Hindfoot Tendinopathies

Tendinopathies are common hindfoot injuries that can result in high morbidity for the patient. While the exact incidence in the hindfoot remains unknown, around 30% of all musculoskeletal consultations in the general practice are associated with this disabling condition (Kaux JF, Forthomme B, Goff CL, Crielaard JM, Croisier JL, J Sports Sci Med. 10:238–53, 2011). In the acute phase, hindfoot tendinopathies are often missed or mistaken for an ankle sprain (Gorter K, de Poel S, de Melker R, Kuyvenhoven M, Fam Pract. 18:569–73, 2001). On the other hand, overuse or chronic injuries are difficult to diagnose due to the slow onset of symptoms. As tendinopathies can have a strong impact on the patient’s quality of life, timely and accurate diagnosis is important for effective management and to avoid socioeconomic burden (Yelin E, Weinstein S, King T, Semin Arthritis Rheum. 49:1–2, 2019). In recent times, our understanding of tendon injuries has evolved significantly and today tendinopathy is considered a chronic, degenerative pathology. The cause of tendinopathies is mostly multifactorial and can be an expression of systemic or general musculoskeletal problems. A combined thorough patient history and physical examination are the cornerstone for diagnosing the tendinopathy itself as well as to find possible contributing factors or underlying diseases. Additional diagnostic modalities such as ultrasound and magnetic resonance imaging can be used to confirm the clinical suspicion of tendinopathy. This chapter provides an overview of the pathophysiology, patient history, risk factors, and physical examination of tendinopathy with special emphasis on the hindfoot tendons.