Key Insights For Diagnosing And Treating Tendinosis

By Babak Baravarian, DPM

   Tendinosis is one of those diagnostic terms that took me a while to truly understand. People most often use this term in relation to the Achilles complex but tendinosis can be related to any tendon of the foot or ankle. In most cases, tendinosis is associated with the tendons about the ankle and the most commonly affected tendons are the Achilles, posterior tibial and peroneals.    While tendinosis is a very simple concept to explain, it is a far more difficult concept to truly understand and treat. Essentially, tendinosis involves the fraying or scarring of the fibers of the associated tendon and the replacement of a small or extended region of the tendon with scar tissue or fibrous tissue. The level of scar may be palpable to pressure on the associated region or may be microscopic in nature. There may be a bulbous region of damage or very small, scattered regions of damage.    When tendinosis involves the posterior tibial or peroneal tendons, there is no associated peritenon and accordingly no peritenonitis or peritenosis. The most common regions of tendinosis are at stretch areas such as the associated malleolar bends, the navicular insertion for the posterior tibial tendon and the fifth metatarsal base for the peroneus brevis tendon. There are also far less visible signs of problems and one may define the major pathology with an ultrasound or an MRI of the region. The Achilles is a totally different animal and may have many different pathology findings due to the fact that there is a tendon, a prominent insertion site and a paratenon.

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