Tendonitis of the Foot and Ankle

Overuse injuries to your feet and ankles can sideline you

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One of the most common causes of foot or ankle pain is tendonitis. The leg, foot, and ankle muscles are attached to the bone by tendons, which are strong, cord-like tissues.

Tendonitis is swelling that happens around a tendon. It causes pain with activity that usually goes away with rest, only to return.

Learn more about what causes tendonitis, when to see your healthcare provider, and how to prevent it.

Types of Tendonitis

Tendonitis can affect different parts of the foot and ankle. These different areas include:

  • Back of the ankle
  • Inner side of the ankle
  • Outer side of the ankle
  • Outer back of the ankle
  • Top of the foot

Rest and at-home care will usually heal these injuries within a few weeks. The following are common types of tendonitis of the foot and ankle.

causes of foot and ankle tendonitis

Verywell / Brianna Gilmartin

Achilles Tendonitis (Back of Ankle)

The Achilles tendon is the large tendon that attaches the calf muscles to the back of the heel. With Achilles tendonitis, pain is located 1 to 4 inches above the area where the tendon attaches to the heel bone. This is the weakest part of the tendon and is usually the spot where tendon tears occur.

Achilles tendonitis is a common sports injury. It can happen if your activity level has recently increased, you've started playing a new sport, or you've started wearing new shoes. In addition, tight calf muscles can add to the problem.

Surgery may be an option if your symptoms don't clear up in a couple of months.

Posterior Tibial Tendonitis (Inner Side of Ankle)

The tendon of the tibialis posterior muscle (the deepest muscle in the back of the lower leg) wraps around the inside (big toe side) of the ankle and instep of the foot. That is the area where the pain occurs with this type of tendonitis.

Posterior tibial tendonitis is usually associated with flat feet. Flat feet usually show the "too-many-toes" sign—where you can see all four toes when looking from behind the heel. As the condition gets worse, the foot becomes flatter, and the toes fan further outward.

You may need a short leg cast or walking boot if you have this type of tendonitis. This allows the tendon swelling to go down. After that, you may need to wear a brace or orthotics (shoe inserts that hold your foot in a better position).

Peroneal Tendonitis (Outer Side of Ankle)

The tendons of the peroneal muscles wrap around the outside (little toe side) of the ankle. With peroneal tendonitis, pain and possibly swelling happen around the outer ankle and just below and above it.

If you have high-arched feet and a history of ankle sprains, you may be at risk for getting this type of tendonitis.

Flexor Tendonitis (Inner Back of Ankle)

With flexor tendonitis, people feel pain deep in the back of the ankle, on the big toe side. This type of tendonitis is usually seen in dancers or those who do activities that require a lot of toe balancing.

Extensor Tendonitis (Top of Foot)

Tendonitis affecting the extensor tendons on the top of the foot is usually caused by your foot rubbing against your shoe. Less frequently, health conditions that cause general swelling, like rheumatoid arthritis, can cause it.

High-arched feet are more likely to cause shoe friction that leads to this type of tendonitis.

Tendonitis Symptoms

With tendonitis, you will notice pain, especially when you first start an activity, like getting up and walking. The pain may go away for a little while but then return as you keep walking or doing other activities. The main symptoms of tendonitis include:

  • Pain near the ankle
  • Swelling when you use, move, or stretch the affected tendon

Rest usually makes the pain go away, although the affected tendon may still be painful to touch. Swelling is not usually an immediate symptom, though it may occur later. Often, your foot and ankle will become stiff when you have tendonitis.

Causes

Several things may cause tendonitis. You have more control over some of the causes than others. For example, you can be careful to stretch and not overuse your muscles. However, you can't control your foot structure or whether you develop certain health conditions.

Causes of tendonitis include:

  • Overuse: The most common cause of tendonitis is overuse. This usually means a tendon has been stretched too far. When this happens, the tendon may pull apart or tear. This can occur when you start walking, running, or playing sports more often or more intensely.
  • Abnormal foot structure: Flat feet or high arches can cause certain muscles to be out of balance. This can put stress on one or more tendons.
  • Trauma: A foot or ankle injury can cause tendonitis. This kind of trauma might happen with sudden, powerful motions like jumping. It can also occur if your foot constantly rubs against your shoe. These kinds of injuries most often are located at the top of the foot or heel.
  • Medical conditions: Certain medical conditions that cause general inflammation can lead to tendonitis. Rheumatoid arthritis, gout, and spondyloarthropathy are examples of medical conditions that can cause Achilles tendonitis or posterior tibial tendonitis.

Diagnosis

Your healthcare provider will take your medical history and may order X-rays or a magnetic resonance imaging (MRI) scan. These tests will help your healthcare provider see whether you have a broken bone, a build-up of calcium in the tendon (called calcification), or if your tendon has torn.

Knowing the source of the pain will help your healthcare provider determine how to treat it. For example, a torn tendon must be kept very still with a cast or boot and may even require surgery.

If you often experience tendonitis symptoms, you may want to get an evaluation by a podiatrist (a healthcare provider that specializes in feet and ankles). They can help identify foot abnormalities that may be causing your problem.

Treatment

The general idea for treating foot and ankle tendonitis is to rest the injury so the body can heal. This takes time, usually weeks to months. You may be able to treat tendonitis at home, but if it doesn't get better, you should see a healthcare provider.

Self-Care

When tendonitis symptoms occur, the first thing to do is treat it with R.I.C.E, which stands for rest, ice, compression, and elevation. To treat with R.I.C.E., do the following:

  • Limit your activity as much as possible.
  • Apply ice or a cold compress for 20 minutes at a time. While a cold cloth and ice are helpful for swelling, recent medical studies have shown that applying heat to sore areas is equally helpful for soreness.
  • Provide compression (or pressure) by applying a gauze bandage wrap or a store-bought ankle support. This can bring swelling down and keep the ankle from moving too much.
  • Try to keep the foot elevated at about the level of your heart whenever possible, such as while watching television.

Medical Care

If pain and swelling get worse, do not get better with home care, or occur while you are resting, it is best to seek medical attention as soon as possible. In addition to rest, your healthcare provider may suggest other treatments like:

  • A walking boot: This will keep your foot and ankle immobilized so you aren't using it. Or, your healthcare provider may ask you not to put any weight on the affected foot.
  • Orthotics: These may include shoe recommendations, arch supports or inserts, and prescription braces.
  • Nonsteroidal anti-inflammatory drugs: These may include prescription-strength or over-the-counter (OTC) medications like Advil (ibuprofen).
  • Home treatment: At-home treatment may include icing, alternating heat and cold, and stretching.
  • Physical therapy: Stretching and strengthening exercises can help reduce the stress on the affected tendon.

Prevention

One of the best ways to prevent tendonitis is by doing foot and ankle stretches before exercise. Tight muscles put extra strain on your tendons. 

You also should wear shoes that offer plenty of support and avoid worn-out sneakers. Finally, when you start a new activity or sport, increase your time and intensity gradually.

Summary

Tendonitis causes pain and swelling in the tendons of your foot and ankle. There are several types of tendonitis, each affecting different parts of the ankle or foot.

Tendonitis can be caused by overuse, injury, foot problems, and some medical conditions. The first line of treatment is resting the ankle. Your healthcare provider may also suggest shoe inserts or other orthotics, anti-inflammatory medication, or physical therapy.

Stretching your muscles before exercise is a good way to prevent tendonitis. Using proper shoes with adequate support and increasing your activity level slowly can also help prevent tendonitis.

A Word From Verywell

Pain in your foot or ankle from tendonitis is a sign that you need to take it easy. However, if the pain continues despite rest, see your healthcare provider. They will help you find a treatment plan that works for you. While it may mean weeks away from your favorite activities, the goal is to prevent complications that can sideline you for even longer.

Frequently Asked Questions

  • What does tendonitis of the foot and ankle feel like?

    Tendonitis pain and stiffness vary with activities. The pain is typically greatest when you first start walking on it. As you get moving, the pain usually subsides for a bit, then return if you overdo it. Rest usually helps to ease the pain, however, it may still be tender to the touch.

  • How long does it take tendonitis to heal?

    Depending on the extent and cause of your injury, tendonitis can take a few weeks to a few months to heal. Some cases of tendonitis will require physical therapy to fully heal. Talk to your doctor if you have any concerns.

  • What are the symptoms of peroneal tendonitis?

    In peroneal tendonitis, the pain is located on the outer side of the ankle. Swelling can occur above and below the ankle bone. Peroneal tendonitis is more common in people with high arched feet or frequent ankle sprains.

  • Is posterior tibial tendonitis related to flat feet?

    Yes, people with flat feet are more prone to posterior tibial tendonitis. The posterior tibial tendon attaches the calf muscle to the bottom of the feet. It runs along the inner side of the ankle and arch. Shoe orthotics are often used to prevent and treat posterior tibial tendonitis.

  • What type of tendonitis is common in ballet dancers?

    Flexor tendonitis—felt deep in the back of the ankle on the interior side—is common in ballet dancers. It can also be caused by other activities that require balancing on your toes.

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12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • American Academy of Orthopaedic Surgeons. Posterior tibial dysfunction. Updated September 2017.

  • American Academy of Orthopaedic Surgeons. Achilles tendinitis. Updated June 2010.

  • American Orthopaedic Foot & Ankle Society. Peroneal tendinosis. Updated 2020.

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