Types of foot tendonitis by location
- Achilles tendonitis: pain at the back of the heel or above it; see Achilles tendonitis.
- Posterior tibial tendonitis: pain on the inside of the ankle and arch, sometimes with a flattening arch.
- Peroneal tendonitis: pain behind and below the outer ankle bone; see peroneal tendonitis.
- Extensor tendonitis: pain on the top of the foot, often from tight laces; see extensor tendonitis.
- Flexor hallucis longus tendonitis: pain on the inside of the ankle and under the big toe, common in dancers.
- Anterior tibial tendonitis: pain at the front of the ankle.
Symptoms
- Pain that starts gradually and is worse with activity.
- Stiffness and pain in the first steps in the morning.
- Tenderness when pressing along the tendon.
- Swelling or thickening of the tendon.
- Creaking or crackling with movement in some cases.
- Weakness when pushing off or rising onto tiptoes.
Causes and risk factors
- Sudden increase in running, walking or sport.
- Hill running or hard surfaces.
- Worn or unsupportive shoes, or tight laces.
- Flat feet or high arches.
- Tight calf muscles.
- Inflammatory arthritis, gout or diabetes.
- Some antibiotics (fluoroquinolones), which can increase the risk of tendon problems.
- Ageing, as tendons become less elastic.
How it is diagnosed
A doctor or physiotherapist examines the foot, presses along the tendons and tests strength, often asking you to stand on tiptoe or turn the foot against resistance. Ultrasound or MRI may be used if the diagnosis is unclear, symptoms are severe, or a tear is suspected. X-rays can show bone spurs or other causes of pain. The NHS lists many causes of foot pain, including tendon problems, that can be distinguished by examination.
Early self-care
- Reduce or modify the activity causing pain, but keep moving.
- Use ice wrapped in a cloth for 15–20 minutes after activity.
- Take simple pain relief if needed, for a short time.
- Wear supportive, well-cushioned shoes.
- Loosen laces or change lacing patterns for top-of-foot pain.
- Avoid running on hills or hard surfaces for a few weeks.
Exercises for foot tendonitis
- Calf raises: slowly up and down, progressing to single-leg and then off a step.
- Resistance band inversion: for the posterior tibial tendon, turning the foot inward against a band.
- Resistance band eversion: for the peroneal tendons, turning the foot outward.
- Toe curls and towel scrunches for the flexor tendons.
- Calf stretches: straight and bent knee.
- Balance exercises on one leg.
- Mild pain during exercise is usually acceptable if it settles within 24 hours.
What the evidence shows
Tendons respond to gradual, progressive loading. A randomised trial in people with early-stage posterior tibial tendon dysfunction found that foot orthoses combined with progressive resistance exercise, performed at home over 12 weeks, reduced pain and improved function. Similar loading principles are used for Achilles and other tendinopathies. Rest alone often leads to symptoms returning when activity resumes.
Footwear, insoles and braces
Supportive shoes with a firm heel counter and cushioning reduce strain on tendons. Arch supports or custom orthotics may help posterior tibial and peroneal tendon problems. A heel raise can temporarily offload the Achilles tendon. Ankle braces may be used for unstable ankles. Flat feet can contribute to posterior tibial problems; see flat feet exercises.
Medical treatments
If symptoms persist, a physiotherapist or podiatrist can guide a structured programme. Other options include shockwave therapy for some tendinopathies, walking boots for severe cases, and treating underlying conditions such as inflammatory arthritis. Steroid injections are used cautiously near weight-bearing tendons because of the risk of rupture. Surgery is rarely needed, mainly for tears or advanced posterior tibial tendon dysfunction.
Three common situations
- Runner with pain on the inside of the ankle after adding hills: reduce hills, strengthen with band exercises and check footwear.
- Pain on the top of the foot after new boots: loosen lacing and rest; it often settles quickly.
- Sudden snap at the back of the heel during sport: seek urgent assessment for Achilles rupture.
Returning to running and sport
- Start once walking and single-leg heel raises are comfortable.
- Begin with short, easy runs on flat ground, every other day.
- Increase distance gradually, by around 10% a week.
- Add hills, speed work and jumping last.
- Keep doing strengthening exercises two to three times a week.
- Back off if pain increases the next morning.
Key points to remember
- The location of pain suggests which tendon is involved.
- Overuse, footwear and foot shape are common causes.
- Gradual strengthening is the main treatment.
- Sudden snap or inability to push off needs urgent care.
Questions about foot tendonitis
These answers are general information and do not replace an examination or individual medical advice.
How long does foot tendonitis take to heal?
Mild cases may settle in a few weeks; longer-standing tendinopathy can take three to six months of exercise.
Should I walk with foot tendonitis?
Walking in supportive shoes is usually fine if pain is mild. Reduce distance if pain increases.
Is foot tendonitis serious?
Usually not, but untreated posterior tibial problems can lead to a collapsing arch.
Can shoes cause foot tendonitis?
Yes. Worn, unsupportive or tight shoes are common contributors.
Is heat or ice better for foot tendonitis?
Ice is often used after activity for pain relief; heat may ease stiffness before exercise.
Sources
- Kulig K, et al. Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Phys Ther. 2009
- NHS · Foot pain
- NHS · Tendonitis
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.