Tendinosis in the foot and leg.
Tendinosis (tendonosis), or chronic tendinopathy is damage to a tendon at a cellular level. It is thought to be caused by micro-tears in the connective tissue in and around the tendon, leading to an increase in tendon repair cells. This may lead to reduced tensile strength, thus increasing the chance of tendon rupture. Tendinosis is often misdiagnosed as tendinitis due to the limited understanding of tendinopathies by the medical community.
Tendons are very slow to heal if injured, and in many cases these tendons do not regain their original strength. Partial tears heal by the rapid production of disorganized type-III collagen, which is weaker than normal tendons. Recurrence of injury in the damaged region of tendon is common. Initial recovery is usually within 2 to 3 months and full recovery is within 3 to 6 months. It is estimated that upto 80% of patients will fully recover.
Common Tendinosis sites treated by Podiatrist include Achilles Tendinosis, Tibialis Anterior Tendinosis, Posterior Tibial Tendinosis and Peroneal Tendinosis.
Cause
The most common cause of tendinosis is over use injuries. Overuse injuries are the result of repetitive use, stress and trauma to the soft tissues of the body (muscles, tendons, bones and joints) without proper time for healing. They are sometimes called cumulative trauma, or repetitive stress injuries. Commonly this over use is due to poor biomechanics, foot posture, poor foot wear and are more likely in elite athletes, the elderly and new exercisers who do too much, too soon without enough rest.
Diagnosis
Diagnosis of Tendinosis is largely based on clinical history and by manually assessing the ligaments for pain or swelling. Swelling in a region of micro damage or partial tear can usually be detected visually or by touch however in some cases an ultrasound maybe ordered by your Podiatrist to assess the integrity of the tendon.
Treatment
Unlike tendonitis, tendonosis is not an inflammatory disease and thus cannot be treated in the same manner. Stong anti-inflammatory medicine in many cases should therefore not be taken unless the site is re-injured or the tendon is both weakened and inflammed.
Standard treatment of tendinosis injuries is largely conservative and do not require surgery. The use of non-steroidal anti-inflammatory drugs (NSAIDs) combined with orthotics (if required), Physical Therapy (eccentric loading, stretching and massage), rest and gradual return to exercise is a common. There is controversy as to whether or not NSAIDs provide any benefit to these conditions other than pain relief. There are a variety of treatment options, but more research is necessary to determine their effectiveness.
Eccentric Loading
Eccentric loading is one of the most popular treatments for tendonosis as studies have shown impressive rates of recovery and the possibility of complete remodeling of chronically damaged tenon tissue. Eccentric loading consists of a number of exercises specifically designed to place positive forces on the area of damage. These forces encourage tissues to remodel and repair.
Extracorporeal Shockwave Therapy (ESWT)
Shock-wave therapy may be effective in treating calcific tendonosis and is only available in Adelaide with a referral first from a Podiatrist or your GP. It is believed that ESWT increases levels of healing hormones an proteins leading to increased cell proliferation and tissue regeneration in tendons However conflicting evidence is present around its effectiveness. If previous conservative measures have failed for your condition, than this treatment may be considered as an option. Before initiating this treatment, an ultrasound referral will be required by one of our podiatrists, or your doctor, to determine your suitability.
During Recovery....
It’s important to start slow and increase your training time and intensity over time. Following the "Ten percent rule" is helpful in avoiding overuse injuries
To prevent the return of tendonitis overuse injuries and tendonitis, athletes should maintain a training schedule that includes varied intensity and duration as well as type of activity.
If you re-injure and area always remember to treat it with the RICER principal until it settles down again before resuming activities.
Related Articles
- Tendonitis
- Achilles Tendonitis
- Orthotics
- Plantar Fasciopathy; a chronic heel pain
- Tendonitis Vs Tendinosis
Tendons are very slow to heal if injured, and in many cases these tendons do not regain their original strength. Partial tears heal by the rapid production of disorganized type-III collagen, which is weaker than normal tendons. Recurrence of injury in the damaged region of tendon is common. Initial recovery is usually within 2 to 3 months and full recovery is within 3 to 6 months. It is estimated that upto 80% of patients will fully recover.
Common Tendinosis sites treated by Podiatrist include Achilles Tendinosis, Tibialis Anterior Tendinosis, Posterior Tibial Tendinosis and Peroneal Tendinosis.
Cause
The most common cause of tendinosis is over use injuries. Overuse injuries are the result of repetitive use, stress and trauma to the soft tissues of the body (muscles, tendons, bones and joints) without proper time for healing. They are sometimes called cumulative trauma, or repetitive stress injuries. Commonly this over use is due to poor biomechanics, foot posture, poor foot wear and are more likely in elite athletes, the elderly and new exercisers who do too much, too soon without enough rest.
Diagnosis
Diagnosis of Tendinosis is largely based on clinical history and by manually assessing the ligaments for pain or swelling. Swelling in a region of micro damage or partial tear can usually be detected visually or by touch however in some cases an ultrasound maybe ordered by your Podiatrist to assess the integrity of the tendon.
Treatment
Unlike tendonitis, tendonosis is not an inflammatory disease and thus cannot be treated in the same manner. Stong anti-inflammatory medicine in many cases should therefore not be taken unless the site is re-injured or the tendon is both weakened and inflammed.
Standard treatment of tendinosis injuries is largely conservative and do not require surgery. The use of non-steroidal anti-inflammatory drugs (NSAIDs) combined with orthotics (if required), Physical Therapy (eccentric loading, stretching and massage), rest and gradual return to exercise is a common. There is controversy as to whether or not NSAIDs provide any benefit to these conditions other than pain relief. There are a variety of treatment options, but more research is necessary to determine their effectiveness.
Eccentric Loading
Eccentric loading is one of the most popular treatments for tendonosis as studies have shown impressive rates of recovery and the possibility of complete remodeling of chronically damaged tenon tissue. Eccentric loading consists of a number of exercises specifically designed to place positive forces on the area of damage. These forces encourage tissues to remodel and repair.
Extracorporeal Shockwave Therapy (ESWT)
Shock-wave therapy may be effective in treating calcific tendonosis and is only available in Adelaide with a referral first from a Podiatrist or your GP. It is believed that ESWT increases levels of healing hormones an proteins leading to increased cell proliferation and tissue regeneration in tendons However conflicting evidence is present around its effectiveness. If previous conservative measures have failed for your condition, than this treatment may be considered as an option. Before initiating this treatment, an ultrasound referral will be required by one of our podiatrists, or your doctor, to determine your suitability.
During Recovery....
It’s important to start slow and increase your training time and intensity over time. Following the "Ten percent rule" is helpful in avoiding overuse injuries
To prevent the return of tendonitis overuse injuries and tendonitis, athletes should maintain a training schedule that includes varied intensity and duration as well as type of activity.
If you re-injure and area always remember to treat it with the RICER principal until it settles down again before resuming activities.
Related Articles
- Tendonitis
- Achilles Tendonitis
- Orthotics
- Plantar Fasciopathy; a chronic heel pain
- Tendonitis Vs Tendinosis
