Tendons are the link between the muscles and the bones. They transmit the force created by the muscle and guarantee full function of the joints. Tendons are more often affected by overuse and micro-injuries but other tendons also can rupture due to an injury.
On the outside of the ankle joint are the two peroneal tendons that help to stabilise the ankle joint. Those tendons may show some wear and tear but often do not cause a lot of pain. When the tendons split, dislocate or develop a lot of inflammation in the surrounding tissue pain becomes more intense and patients need further treatment.
On the inside of the ankle joint, the tibialis posterior tendon is the most commonly affected tendon that can result in pain, weakness and eventually may lead to a flat foot deformity.
Tendon problems may cause pain when starting to be active or after finishing activities and the intensity of pain may vary on a daily basis.
It is important to detect tendon problems early enough to prevent further deterioration which may then need surgical intervention.
A tarsal coalition might only be detected if symptoms do not improve after a simple sprain despite the correct treatment. Identifying the problem is crucial and once the diagnosis is confirmed (ideally with CT or MRI scan) relative rest and footwear modification will be paramount to help to eliminate the pain. In case symptoms do persist surgery might be indicated. Younger patients may benefit from removing the tissue that connects the two bones but in most cases fusing the affected bones together will be the only options to settle the pain. As the affected joints are, due to the coalition already not mobile, “knitting” the bones together will not cause any further stiffness but will permit patients to regain good function of the ankle/foot. Pain will settle once the bones have healed together and the operation will permit to realign the often flat foot at the same time.
