What is the diagnosis and treatment for foot tendonitis (inflammation of the tendons in the foot)?

From the Guidelines

Foot tendonitis should be managed with a combination of relative rest, icing, and eccentric strengthening exercises, as most patients fully recover within three to six months with these conservative measures. The treatment approach should prioritize reducing load-related localized pain and addressing the underlying causes of the condition, such as overuse, improper footwear, or biomechanical issues 1.

Key Components of Treatment

• Relative rest of the affected area to reduce pain and inflammation
• Icing for 15-20 minutes several times daily, especially after activity
• Eccentric strengthening exercises to promote tendon healing and strengthening
• Supportive footwear with proper arch support or orthotic inserts to reduce stress on the tendons
• Gentle stretching exercises for the foot and calf muscles, holding each stretch for 30 seconds and repeating 3 times daily

Additional Treatment Options

• Topical and systemic nonsteroidal anti-inflammatory drugs (NSAIDs) may be effective for acute pain relief, but their use should be limited due to potential side effects 1
• Injected corticosteroids can relieve pain, but their use should be cautious and reserved for cases where conservative measures have failed 1
• Surgery may be an effective treatment option for patients who have failed conservative therapy, and involves excision of abnormal tendon tissue and performance of longitudinal tenotomies to release areas of scarring and fibrosis 1

Importance of Accurate Diagnosis

Accurate diagnosis is crucial in managing foot tendonitis, and requires physicians to recognize the historical features, anatomy, and useful physical examination maneuvers for these common tendon problems 1. Examination should include thorough inspection, range-of-motion testing, palpation for tenderness, and examination maneuvers that simulate tendon loading and reproduce pain. Imaging studies such as plain radiography, ultrasonography, and magnetic resonance imaging can be helpful if the diagnosis remains unclear 1.

From the FDA Drug Label

Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. Naproxen has been studied in patients with rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout

Foot Tendonitis Treatment with Naproxen:

• The recommended starting dose of naproxen for acute tendonitis is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required 2.
• Naproxen may be used for the management of acute painful conditions, including tendonitis, when prompt onset of pain relief is desired 2.
• Naproxen has been shown to be effective in treating tendonitis and bursitis, with improvement in patients demonstrated by reduction in pain and inflammation 2.

From the Research

Foot Tendonitis

• Foot tendonitis is not explicitly mentioned in the provided studies, but related conditions such as Achilles tendinopathy are discussed 3, 4.
• Achilles tendinopathy is a condition that presents with pain approximately 2 to 6 cm proximal to the Achilles insertion on the heel, and its primary nonoperative treatment involves eccentric strengthening exercises 3.
• Injection therapies such as platelet-rich plasma (PRP) and prolotherapy have been trialed for Achilles tendinopathy, but more evidence is required to show efficacy 4.
• Other foot and ankle conditions, such as plantar fasciitis and Morton's neuroma, are also associated with pain and disability, and their treatment options include orthotics, corticosteroid injections, and extracorporeal shockwave therapy 3, 4, 5.
• The effectiveness of these treatments can vary, and some may provide only short-term relief, highlighting the need for further research to evaluate the long-term effects of these treatments 4.

Treatment Options

• Orthotics, both prefabricated and custom fitted, have been shown to reduce pain and improve function in adults with acute plantar fasciitis 5.
• Platelet-rich plasma (PRP) injections have been found to provide long-term relief for some foot and ankle conditions, including Achilles tendinopathy 4.
• Eccentric strengthening exercises are a primary nonoperative treatment for Achilles tendinopathy 3.
• Shockwave therapy, exercise, and corticosteroids have also shown good outcomes for some foot and ankle conditions, although the effect of corticosteroids may be short-term 4, 6.

Research Gaps

• There is a need for further research to evaluate the long-term effects of various treatments for foot and ankle conditions, including tendonitis 4.
• More evidence is required to show the efficacy of certain injection therapies, such as PRP and prolotherapy, for Achilles tendinopathy 4.
• The treatment of partial-thickness tears in gluteal tendinopathy is an area where insufficient evidence is available to provide guidelines 6.