If you’ve been told you have “tendonitis” in your Achilles, peroneal tendon, or another tendon in your ankle, that term may be outdated. More importantly, it could be leading you toward the wrong approach for recovery.
Tendonitis suggests that inflammation is the main cause of your pain. This can make it seem like the answer is simple: ice the area, take anti-inflammatory medication, and rest until the pain goes away. However, research does not support this model for most cases of ongoing tendon pain.
In many cases, acute inflammation is not the main cause of the problem. This is why tendinopathy is now the preferred and more accurate term. The difference matters because it changes how you approach treatment and recovery.
The Load vs. Capacity Model
Instead of focusing only on inflammation, it helps to think about the relationship between load and capacity.
Load is anything that challenges your tendon. This can include walking, running, jumping, hopping, or other repetitive movements. Capacity is your body’s ability to handle that load, recover from it, and adapt over time.
Tendinopathy can develop when the load placed on a tendon consistently exceeds its current capacity. This is why these injuries are often described as overuse or relative overload problems. In simple terms, the tendon is being asked to do more than it is currently prepared to handle.
Unlike a sprain, there is usually no single moment when the injury happens. Instead, the problem tends to build over time.
Why Your Capacity Isn’t Just About the Tendon
One thing people often miss is that your ability to tolerate load isn’t only about the tendon itself. Your overall capacity can also be affected by factors such as certain medications, poor sleep, and metabolic health.
This helps explain why two people can do the same amount of running or jumping, yet only one develops tendon pain. Their bodies may have different levels of capacity and recovery.
Rehab that focuses only on the painful tendon may miss these other factors. Looking at the bigger picture can help identify what may be affecting your ability to recover and tolerate load.
Different Tendons, Same Underlying Problem
The same load-versus-capacity issue can affect several tendons throughout the ankle and foot.
The Achilles tendon is the thickest and strongest tendon in the body. It can experience forces several times your body weight during activities like walking and running. Achilles tendinopathy often causes localized pain that gets worse with activities that load the tendon. Morning stiffness is also common.
The tibialis posterior tendon helps support your foot’s arch and can also develop tendinopathy. This may happen after a sudden increase in running mileage or develop more gradually over time.
The flexor hallucis longus tendon is often affected in dancers and gymnasts. Tibialis anterior tendinopathy is less common but can occur after an increase in activities that involve repetitive ankle movement.
The tendon may be different, but the underlying issue can be the same: the load has exceeded the tendon’s current capacity.
What This Means for Treatment
If inflammation isn’t the main driver, then complete rest and anti-inflammatory treatments alone may not address the underlying problem. Effective tendinopathy treatment focuses on gradually rebuilding the tendon’s ability to handle load.
This often includes progressive strengthening exercises, such as calf raises for Achilles and tibialis posterior issues. It may also require adjusting your training volume, speed, distance, or frequency to match your current capacity.
Recovery can take longer than most people expect, but the goal is to address the actual problem rather than simply quieting the symptoms. By gradually increasing the load your tendon can tolerate, you can work toward building the strength and capacity needed to return to the activities you enjoy.
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Dr. Jonny Blue is a Doctor of Physical Therapy and founder of Land and Sea Physical Therapy in Oceanside, CA. He specializes in orthopedic PT, root cause methodology, and helping active adults in North County San Diego get back to the activities they love without surgery or pain medication.