There are a number of different types of tendon problems which can occur. Tendons and ligaments serve different functions. A tendon connects a muscle to a bone. When the muscle contracts, the tendon pulls on the bone and movement occurs at a joint. Ligaments are not dynamic, and act as check-reins to stop a joint moving too far in a particular direction. Although tendons can be thought of as ropes, and are not as dynamic as the muscle, they do have a degree of elasticity. Wear and tear (tendinopathy) of the tendon results in thickening, splitting or even tearing of the tendon. When this occurs the whole unit of muscle and tendon loses elasticity and cannot function properly.
Symptoms
Patients may notice pain, swelling, weakness or poor balance. Sometimes neighbouring tendons, ligaments or joints become secondarily problematic. Types of tendon problems.
Achilles tendinopathy
Pain and discomfort arises just above the heel bone. This is where it has a poor blood supply. Thickening and tenderness of the tendon causes pain and stiffness and is often worse first thing in the morning.
Insertional tendinopathy
This condition occurs when the back of the heel bone, where the tendon inserts onto the bone, becomes painful and swollen. Normally care with shoes, insoles and some physiotherapy is sufficient to treat the problem, however surgery may be needed for the most severe cases of inflammation (bursitis).
Adult flat-foot – Tibialis Posterior tendinopathy
Not every ‘fallen arch’ or flat foot is due to a tendon problem. However, tendinopathy of the posterior tibial tendon is the most common cause. This tendon runs around the inner ankle bone and attaches to the navicular bone in the instep. It functions like braces to hold up the arch of the foot and if the tendon fails to work effectively, adult flat foot is likely to develop.
Peroneal Tendinopathy
This condition occurs when there is damage to the tendons which run around the outer ankle bone and turn upwards and outwards at the ankle. Pain, swelling and giving-way or ankle instability are the usual complaints from this type of tendon problem.
Tendonitis
There are two areas of the Achilles prone to this problem: in the middle of the tendon (mid-substance Achilles tendonitis) and at its insertion into the heel bone (insertional Achilles tendonitis).
Symptoms
Insertional tendonitis is seen in runners, but also in individuals with a certain shape of heel bone. It presents with pain right at the back of the heel. In both forms of tendonitis the pain is often worst first thing in the morning and after periods of rest, so-called “start up” pain. Once the individual has “warmed up” the symptoms often improve but shoes can be very bothersome where the shoe rubs on the sore area.
Causes
Mid-substance tendonitis presents as a painful swelling of the tendon and is often seen in long-distance runners. However, it can follow un-accustomed activity or after a minor injury and rarely in the elderly after taking certain antibiotics (Fluoroquinolones).
Diagnosis
Diagnosis of tendonitis is based on the symptoms you are having and a physical examination. If the tendonitis has caused the greasy liquid that protects the tendon to become dry, this can be heard through a stethoscope because of the friction inside the affected area. Any calcium deposits in the tendon or the surrounding sheath can sometimes be seen on an x-ray.
Treatment
In many people, the condition will improve with time (12–18 months), anti-inflammatory medication, activity and footwear modification but the mainstay of treatment is physiotherapy. Steroid injections should be avoided as they are associated with an unacceptable rupture rate. There has recently been a lot of interest in experimental techniques such as blood injections and dry needling but results have been disappointing.
