Tendinopathies of the lower limb are particularly common among runners and running based sports. The nature of these sports expose our limbs to high repetitive loads; this can increase the risk of tendon overuse in the lower extremity. The most commonly affected tendons are – Achilles Tendon, Peroneal Tendon and Tibialis Posterior Tendon.
All tendinopathies are primarily driven by excessive load. The amount of load placed on our tissues is determine by both intrinsic (within the body) and extrinsic (outside the body) factors.
Common intrinsic factors may include;
- Poor muscle strength
- Running technique / form
- Muscle flexibility
- Joint stiff / range of motion
- Posture
Common extrinsic factors may include;
- Footwear
- Running intensity
- Mileage / running distances
- Terrain / running surface
Achilles Tendon
Anatomy
– The achilles tendon gives rise to the attachment of our calf muscle complex to our foot. It is the conjoint tendon of our two calf muscles and runs from these muscles to the back of our heel.
– The primary role of the achilles tendon is foot / ankle plantarflexion (foot pointing downwards), the achilles tendon is under tensile load in the position.
– Compressive load of the achilles tendon is produced when the foot and ankle are in excessive dorsiflexion e.g. aggressive heel striking.
– Common contributing factors include; changing too rapidly and unnecessarily to a mid/forefoot strike, lack of calf strength, forceful push off, excessive hill running.
Tendon Tissue
– Achilles tendinopathy can exist in different forms. It is important to identify which of these it may be as management of the two may differ.
o Insertional- at the point where the tendon joins to the bone at the base / back of the heel
o Mid portion – In the length of tendon between the heel and the muscle.
o Enthesopathy – Breakdown existing within both the insertional tendon fibers and the bone endplate
Management
- Managing your load safely / taking note of any sudden load increase (distance, intensity, terrain etc.)
- Adding a heel raise to your shoe can help deload the achilles tendon and calf complex.
- Walking up any uphill sections throughout your runs
- Having your running reviewed by a physiotherapist
- Addressing strength and tendon rehabilitation exercises
Peroneal Tendons
Anatomy
– The peroneals are a small group of three muscle (longus, brevis and tetris) that run down the outside of our lower leg. The muscles originate from the top of the fibula (outside and below the knee), and its tendons insert at multiple points in the foot.
– The primary action of the peroneals is ankle supination and eversion (upward and outward movement of the ankle), the peroneal tendon/s are under tensile load in this position.
Tendon Tissue
– Compressive load of the peroneal tendon/s occur when the foot and ankle is inverted and dorsiflexed.
Contributing Factors
– Common contributing factors include; excessive ankle supination, running on cambered path, ill-fitting footwear.
Management
- Managing your load safely / taking note of any sudden load increase (distance, intensity, terrain etc.)
- Having your running reviewed by a physiotherapist.
- Addressing strength and tendon rehabilitation exercises.
- Having your footwear reviewed
Tibialis Posterior Tendon
Anatomy
– The tibialis posterior is a muscle that run behind the tibia (shin bone). Its tendon sits underneath the inside ankle bone (medial malleolus) and attaches at numerous sites in the foot.
– The primary action of the tibialis posterior in foot and ankle pronation and inversion (upwards and inwards), and is under tensile load in this position
Tendon Tissue
– The tibialis posterior tendon goes under compressive load as it wraps under the medial malleolus when the foot is everted and plantarflexed.
Contributing Factors
– Common contributing factors include; excessive ankle pronation, ill-fitting footwear, cambered or uneven running surface, heavy foot strike.
Management
- Managing your load safely / taking note of any sudden load increase (distance, intensity, terrain etc.)
- Having your running reviewed by a physiotherapist.
- Addressing strength and tendon rehabilitation exercises.
- Having your footwear reviewed
