A tendon is a fibrous connective tissue which attaches muscle to bone. Tendons cross joints in order to move the bone. One tendon is made up of hundreds of tendon fibers to make a cord like structure that is flexible and elastic inelastic and capable of withstanding significant tension.

Injury to a tendon is called tendinopathy. Tendonitis is the inflammation of a tendon. Tendonitis is a type of tendinopathy. Chronic tendon injury is called tendinosis. The inflammation is usually a result of multiple micro tears to the substance of the tendon. Tendonitis can affect people of any age, but is more common in adults who do a lot of activity. Elderly individuals are also susceptible to tendonitis because tendons lose their elasticity and become weaker with age.

TENDONITIS SIGNS AND SYMPTOMS:
Pain- if the affected area is moved the pain worsens
A feeling that the tendon is crackling or grating as it moves. This sensation is more common on examination.
Swelling in the affected area
The affected area may be hot or red
A lump that develops within the tendon

ACHILLES TENDONITIS
The Achilles tendon is a strong, thick, and important structure that functions to bring the ankle and foot downwards and propel the body forward with gate. Thousands off fibrous brands of tissue bind together to form the dense Achilles. The calf muscle (gastrocnemius) becomes the Achilles tendon about midway in the lower leg. The tendon travels down the back of the leg, crosses the ankle, and attaches to the top and back of the heel bone (calcaneous). The Achilles tendon acts as a “rubber band” that stretches back and forth with each step. When there is an acute or new injury to a portion of the tendon and it becomes inflamed, this is called Achilles tendonitis (-it is=inflammation)

ANTERIOR TIBIAL TENDONITIS
The Anterior Tibial tendon lies on the inner-front of the ankle. The muscle for the tendon lies on the front of the shin. The muscle and tendon act to flex the foot upwards when walking. Without this tendon, the foot and toes would drag on the ground when the foot follows through during gait.

Anterior tibial tendonitis is an inflammation of the tendon from injury by trauma or overuse over time. Left untreated, tendonitis can lead to split tears or thickening within the tendon and further damage and pain. In some cases of major trauma, this tendon can rupture. Diagnosis is made by careful clinical examination and sometimes diagnostic ultrasound or MRI.

Patients may complain of a deep achy pain and or weakness on the front of the ankle with walking or activity. The tendon can become strained or frayed or torn and split or ruptured. In some patients with nerve damage, the muscle can become weak leading to a “drop foot”. Those patients with high arched foot types are more prone to anterior tibial tendon damage.

When diagnosed early, anterior tibial tendonitis can be treated conservatively with complete rest of the tendon in a special waking boot or physical therapy. Custom molded orthotics can redirect the pull on the tendon and support the arch to help prevent recurrence.

In some cases, Dr. Heath may offer platelet rich plasma insertions (PRP) therapy. This treatment can stimulate the tendon and promote healing.

Some cases will require surgical repair of the tendon. Surgery will remove any damaged portion of the tendon and repair any splits and tears. In cases of a complete rupture, surgical repair is always indicated. Patients with permanent weakness of the muscle and tendon may require a special brace to support the drop foot or surgery to redirect another tendon to the top of the foot to flex the foot upwards. In severe cases, the tendon may need to be augmented with donated human tendon, PRP, graft. Tendons may also be wrapped with a special graft to straighten and allow healing.

PERONEAL TENDONITIS
The peroneal tendons are on the outer side of the ankle. The muscles of these tendons are on the outside of the calf. The job of these tendons is to flex the foot downward and away from the other foot. There are 2 tendons, one short (peroneus brevis) and one longer (peroneus longus).

Peroneal tendonitis is an inflammation of the tendons from injury. One or both of these tendons can become damaged from trauma or overuse over time. Left untreated, tendonitis can lead to split the tears within the tendon and further damage and pain. Diagnosis is made by a careful clinical examination and sometimes diagnostic ultrasound or MRI.

Patients may complain of a deep achy pain on the outer side of the ankle with walking or activity. In some cases the tendons can dislocate from the groove of the outer ankle bone that they lie within. They can become strained or frayed or torn and split. Those patients with high arched foot types are more prone to peroneal tendon damage. Patients with severe ankle sprains or chronic ankle instability often have associated peroneal tendon damage. When diagnosed early, peroneal tendonitis can be treated conservatively with complete rest of the tendon in a special walking boot and physical therapy. Custom molded orthotics, can redirect the pull of the tendon to help prevent recurrence,

In chronic cases, Dr. Heath may offer platelet rich plasma or amnion injection therapy. This treatment can stimulate the tendon and promote healing. Some cases will require surgical repair of the tendon. Surgery will remove any damage portion of the tendon and repair any splits and tears. When needed, the groove in the ankle bone can be depended in cases of tendon subluxation. In severe cases, the tendon may need to be augmented with donated human tendon, PRP, and stem cells, and an injection of amnion tissue.

POSTERIOR TIBIAL TENDONITIS
The posterior tibial tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the foot