Tendinitis is the inflammation or irritation of a tendon. Tendons are thick fibrous cords of tissue that connect muscles to bone. The condition causes pain and tenderness just outside a joint. While tendinitis can occur in any of your body's tendons, it's most common around your shoulders, elbows, wrists and heels.Undue strain results in over 230,000 Achilles tendon injuries per year in the U.S. alone.There are many tendons in the foot and ankle. The largest and strongest tendon of the foot is the Achilles tendon, which extends from the calf muscles down to the heel bone. Its strength and function allows humans to run, jump, walk up stairs, and stand onto the toes. Achilles tendinitis (pain on the back of the heel) or an inflammation of the Achilles tendon, is one of the most common causes of foot or ankle pain. Other types of foot/ankle tendinitis include posterior tibial tendinitis (pain on the bottom of the foot) and peroneal tendinitis(pain on the side of the foot). Causes Tendinitis can result from an injury or over-use of a part of the foot. Undue strain could be caused by a variety of factors, including tightness or weakness of the leg, knee, hip, or back; high or low arches; uneven leg lengths; and/or sudden (rather than gradual) increases in training, such as running faster, further, or up steeper hills. Not stretching or incorrect stretching prior to exercise or incorrect form during physical activity can also cause tendinitis. Although tendinitis can be caused by a sudden injury, the condition is much more likely to stem from repeating a particular movement over time.Most people develop tendinitis because their jobs or hobbies involve repetitive motions, which put stress on the tendons needed to perform the tasks. Using proper technique is especially important when performing repetitive sports movements or job-related activities. Improper technique can overload the tendons and lead to tendinitis. Some people are at higher risk for developing tendinitis such as those with flat feet, tight tendons and arthritis.Risk factors for developing tendinitis include age, working in particular jobs or participating in certain sports. As people get older, their tendons become less flexible which makes them easier to injure. Tendinitis is more common in people whose jobs involve repetitive motions, awkward positions, frequent overhead reaching, vibration and forceful exertion. You may be more likely to develop tendinitis if you participate in certain sports that involve repetitive motions, especially if the technique isn't optimal. Symptoms Pain is the most common symptom of tendinitis. The pain will be most noticeable when you try to move that part of your body that is inflamed. Signs and symptoms of tendinitis occur at the point where a tendon attaches to a bone and typically include pain, often described as a dull ache, especially when moving the affected limb or joint, tenderness, and mild swelling. Prevention To reduce your chance of developing tendinitis, follow these suggestions: o Ease up. Avoid activities that place excessive stress on your tendons, especially for prolonged periods. If you notice pain during a particular exercise, stop and rest. o Mix it up. If one exercise or activity causes you a particular, persistent pain, try something else. Cross-training can help you mix up an impact-loading exercise, such as running, with lower impact exercise, such as biking or swimming. o Improve your technique. If your technique in an activity or exercise is flawed, you could be setting yourself up for problems with your tendons. Consider taking lessons or getting professional instructions when starting a new sport or using exercise equipment. o Stretch first. Before you exercise, take time to stretch in order to maximize the range of motion of your joints. This can help to minimize repetitive microtrauma on tight tissues. Remember to stretch after exercise, too. o Use proper equipment and space in your workplace. If possible, check out your work space, for example adjust your chair and other equipment for your usual tasks. This will help protect all your joints and tendons from excessive stress. o Prepare your muscles to play. Strengthening muscles used in your activity or sport can help them better withstand stress and load. o Gradually increasing your activity level with an appropriate training schedule -- up to a 5 kilometer run, for instance, instead of simply running the whole course the first day -- can also help prevent tendinitis. o The best way to prevent an Achilles tendon injury is to stay in overall good shape, and warm-up, stretch, and strengthen the Achilles tendons. When to visit a podiatrist If you develop some tendinitis it is best to rest and ice the area. Stay off your foot or ankle as much as possible and apply ice for up to 15 minutes at a time, three to four times a day. You can also take some over the counter anti-inflammatory tablet. If the pain doesn't go away with ice and rest, or if the pain persists beyond a week, it's time to see a podiatrist. Don't wait. Tendinitis can become a chronic problem, and it's a lot harder to treat chronic problems than acute injuries. Diagnosis and treatment When you see the podiatrist, they will ask you some questions about your pain and general health and perform a complete physical examination of your feet and ankles. X-rays or an MRI might be ordered to rule out any other problems, such as a fracture or torn tendon.The treatment will focus on relieving the pain-reducing inflammation and preventing further injury. Medication can help too. Your podiatrist may recommend or prescribe oral medication. These may include pain relievers and anti-inflamatories. Topical creams with anti-inflammatory medication may also be effective in relieving pain without the potential side effects. Sometimes your doctor may inject a corticosteroid medication around a tendon to relieve tendinitis. Such injections reduce inflammation and can help ease pain. However, repeated injections may weaken a tendon, increasing your risk of rupturing the tendon.Your podiatrist may create shoe inserts or a soft cast to effectively immobilize the affected area for a period of time. (Often, a couple of weeks are needed for the tendon to heal.) You might benefit from a program of specific eccentric exercises designed to stretch and strengthen the affected muscle-tendon unit that has been shown to be effective in treating chronic tendon inflammation.Most cases of tendinitis can be successfully treated with rest, physical therapy and medications to reduce pain. However, if tendinitis is severe and leads to the rupture of a tendon, you may need surgical repair. o For more information visit www.apma.org or www.mayoclinic.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street; or call 325-2996 for an appointment; or call Bahamas Surgical Associates Centre on Albury Lane, off Shirley Street; or call 394-5820 for an appointment.

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