Tendons are the link between the muscles and the bones. They transmit the force created by the muscle and guarantee full function of the joints. Tendons are more often affected by overuse and micro-injuries but other tendons also can rupture due to an injury.
On the outside of the ankle joint are the two peroneal tendons that help to stabilise the ankle joint. Those tendons may show some wear and tear but often do not cause a lot of pain. When the tendons split, dislocate or develop a lot of inflammation in the surrounding tissue pain becomes more intense and patients need further treatment.
On the inside of the ankle joint, the tibialis posterior tendon is the most commonly affected tendon that can result in pain, weakness and eventually may lead to a flat foot deformity.
Tendon problems may cause pain when starting to be active or after finishing activities and the intensity of pain may vary on a daily basis.
It is important to detect tendon problems early enough to prevent further deterioration which may then need surgical intervention.
Identifying the underlying problem can at times be difficult and thorough clinical examination plus scanning of the relevant part of the ankle/foot will provide the information needed. Thereafter it is crucial to start conservative treatment including physiotherapy and avoiding excessive stress to the tendon. At times stretching and strengthening exercises will give good relief but relative rest and footwear adjustments/insoles will further help. Depending which tendon is affected conservative treatment will most of the times be sufficient (eg tibialis anterior tendon). Peroneal tendons might present at a later stage and therefore often only get better when the tendons are “cleaned up” and brought into shape again. Problems of the tibialis posterior tendon are often associated with a flat foot deformity and taking care of the tendon only will not be sufficient. One has to address the underlying malalignment and support the injured tendon with another tendon to regain full function of the foot.