Generality
Ankle tendinitis is the inflammation of one or more tendons that insert into the homonymous joint.
Episodes of ankle tendonitis can be the result of: acute or chronic ankle trauma, functional overload of the ankle or a form of arthritis (eg, rheumatoid arthritis).
The typical symptoms and signs of tendon inflammation are: pain, swelling and joint stiffness.
In general, physical examination and medical history are sufficient for a definitive diagnosis.
The classic treatment of the most common cases of ankle tendonitis includes: rest from any activity that causes pain, application of ice, elevation of the painful lower limb and the use of anti-inflammatories.
In the event that the therapies are late or inadequate, the symptoms may become chronic or, worse, the inflamed tendon suffers an injury, which makes surgery indispensable.
Outline of anatomy: the ankle and its tendons
Located between the leg and the foot, the ankle is the synovial joint of the human body, which acts as a junction point between the distal ends of the tibia and fibula and the upper portion of the talus (talo).
Tibia and fibula (or fibula ) are the bones that make up the skeleton of the leg ; the astragalus, on the other hand, is one of the 7 bones of the tarsus of the foot .
The ankle joint, also known as the talocrural joint, allows the foot to perform plantarflexion, dorsiflexion, eversion and inversion movements.
| Table: movements of dorsiflexion, plantarflexion, eversion and inversion of the foot. | |
 | Dorsiflexion : it is the movement that allows you to lift your foot and walk on your heels. |
 | Plantarflexion : it is the movement that allows you to point your foot towards the floor. The human being performs a plantarflexion movement when he tries to walk on his toes. |
 | Eversion : means raising the side edge (ie the outer edge) of the foot, keeping the medial edge (ie the inner edge) on the floor. |
 | Inversion : it means raising the medial edge of the foot, keeping the side edge on the floor. |
ANKLE TENDONS
A tendon is an extremely flexible band of fibrous connective tissue, which combines a skeletal muscle with a bone.
With a stabilizing and supporting function towards the ankle, the tendons in close contact with the latter are:
- The Achilles tendon . Connect the calf muscles (the twins and the soleus) to the tarsal bone known as the calcaneus. It is essential for walking, running and jumping.
- The anterior tibial tendon . Connects the tibialis anterior muscle to a bone of the tarsus of the foot, called the medial cuneiform.
- The posterior tibial tendon . It joins the posterior tibial muscle to the medial navicular and cuneiform tarsal bones.
- The three peroneal tendons . They join the long, short and anterior (or third) peroneal muscles to the lateral bones of the tarsus of the foot. They slide sideways to the ankle.
The achilles tendon, the two anterior and posterior tibial tendons and the three peroneal tendons are improperly called ankle tendons .
What is ankle tendonitis?
Ankle tendinitis is an inflammatory condition that affects one or more ankle tendons.
This is a particular form of tendonitis in the foot .
TYPES OF ANKLE TENDINITIS
According to the tendon that is the object of the inflammatory process, the doctors distinguish 4 types of tendonitis in the ankle: the yarrow tendinitis (that is the tendinitis of the Achilles tendon), the anterior tibial tendinitis (or the tendinitis of the anterior tibial tendon), the tibial tendinitis posterior (ie the tendonitis of the posterior tibial tendon) and the tendonitis peronea (ie the tendonitis of a peroneal tendon).
Causes
The main causes of ankle tendonitis include traumatic ankle injuries, functional ankle overload and some forms of arthritis .
TENDINISTS AFTER TRAUMATIC INJURIES TO THE ANKLE
Ankle trauma can damage various components of the joint, including tendons.
For ankle injuries, both acute and direct phenomena - such as the so-called ankle sprains - and chronic and repetitive phenomena, such as continuous and repeated rubbing on the ankle of a shoe that is too narrow are meant.
As a rule, episodes of ankle tendonitis are the result of acute trauma and, in particular, of the aforementioned ankle sprains.
Those most at risk of ankle tendonitis of traumatic origin are those who practice sports, such as: running, soccer, basketball, volleyball, rugby and tennis.
ANKLE FUNCTIONAL OVERFLOW TENDINITIS
The functional overload pathologies are conditions that arise due to the exaggerated and continuous repetition, over time, of particular gestures / movements.
Ankle tendonitis due to functional overload (of the same ankle) is the result of a certain movement of the foot, repeated many times during the day, which affects the health of a very specific tendon.
The people most prone to develop functional overload ankle tendonitis are the medium / high level athletes, who, for performance reasons, train many hours every day and for long periods of time.
FOOT tendonitis from arthritis
In medicine, the term arthritis refers to any inflammatory process involving one or more joints.
There are many forms of arthritis; Among the various forms of existing arthritis, those that have the greatest tendency to cause ankle tendinitis are: rheumatoid arthritis, ankylosing spondylitis, gout and reactive arthritis .
RISK FACTORS
Doctors and experts agree that they are risk factors for ankle tendonitis:
- Practice at high levels of sports such as football, running, basketball, rugby, American football and tennis;
- The practice of work activities that subject the feet and in general the lower limbs to stressful movements;
- The habit of wearing shoes that are particularly narrow at the ankle level;
- The presence of rheumatoid arthritis, reactive arthritis or gout.
Symptoms, signs and complications
The most common symptoms and signs of ankle tendonitis are ankle pain, ankle swelling and joint stiffness .
The precise location and severity of the aforementioned clinical manifestations depend, respectively, on the site of tendon inflammation and the severity of the inflammatory process.
ACHE
First by appearance, pain is the most characteristic symptom of ankle tendonitis.
Generally, it tends to be a sharp and burning sensation, which, in the absence of adequate treatments, spreads from a precise point (where the inflamed tendon is) to the whole ankle.
The pain from ankle tendonitis is stronger in the morning, immediately after waking up, and when the movements are resumed, after long periods of immobility (eg: a trip by car for many hours).
- Tendonitis of the Achilles tendon: it causes pain from the heel to the calf. The painful sensation increases with the practice of activities such as walking and, above all, running;
- Tendonitis of the anterior tibial tendon: it causes pain on the inner side of the foot. This pain tends to increase when you stand up or push the affected foot outward;
- Tendonitis of the posterior tibial tendon: causes pain on the front of the foot. As a rule, this painful sensation tends to increase by going down the stairs or walking / running on a downhill surface.
- Artificial tendonitis: induces pain on the back side and on the external side of the ankle and foot in general. Typically, the painful sensation increases when you stand up.
SWELLING
In the presence of an ankle tendonitis, swelling is a clinical sign that appears, generally, gradually. Initially, in fact, it is hardly mentioned; after a few weeks, on the other hand, it has dimensions that clearly show it.
To the touch, the area with swelling appears soft.
RIGIDITY
In ankle tendonitis, joint stiffness makes movement of the affected foot difficult.
Like pain, it is more pronounced after long periods of immobility, therefore upon awakening from sleep at night, after a long stay on a chair, etc.
Generally, it tends to fade with movement.
COMPLICATIONS
Failure to treat certain types of ankle tendonitis, associated with the perpetuation of activities harmful to the ankle tendons, can lead to chronic symptoms or, even worse, tendon injury .
A well-known tendon lesion that is of some importance in the medical-clinical field is the lesion of the Achilles tendon . Better known as Achilles tendon rupture, Achilles tendon injury severely limits the motor skills of the affected individual and requires surgical intervention.
Diagnosis
In most cases, doctors diagnose ankle tendonitis and identify the triggering causes thanks to a thorough physical examination and a thorough medical history . If they resort to more thorough tests, such as nuclear magnetic resonance, it is because they have some doubts or want to clarify the exact state of health of the anatomical components of the ankle.
IMPORTANCE OF ACCURATE DIAGNOSIS OF CAUSES
In the context of ankle tendonitis, the identification and knowledge of the triggering causes are of enormous help to doctors in planning the most appropriate therapy.
Basic information on the causal factors comes from the anamnesis, which clarifies whether the patient suffers from some form of arthritis, practices sports activities or work at risk etc.
Therapy
The canonical treatment of the most common episodes of ankle tendonitis involves a therapy against pain and inflammation, and a preventive therapy against all possible aggravating factors or which can, in some way, compromise the healing process.
In patients with complications, the therapeutic plan changes; in these cases, before a chronic symptomatology, the aforementioned therapies are added to physiotherapy ; in the presence of a tendon lesion, however, surgery is required, followed by proper physiotherapy rehabilitation .
CLASSIC TREATMENT
The classic treatment of uncomplicated ankle tendinitis consists of:
- Rest and abstinence from all physical / motor activities that induce ankle pain . The rest of the tendon that causes pain is essential for the resolution of the inflammatory state;
- Application of ice on the painful and swollen area . The use of ice has a remarkable anti-inflammatory power, which many people underestimate.
Normally, under conditions such as ankle tendonitis, doctors recommend applying ice 4-5 times a day for at least 15-20 minutes;
- Elevation of the painful lower limb . It is a remedy that relieves the ankle and the foot of the body load, favoring recovery from inflammation;
- Use of crutches, to avoid "giving weight" to the ankle and to the sore foot. Crutches are indicated for patients with very severe tendinitis;
- Administration of non-steroidal anti-inflammatory drugs ( NSAIDs ). As can be guessed from their name, these medicines act against inflammation, reducing it. The most widely used NSAIDs among people with ankle tendinitis are ketoprofen and naproxen sodium.
Prognosis
If the therapies are timely and adequate, the prognosis of ankle tendonitis is almost always positive. In these situations, healing times have a reasonable duration, which depends specifically on the severity of the inflammation: for less severe tendinitis, a few days of rest, ice, anti-inflammatories, etc are sufficient; for the more severe tendinitis, on the other hand, it takes several weeks of careful treatment.
HOW CHANGE PROGNOSIS IN THE PRESENCE OF COMPLICATIONS
In the presence of complications, the prognosis becomes more uncertain and the path leading to recovery becomes longer and full of obstacles:
- In the case of chronic symptoms, classic therapy and physiotherapy could last for a long time (several months) and, at the end, be only partially effective;
- In the event of a tendon injury, surgery must be followed by several months of rest and physiotherapy, to allow for the correct welding of tendon tissues undergoing repair.
An athlete who suffers the rupture of the Achilles tendon can return to playing sports at full capacity after 8 months of rehabilitation and physiotherapy, even if there are cases of faster recovery, assisted by modern rehabilitation techniques.
Prevention
Do not overdo sports activities at risk, avoid the continuous repetition of wrong movements with the ankle, wear comfortable shoes, observe breaks during work activities that require continuous use of the lower limbs and feet in particular, wear special braces ( clearly when it is possible or permitted) and, finally, performing ankle lengthening exercises for the ankle and foot are the main preventive measures against ankle tendonitis.
HOW TO AVOID THE SEWING OF AN ANKLE TREE
Refrain from activities that involve pain and avoid taking painkillers without first consulting a doctor (as the aforementioned drugs cancel the pain, deluding the patient of having solved the problem), are the main advice given by doctors to prevent the aggravation of an ankle tendonitis.
