Inflammation foot tendons

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally-known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Tendons can be affected by many different problems. A tendon is actually a piece of tissue that connects muscle to bone.

When the muscle contracts, the bone is pulled. The tendon is surrounded by a sheath that is lined with synovial tissue and lubricated by synovial fluid. This allows the tendon to glide smoothly.

Tendons in the foot may be inflamed as a result of trauma, repetitive motion/stress, and arthritis such as rheumatoid arthritis, psoriatic arthritis, and Reiter’s disease.

The tendons which straighten the toes run along the top of the foot and are known as the extensor tendons. These tendons can become inflamed causing pain and swelling.


• Pain on the top of the foot (dorsal foot pain).
• Diffuse swelling on the top of the foot.
• Pain along the top of the foot which is worse during running.
• Pain when the tendons are passively stretched.


• Overuse
• Badly fitting shoes or shoes that are laced too tightly causing pressure on the top of the foot.
• It can also be caused by a change in running terrain, particularly hill running. Running uphill makes the extensor muscles work harder to lift the foot and downhill they have to work harder to slow down.


• Rest.
• Ice.
• Alter shoes or get shoes that fit properly!
• Ensure shoe laces are not tied too tightly.
• Pad the shoe in the forefoot.
• A rehabilitation program that strengthens the extensor muscles and stretches the calf muscles.
• Anti-inflammatory medication.
• Steroid injection may be given, although is is discouraged.
• In very rare cases surgery is performed.

The tendons which bend the toes originate from two muscles of the lower leg; the flexor digitorum longus and the flexor hallucis longus muscles. They run down the inside of the ankle and under the foot to the toes and are known as the flexor tendons.

Flexor tendinitis is less common than extensor tendinitis but can be more painful and disabling.


• Tenderness along the course of the tendons.
• Pain when the big toe is bent against resistance.
• Pain on the inside rear portion of the ankle.
• Pain in the arch of the foot.


• Rest.
• Ice.
• Tape the foot to protect the arch.
• Anti-inflammatory medication.

A newer treatment for tendonitis may be more effective.

Percutaneous needle tenotomy (PNT) is a technique where a small gauge needle is introduced using local anesthetic and ultrasound guidance. The needle is used to poke several small holes in the tendon. This procedure is called "tenotomy." Tenotomy induces an acute inflammatory response. Then, platelet rich plasma, obtained from a sample of the patient's whole blood is injected into the area where tenotomy has been performed. Platelets are cells that contain multiple healing and growth factors. The result? Normal good quality tendon tissue is stimulated to grow with natural healing. We have had excellent results with this technique. Many physicians and surgeons still don't know about this procedure.

(And remember, if a doctor isn't "up" on something, he or she is usually "down" on it).

For more information about PNT and PRP, visit our sister site:

Tendonitis provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.

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