Tendonitis, or inflammation of a tendon, can affect the tendons at the front of the foot, but also particularly the Achilles tendon (Achilles tendinitis), the peroneus longus, and the toe flexor tendons at the calcaneus. This is known as foot tendonitis. It is important to distinguish it from aponeurotic conditions affecting the sole of the foot, such as plantar aponeurosis disorders. Insertional enthesopathies affecting the calcaneus should also be considered.
Symptoms of foot tendonitis
The symptoms are similar to those of common tendon disorders: local pain triggered by movement and often increased at the end of exercise. Calcaneal tendonitis can cause significant pain in the morning, when the patient gets out of bed and places their foot on the ground. Achilles tendonitis may also be accompanied by local inflammatory signs, such as palpable nodules, as well as signs of tendon injury that may feel like an “axe blow.”
How is tendonitis diagnosed?
The diagnosis is essentially based on a clinical triad:
- Pain caused by passive stretching of the tendon.
- Pain caused remotely by voluntary contraction of the tendon against resistance.
- Pain caused by palpation of the tendon.
The diagnosis can now be confirmed by ultrasound, which is the examination of choice for this type of pathology, although it is not always necessary. Rare forms of calcific tendinitis can be clearly demonstrated using a simple X-ray. Depending on the case, the doctor may also request blood tests, such as rheumatoid factor, uric acid, or serum calcium levels.
The different treatments
Treatment primarily involves resting the affected tendon. In highly inflammatory forms, applying cold may also be recommended. Oral analgesics may be combined with anti-inflammatory medication when appropriate. Treatment can also include topical products containing capsaicin, which has analgesic properties, or certain anti-inflammatory substances such as ketoprofen.
Physiotherapy may subsequently be used, including ultrasound therapy or, in some cases, shock waves. Due to the intensity of the pain, some forms may be treated directly with corticosteroid infiltration. However, this remains a second-line treatment and should be considered according to the clinical situation, particularly when previous treatments have failed or provided insufficient relief.
A mechanical assessment should also be carried out to identify factors that may contribute to tendonitis, such as unsuitable footwear or sports equipment. A nutritional assessment may also be considered, particularly in cases involving inadequate hydration or an unbalanced diet.
As soon as the clinical symptoms gradually improve, and without waiting for the condition to become chronic, it may be appropriate to consider nutritional support aimed at providing nutrients involved in tendon health and recovery. This approach may also be considered in cases of recurrent tendonitis, depending on the individual situation and medical advice.
