Important tendons cross the anterior, medial and lateral aspects of the ankle. These include, respectively, the tibialis anterior; the tibialis posterior; and the pair of peroneal tendons (peroneus longus and brevis). Due to their important roles during gait, each of these tendons may be subject to overuse and inflammation. When symptoms of inflammation are present, the clinical diagnosis of tendonitis may apply. The large Achilles tendon runs posterior to the ankle and inserts into the calcaneus. It may be affected by a number of clinical conditions that are reviewed in chapter 8 (Achilles tendon disorders) and chapter 14 (Achilles tendon rupture).
The terminology of tendon disorders may be confusing. (Indeed, the first hit on Google for the term “tendonitis” takes you to a site about “tendinitis.”) Although it is certainly acceptable to use “Tendinopathy” as an all-encompassing term denoting a disease of a tendon, it may be helpful to think of three distinct disorders:
Tendonitis, also known as Tendinitis, refers to a painful clinical condition where there is acute pain and swelling due to microtearing of the tendon and the resulting inflammatory response.
Tendonosis (or tendinosis) is a chronic degenerative condition in which repetitive overuse and aging leads to a non-inflammatory degeneration of the tendon’s collagen over time.
Paratenonitis is an inflammation of the lining of the thin lining of connective tissue that surrounds many tendons allowing the tendon to glide more easily, namely the paratenon.
In a nutshell, you must ask: is the problem an acute inflammatory problem, or is this a degenerative condition? Or is the problem extrinsic to the tendon altogether? Note that it can be difficult at times to differentiate clinically between these three conditions. Many cases of acute inflammatory tendonitis occur in the setting of underlying degenerative changes within the tissue. Therefore, while the term tendonitis will be used broadly in this chapter, it should be kept in mind that the described condition may not be tendonitis, per see.
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