Tendonitis of the Foot and Ankle

Overuse injuries to your feet and ankles can sideline you

Tendonitis is one of the most common causes of foot or ankle pain. The muscles of your leg, foot, and ankle 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 when you move it again.

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

Types of Tendonitis

Tendonitis can affect different parts of the foot and ankle.

These different areas include:

  • Posterior (back of the ankle)
  • Medial (side along the big toe)
  • Lateral (side along the pinky toe)
  • Dorsal (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 two to six centimeters (about one to three inches) above the area where the tendon attaches to the calcaneus (heel bone) or at the insertion site of the tendon to the heel bone.

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.

There are plenty of conservative therapies you can try, and Achilles tendonitis rarely needs surgical intervention.

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 can show the "too-many-toes" sign—where you can see four toes when looking from behind the heel. As the condition gets worse, the foot becomes flatter, and the toes fan further outward.

Physical therapy can be beneficial. 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).

A brace used for this condition should be Ankle Foot Orthotic (AFO), a custom brace that holds the ankle in a certain position to allow the tendon to relax and heal, This is usually worn for over 6 months, with a typical maximum of up to a year, and surgery can be a final solution for some people.

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.

Or it will be painful at the styloid process of the 5th metatarsal, along the pinky toe side between the toe and the ankle where the tendon inserts into the bone.

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

Flexor Tendonitis (Inner Back of Ankle)

Flexor tendonitis causes pain deep in the back of the ankle, on the big toe side. This type of tendonitis usually affects dancers or people 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
  • Swelling
  • Symptoms worsen 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.

Common 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 overused or out of balance. This can put stress on one or more tendons as you walk, and it can affect your gait.
  • 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, calcification (a build-up of calcium in the tendon), or if your tendon has torn.

Knowing the source of the pain will help guide treatment. 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 benefit from seeing a podiatrist (a healthcare professional who 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 manage your tendonitis with self-care until it heals, 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.
  • While a cold is helpful for swelling, recent medical studies have shown that applying heat to sore areas is equally helpful for soreness. Use a cold compress for 20 minutes at a time for the first 72 hours. After 72 hours, use 20 minutes of heat, followed by 20 min of ice, and then 20 min of nothing, and repeat as many times as you like.
  • Provide compression (or pressure) by applying a gauze bandage, ACE bandage or Coban, or store-bought ankle support. Use a gauze bandage if you are also covering wounds from an injury. Compression can bring swelling down and keep the ankle from moving too much. Wrap so it fits snug, not too loose or too tight. If it's too loose, it will not provide enough support, and wrapping too tight may hurt and cause harm.
  • Try to keep your foot elevated at about the level of your heart whenever possible, such as while watching television.

Medical Care

If pain and swelling don't improve with home care, get worse, or occur while you are resting, you need to seek medical attention as soon as possible.

In addition to rest, your healthcare provider may suggest:

  • A walking boot: This will keep your foot and ankle immobilized and properly distribute weight and placement for healing. Or, your healthcare provider may ask you not to put any weight on the affected foot.
  • Orthotics: These may include shoe recommendations, arch supports, inserts, prescription braces. custom foot orthotics (molded to your foot). An Ankle Foot orthotic custom brace includes the ankle.
  • 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—and often it's a combination of these factors. 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 gradually 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. 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 symptoms fluctuate with activity. The pain is typically at its worst when you first start walking on it. As you get moving, the pain usually subsides for a bit, then returns if you overdo it. Rest usually helps to ease the pain, however, the area 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. It may require physical therapy or orthotics to fully heal.

  • What are the symptoms of peroneal tendonitis?

    In peroneal tendonitis, the pain is located on the outer side of the ankle and at the base of the 5th metatarsal bone. 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 from the tibia/ interosseous membrane and fibula and inserts to multiple bones 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.

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.
  1. Kaux JF, Forthomme B, Goff CL, Crielaard JM, Croisier JL. Current opinions on tendinopathy. J Sports Sci Med. 2011;10(2):238-53.

  2. Thomopoulos S, Parks WC, Rifkin DB, Derwin KA. Mechanisms of tendon injury and repair. J Orthop Res. 2015;33(6):832-9. doi:10.1002/jor.22806

  3. Bubra PS, Keighley G, Rateesh S, Carmody D. Posterior tibial tendon dysfunction: an overlooked cause of foot deformity. J Family Med Prim Care. 2015;4(1):26-9. doi:10.4103/2249-4863.152245

  4. Davda K, Malhotra K, O'Donnell P, Singh D, Cullen N. Peroneal tendon disorders. EFORT Open Rev. 2017;2(6):281-292. doi:10.1302/2058-5241.2.160047

  5. Simpson MR, Howard TM. Tendinopathies of the foot and ankle. Am Fam Physician. 2009;80(10):1107-14.

  6. Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466(7):1539-54. doi:10.1007/s11999-008-0260-1

  7. Houghton KM. Review for the generalist: evaluation of pediatric foot and ankle pain. Pediatr Rheumatol Online J. 2008;6:6. doi:10.1186/1546-0096-6-6

  8. Cleveland Clinic. Tendinitis.

  9. Penn Medicine. Foot and ankle injuries treatment.

  10. Van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, Van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. 2012;47(4):435-43. doi:10.4085/1062-6050-47.4.14

  11. Li HY, Hua YH. Achilles tendinopathy: Current concepts about the basic science and clinical treatments. Biomed Res Int. 2016;2016:6492597. doi:10.1155/2016/6492597

  12. University of Rochester Medical Center. The best ways to prevent, treat tendonitis.

Additional Reading
  • American Academy of Orthopaedic Surgeons. Posterior tibial dysfunction.

  • American Academy of Orthopaedic Surgeons. Achilles tendinitis.

  • American Orthopaedic Foot & Ankle Society. Peroneal tendinosis.

  • DeLee JC, et al. Tendon injuries of the foot and ankle. In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2015.

By Catherine Moyer, DPM
Catherine Moyer, DPM, is a podiatrist experienced in the diagnosis, treatment, and prevention of disorders of the foot and ankle.