About Tendinitis

Definition

Tendinitis (also known as tendonitis) is an inflammation of a tendon (a band of fibrous tissue connecting muscle to bone) that causes pain, tenderness and occasionally, restricted movement of the muscle attached to the affected tendon.

Description

Sometimes the discomfort of tendinitis disappears within a matter of weeks, especially if you rest the affected area. In elderly people and those who continue to use the affected area, tendinitis often heals more slowly and can sometimes progress to a chronic condition involving permanent damage to the tendons and loss of flexibility due to scarring of the tissues.

Types of Tendinitis

Almost any tendon in the body can be affected, however, those located around the knee, foot, elbow and shoulder are most frequently affected.

Foot Tendinitis

Tendinitis can affect four different tendons of the foot - the achilles tendon, the posterior tibial tendon, the anterior tibial tendon and the peroneal tendon.

1. The most common foot tendinitis occurs in the achilles tendon. The achilles is the large tendon connecting the two major calf muscles to the back of the heel bone.

Symptoms of achilles tendinitis are pain and tenderness anywhere along the back of the tendon, limited ankle flexibility, redness or heat over the painful area, a nodule growth forming on the tendon and a cracking sound that can be heard when the ankle moves. This condition is caused by tight or fatigued calf muscles, inadequate warm-up of muscles, overtraining, excessive hill running, speedwork and inflexible running shoes.

The treatment for achilles tendinitis is to stop running, take aspirin or ibuprofen and ice the area for 15 to 20 minutes several times a day until the inflammation subsides. Self-massage with heating cream or oil may also help. Physical therapists suggest rubbing the ointment in semicircles in all directions away from the knotted tissue three times a day until healed. Once the nodule is gone, stretch the calf muscles. Don't start running again until you can do toe raises again without pain. Next, move on to skipping rope, then jumping jacks and gradually begin running again.

Achilles tendinitis should take about six to eight weeks to heal. If injury doesn't respond to self-treatment in two weeks, see a physical therapist or orthopedic surgeon. Surgery to scrape scar tissue off the tendon is a last resort. Be aware - the surgery is not very effective and it usually just stimulates more scar tissue.

2. The posterior tibial tendon runs along the inside of the ankle and foot. If this tendon is strained, the foot may hurt when it moves forward to push off the ground or when the heel shifts from side to side. The anterior tibial tendon helps control the front of the foot when it meets the ground. If the tendon is strained, you may feel pain when you go downstairs or when you walk or run on hills. The peroneal tendon wraps across the bottom of the foot, from the outside to the inside. If the tendon is strained, you may feel pain when you stand or push off the ground.

Symptoms of posterior tibial tendinitis, anterior tibial tendinitis and peroneal tendinitis are pain and tenderness anywhere along the tendon, limited flexibility, redness or heat over the painful area. Reducing the symptoms is the first step in alleviating the tendinitis. The doctor may tell you to use ice or heat, take certain medications, limit your activity to help control the pain and swelling, and self-massaging of the area. Ice helps prevent swelling and reduces pain. Place ice on the painful area for 10 minutes at a time, several times a day. If you already have swelling, heat may help. Apply a heating pad or hot towels to the tendon for 30 minutes at a time, two or three times a day.

Pain relievers and anti-inflammatory drugs are used to ease immediate symptoms, but alone, they cannot cure the condition or keep it from recurring. Injecting cortisone and a local anesthetic into the area surrounding the tendon usually provides substantial relief within 24 to 72 hours. Rest allows the tissues to heal. Returning to activity too soon may cause the symptoms to reoccur. Self-massage with heat inducing cream or oil may also help. Physical therapists suggest rubbing the ointment in semicircles in all directions away from the knotted tissue three times a day until healed.

Preventive measures for all types of foot tendinitis include proper warm up and stretching exercises, wearing the right shoe for the activity, choosing shoes with good arch and heel support and varying your exercise route and routine. (This will help keep one set of muscles from being overstressed).

For all cases of tendonitis, if the area around the affected tendon appears red or inflamed (swollen or warm), and the person has a fever, this may mean a superimposed infection and a doctor should be consulted right away.

Causes

The most common causes of tendinitis are injury, overuse, infection of the tendon sheath or disease (tendinitis is evident in rheumatoid arthritis, gout, and psoriatic arthritis). There is a greater risk of developing tendinitis when a person performs excessive, repetitive motions of the arms or legs. More often than not, the cause of tendinitis is unknown.

Diagnosis

The diagnosis of tendinitis requires a careful medical history and physical examination. To eliminate other possible reasons for the inflammation, additional tests are sometimes ordered. X-rays are usually taken to rule out abnormalities of the bones and arthritis, blood tests are used to rule out rheumatoid arthritis or diabetes, and aspiration (removal of fluid) of a swollen tendon is used to diagnose an infection or gout.

Prevention

* Proper conditioning

* Gradual introduction of activity

* Warm-up and stretching prior to exercise

* Wearing appropriate shoes for the activity

Questions to Ask Your Doctor

Did the tendinitis result from any other disease or disorder other than trauma?

How long should ice be kept on the affected area?

Are there any medications that you will prescribe to help relieve the tendinitis?

What are the side effects?

What over-the-counter medications work best for this condition?

Approximately how long does the affected tendon need to rest?

When are cortisone injections used? What are the side effects or risks?

If surgery is necessary, how is the procedure performed?

How successful is the surgery for repairing damaged tendons?

Will the affected tendon return to normal use?

PLEASE NOTE:
The information contained in this article is not intended to provide advice for individual problems, nor to substitute for professional advice or care from a physician. For answers to specific questions concerning your personal circumstances, you should consult your physician directly.

SOURCES:
Sources used for updating the GEX ™ Health Library articles include a combination of peer-reviewed journals in medicine, public health, pharmacology, environmental health, nursing and other disciplines,along with reports from federal health agencies (CDC,NIH,AHRQ,etc.), foundations, and well-respected voluntary non-profit health organizations.

All articles are reviewed for accuracy by consulting M.D.s or appropriate content area experts. Prior to final publication, our Chief Medical Officer reviews, edits and approves each article. All articles are reviewed and updated no less than once in a twelve month period or more frequently where new information or research becomes available.