exercise
  • Reduced range of motion in the affected joint
  • Swelling, redness, or even heat


Tendinosis refers to the degeneration and deterioration of a tendon over time, often the result of long-term overuse. Inflammation is not typically associated with this condition. Instead, the tendon tends to thicken and become pained.

Achilles tendinosis is something you might expect to develop if you have been following improper sports protocols (e.g. not warming up, using the wrong footwear, employing the wrong techniques, not taking enough rest days) over a long period of time. It might also be more likely to occur if you have an abnormality in foot structure that places steady, excess pressure on the tendon.

Tendon Tears and Ruptures

While tendinitis and tendinosis might include tiny “microtears” in a tendon, a defined “tear” in the body of a tendon is much more pronounced.

Tears tend to be longitudinal, along the length of a tendon. When the foot and ankle are concerned, tears are more likely to happen in the peroneal tendons or the posterior tibial tendon. However, any tendon can develop a tear.

A rupture is a complete tear of the tendon, and is associated with severe pain and sudden loss of mobility and strength in the affected area. Just as with tears, any tendon around the ankle can develop a rupture. The Achilles tendon is the most frequent tendon to be ruptured, though.

Treatment Options for Tendon Problems

Getting a proper diagnosis for any source of pain is the first step toward finding the most effective treatment.

If you experience sudden foot or ankle pain during activity, or have had persistent pain for more than a couple days without improvement, your wisest move is to stop doing whatever might be causing the pain and contact us about it as soon as possible. Attempting home treatment, especially if you don’t know exactly what you’re dealing with, may end up doing more harm than good.

Methods of treating tendon problems can vary depending on type and severity. For example:

  • Minor cases of tendinitis or tendinosis may only require a period of rest, icing, and specific stretches and exercises to rehabilitate the tendon and connected structures.
  • More severe cases in particular might benefit from our Multiwave Locked System (MLS) laser therapy, which is especially effective for reducing pain and inflammation from tendinitis. (Laser therapy also helps accelerate the natural healing process, so it can be helpful as part of a comprehensive treatment plan for almost any kind of tendon injury at any stage of severity.)
  • Many tendon problems may be aggravated by improper foot structure or mechanics. A proper set of orthotics can not only reduce pressure on the tendon, but “re-set” your foot mechanics to reduce the risk of future injury. We offer advanced 3D-printed orthotics which are lighter, more comfortable, more precise, and far more effective than conventional orthotics.
  • For many ruptures and many longitudinal tears, surgery to repair the tendon may be necessary, or potentially recommended over the non-surgical approach of long-term immobilization. If it is, we will be sure to discuss the full procedure and any other potential options with you to ensure you make a decision with full confidence. 

If you need help for any kind of painful foot or ankle issue, do not wait any longer than you need to. Call our Commerce Township office at (248) 360-3888 or fill out our online contact form to request an appointment.


It's Time To Leave Foot & Ankle Pain Behind!

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9640 Commerce Rd Suite 102 Commerce Township, MI 48382


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