Non-Achilles ankle tendinopathy
- Timothy Ryan Draper, DO, AAFP, CAQ Sports Medicine
Timothy Ryan Draper, DO, AAFP, CAQ Sports Medicine
- Assistant Professor of Family Medicine
- University of North Carolina School of Medicine
- Associate Program Director
- Cone Health Sports Medicine
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Approximately 50 percent of sports-related injuries are related to overuse. Of injuries seen in running clinics, the majority are due to overuse with about half involving the lower leg . Many such injuries involve a tendinopathy.
The clinical presentation and management of tendinopathies involving ankle tendons other than the Achilles is reviewed here. Achilles tendinopathy, as well as acute ankle injuries, are discussed separately. (See "Achilles tendinopathy and tendon rupture" and "Ankle sprain" and "Overview of ankle fractures in adults".)
Tendinopathy, or tendinosis, is a clinical syndrome that often follows an initial period of inflammation (tendonitis). Some clinicians mistakenly use the terms tendinopathy, tendinosis, and tendonitis interchangeably. The histopathology and treatment of tendinopathy differs from that of acute tendonitis. An overview of tendinopathy is provided separately. (See "Overview of overuse (chronic) tendinopathy".)
EPIDEMIOLOGY AND RISK FACTORS
Fifteen percent of overuse injuries affect the ankle, most commonly the Achilles, posterior tibialis, peroneus longus, and peroneus brevis tendons . Tendinopathy can develop in both the athletic and sedentary patient but is uncommon in children. Extrinsic factors that can predispose to ankle tendinopathy include improper training, poor biomechanics (eg, running technique), and improper footwear. Intrinsic factors can include foot malalignment, leg length discrepancy, joint laxity, and obesity.
A number of medications have been associated with musculoskeletal injury, including nonsteroidal antiinflammatory drugs (NSAIDs) and statins. Although rare, fluoroquinolone use may be associated with tendinopathy and acute tendon rupture. The association of specific agents with tendon injury is discussed separately. (See "Nonselective NSAIDs: Overview of adverse effects", section on 'Healing of musculoskeletal injury' and "Statin myopathy" and "Achilles tendinopathy and tendon rupture", section on 'Measures for patients on fluoroquinolones'.)
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- EPIDEMIOLOGY AND RISK FACTORS
- LATERAL ANKLE TENDINOPATHY
- Clinical presentation and physical examination
- Imaging studies
- Differential diagnosis of lateral ankle tendinopathy
- MEDIAL ANKLE TENDINOPATHY
- Clinical presentation and physical examination
- Imaging studies
- Differential diagnosis of medial ankle tendinopathy
- - Posterior tibialis tendinopathy
- - Flexor hallucis longus tendinopathy
- ANTERIOR ANKLE TENDINOPATHY
- Clinical presentation and physical exam
- Imaging studies
- Differential diagnosis of anterior ankle tendinopathy
- FOLLOW-UP AND RETURN TO WORK OR SPORT
- SUMMARY AND RECOMMENDATIONS
- Lateral ankle tendinopathy
- Medial ankle tendinopathy
- Anterior ankle tendinopathy
- Common elements of management