subject: Tendon Injuries of the Foot [print this page] Tendon Injuries of the Foot Tendon Injuries of the Foot
The foot is an incredibly complex part of the anatomy. Due to the strain the foot takes on bearing the weight of the body, injury to its parts is not uncommon. Tendon injuries in particular occur frequently, and can be a source of pain and disability. This article will discuss the three most common tendon injuries in the foot, and how they can be prevented.The foot contains many tendons, which are flat tubes of flexible tissue that attach muscle to bone, and allow the muscle to move the bones to create body movement. Some tendons originate as muscles located within the foot, and others originate in the legs. These muscles, when working together, stabilize the foot and ankle, and when separately acting, allow for movement in all directions. There are three muscle groups in particular that allow for the most motion in the foot, and injury of the tendons of these muscles is not uncommon during activity or trauma. These tendons are the Achilles' tendon, the peroneal tendons, and the posterior tibial tendon.Of the three, the Achilles tendon is the strongest, thickest, and most likely to get injured. The Achilles tendon serves as the tendon for two different muscles in the calf, and essentially its action pulls the foot downward at the ankle. It is prone to injury for two reasons. The first reason is due to the fact that the tendon runs across an area of the body that radically changes direction, and forced movement of the ankle upward can damage the tendon fibers. The body changes direction from a vertical leg to a horizontal foot at the ankle, and the Achilles tendon crosses just behind this point. When the foot is forcibly bent upward during an injury, especially if the calf muscle is trying to actively pull the foot downward, the resulting strain to the tendon can cause tissue damage. This injury pattern can be seen during sports, as well as simple activities such as coming off of a stair or curb forcefully. The second reason this tendon is prone to injury is due to a defect in the blood supply to the tendon. There is an area just above where the tendon attaches to the heel bone that has a limited supply of blood feeding the tissue. This area seems to be less capable of recovering the minor strains of the tendon undergoes on a daily basis, and it can weaken overtime. Eventually, the tendon may become inflamed at this site due to chronic daily stress.Prevention of Achilles tendon injuries essentially involves proper stretching before activity or exercise. By making the tendon more limber, it is less likely to become strained during running or jumping, and also becomes less likely to become chronically strained during daily activity. The use of stable, well fitting shoes helps, as well as a proper warm-up period prior to engaging in exercise, heavy activity, or sports.The second tendon group that becomes commonly injured in the foot are called the peroneal tendons. These two tendons begin with muscles positioned on the outer side of the leg, and run together behind and under the outer side of the ankle. They then split, with the shorter one (peroneus brevis) attaching to the outside of the foot and the longer one (peroneus longus) diving under the foot to attach on the bottom of the inner side of the foot. These tendons work together to pull the foot upward and outward, and helps to stabilize the foot from rolling inward. These motions are vitally important during the act of walking or running, and injury to these tendons can be a source of great pain and functional loss. Like the Achilles tendon, these tendons can become injured through either traumatic means or chronic stress. The peroneal tendons can become traumatically injured when the foot is forced to roll inward. This action often results in an ankle ligament sprain, but injury to the peroneal tendons can also occur at the same time. Injury can also occur if an object strikes the tendons along the side of the ankle or foot, or if the foot is suddenly tweaked inward while the tendons are forcefully pulling the foot outward. Chronic injuries can also occur to the tendons, and these are often seen when one has been active on uneven surfaces, such as a rocky lot or divot-filled field. The constant slight rolling in of the foot during activity on these surfaces can eventually lead to tendon strain, partial tearing, and overall inflammation.Prevention of peroneal tendon injuries centers around wearing stiff, supportive shoes, and being careful on uneven surfaces. Those with weak ankles and a tendency to roll their ankles inward need to use ankle braces during athletic activity, or when walking or hiking on uneven ground. Some people may even need strengthening exercises to help prevent injury.The final most common tendon injured in the foot is the posterior tibial tendon. This tendon is somewhat unique in that injury to its substance can eventually lead to a change in the foot shape if the condition progresses. The posterior tibial tendon begins from muscle in the inner side of the leg, and attaches to the inner side of the foot. Its action is the exact opposite of the peroneal tendons, as it pulls the foot downward and inward. This acts as a strong deterrent to the foot flattening out excessively. Injury to this tendon can come from trauma that forces the foot outward, or from something bluntly striking the foot on the inner side. However, the posterior tibial tendon is more commonly injured by simple day to day stress on the tendon in those with a flat or near-flat foot type. As the foot flattens out naturally during the process of standing and walking, the excess motion a flat footed person has causes increased strain to the inner aspect of the foot an ankle. Eventually, this strain can lead to tendon damage, inflammation, and possibly degeneration. If untreated, this damage will progressively worsen, and the tendon will stretch and weaken. Ultimately, this will lead to further flattening of the feet, chronic pain, and significant foot structural weakness.Prevention for this injury involves long term structural support in the form of stiff-soled supportive shoes and prescription arch supports (orthotics) to control the flattening of the foot. Severe cases may necessitate the use of customized and individualized ankle braces to limit abnormal structural motion, or even surgical reconstruction to keep symptoms from persisting.While there are several other tendons that become injured in the foot through trauma or chronic stress, the above three tendons represent the vast majority of cases. While no amount of prevention is foolproof and accidents do happen, the combination of proper shoe use, foot and ankle support when needed, stretching, and activity warm-up can help prevent many of these injuries, and keep the feet functioning in good health.
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