Management of tendinopathies of the foot and ankle

Foot and ankle tendinopathies are a significant problem in orthopaedic practice. They represent a failed healing response. Such tendons show increased matrix remodelling, leading to a mechanically less stable tendon which is more susceptible to damage. Diagnosis is based on a careful history and detailed clinical examination and investigations. Initially treatment is by relative rest and modification of physical activity, use of rehabilitative exercises, evaluation and correction of intrinsic and extrinsic causes of injury. Surgical management is indicated if conservative management fails, in stage 3 tendinopathy or if tendon rupture occurs. Randomized controlled trials are awaited to clarify the best therapeutic options.