The foot consists of 26 bones including those of the toes. Many muscles, some originating in the lower leg and others within the foot itself, control this body part. Some muscles act as movers to help lift or point the toes for example, while others act as stabilizers to maintain the shape and mechanics of the foot while you stand, walk, run and jump. There are nearly 30 muscles that act on the foot in some way. Each of these muscles has a tendon at either end which connects it to the nearby bones. Tendonitis is a condition that affects the tendons or the musculotendinous junction of a muscle. Tendonitis in the foot can involve muscles contained within the foot as well as muscles that originate higher up in the leg but extend down to the foot. Examples of some tendons in the foot that may be affected by tendonitis include:

• Achilles tendon which connects the calf muscle to the heel bone
• Flexor hallucis longus tendon, which runs along the inside of the ankle and attaches to the big toe
• Flexor digitorum tendon, which runs along the inside of the ankle and attaches to the other toes
• Peroneal tendons, a set of three tendons that run along the outside of the ankle and attach at the shaft of the small toe and the bottom of the foot
• Posterior tibialis tendon, which attaches at the mid-foot and helps maintain the foot's arch
• Anterior tibialis tendon which runs down the front of the leg and attaches to the bones of the midfoot. This tendon pulls the foot toward the body and helps control its motion
• Extensor digitorum brevis: attaches to and extends the outer four toes
• Extensor hallucis brevis: attaches to and extends the big toe
• Flexor digitorum brevis: attaches to and flexes the lateral four toes.

As you know, there are more foot muscles than the ones listed above. Technically any tendon can experience tendonitis though some are less likely to do so than others due to location and mechanism of action. Tendons are a type of fibrous connective tissue that connects muscles to bones. They have unique properties and serve important functions including:

• Tendons help to move our bones and amplify the effect of muscle contractions
• They also play an important role in attenuating and absorbing shock that is transmitted from bone into muscle
• Tendons are strong but they are not designed to stretch or deform easily
• They can become weaker or stronger/stiffer in response to a training stimulus
• Training can make a tendon more prone to or more resilient against, injury.

Tendonitis is often caused by repetitive stress which exceeds the tolerance of the tendon. Causes and contributing factors include ramping up the volume of a new activity too quickly, muscle strength or length impairments, movement pattern inefficiencies and biomechanical errors in the foot, ankle or leg. Signs and symptoms suggestive of foot tendonitis include:

• Pain over the involved tendon when the muscle is contracted (this may be experienced when walking, navigating uneven terrain, running, etc.)
• Pain over the involved tendon when the muscle/tendon is stretched
• Swelling or inflammation over the injured tendon
• Stiffness when moving the foot or ankle near the involved tendon
• A feeling of weakness in the when contracting the involved muscle

The suffix “itis” implies that the foot tendon is inflamed and this may be the case in an acute case of tendonitis. Cases of persisting or chronic tendonitis, however, typically involve minimal to no inflammation at all. Instead, symptoms are caused by degeneration in the fibers of the tendon. This is why it is often more appropriate to use the term tendinopathy which means “disease or disorder of the tendon,” when talking about chronic tendonitis. This also explains why people battling persistent tendonitis find little or only brief relief from using ice and rest. An inflamed tendon can benefit from rest and ice but a tendon that has experienced degeneration actually benefits from careful loading, which improves the strength and stiffness of the tendon.

If you decide to work with a physical therapist to help correct your foot tendonitis, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized foot physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your foot PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY FOR FOOT TENDONITIS

Due to the nature and causes of foot tendonitis, you may find yourself stuck in a cycle of symptom resolution and recurrence. Since full rest may benefit an inflamed and acute case of tendonitis but weaken a tendon that has begun to degenerate, many find their symptoms return and possibly worsen when trying to resume full activity again after taking a break.

When you come to Evolve Physical Therapy, my team of physical therapists and I will apply the latest evidence on tendon management to help improve the strength and stiffness of the tendon while addressing other contributing factors like muscle weakness, nonoptimal movement patterns, lack of flexibility and training errors. Manual therapy techniques to promote tendon fiber alignment, address scar tissue, mobilize edema and reduce pain are implemented early in your care. We then use a carefully prescribed graded loading program to build resilience in the tendon and promote healing of the tissues, therefore increasing its ability to withstand the forces placed on it while you run, jump, cut and climb. Rehabilitating an irritated or injured tendon can be unique so having the guidance of a skilled PT is always a good idea.

Tendonitis of the foot can undoubtedly be a pain but physical therapy can help you find a lasting solution. Stop the cycle of rest and repeat and call Evolve Physical Therapy today. Our team of physical therapists is ready to help you heal that tendon and get back to the activities you love.