Bodyworks: Peritendinitis

How to recognise it, how to overcome it

by Patrick Milroy

The Achilles tendon is surrounded by a paratenon to help lessen friction with movement. You will notice swelling, thickening and tenderness in comparison with the other tendon, due to friction on the paratenon.

Your doctor may also be able to demonstrate crepitus, a crackling sensation in the tendon between finger and thumb as the ankle is moved.

Medical investigations
Soft tissue x-ray should confirm what is already obvious, but may also show thickening in Kagar’s triangle, the area between the front of the tendon and the back of the tibia.

What else could it be?
It could be Achilles tendinitis, although it is important to remember that you may be suffering from several conditions at once.

Ice and gentle stretching should be the mainstay of your management after you have eliminated friction between tendon and shoe back.

Medical treatment
This is one of only two conditions in which a steroid injection near the Achilles can produce dramatic relief. Provided your doctor inserts it into the paratenon and not the tendon, you can achieve a rapid resolution of symptoms and signs. However, if it is inserted into the tendon, there is a high risk of tendon rupture.

Recovery time
You should have a mandatory week’s rest after the injection, but if more conservative methods of treatment are used, training can be increased accordingly as the crepitus and swelling subside.

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Discuss this article

I've just been diagnosed as having Peritendinitis and am a little distraught. I'm a relatively new runner but was gearing up for my first 10K on December 1st, to fulfill my year's ambition. Now it looks like I may not be able to do this.
I've seen a sports masseur who is going to sort me out with some ultra sound and I've just started taking ibuprofen to relieve the swelling. Plus I'm icing regularly.
I wondered if any of you have any handy hints for quick recovery and not loosing fitness before the big day.
Posted: 01/11/2002 at 10:41

Dear Emma,
Firstly, where is the problem, and who made the diagnosis of Peritendinitis?
Some Ultrasound & Ibuprofen may help, but it may only serve to mask an underlying problem with your running action and the biomechanics in your leg(s).
I would advise a consultation with a specialist physio who has experience of running problems.

Posted: 01/11/2002 at 11:47

The diagnosis was made by a trained sports masseur. The problem is at the bottom rear of my leg, on the left hand side above the ankle - this is where the discomfort is primarily. I do wear orthotics, made specifically for me by a podiatrist to resolve my excessive over pronation and have been instructed to wear these for running as well as normal day wear. I've been wearing them for about 8 months. The peritendinitis is a week old today!
I have made an appointment to see a physio now for ultra sound which my sports masseur referred me to.
Posted: 01/11/2002 at 13:29

Hope they can sort you out. In my experience the only real solution is rest, plus some local treatment and some stretches.Have you changed your running route recently & how old are your running shoes, and are they the right ones for you? Even if you wear Orthotics, you still need to change your shoes regularly.
The other aspect to consider is whether it is in fact a problem with the Tendon, or is it referred pain from elsewhere in the leg, or even your lower back. Do you have any back pain? Make sure the physio checks out everything! Take along your running shoes and Orthotics when you go for your appointment
Good luck!
Posted: 01/11/2002 at 23:56


Just a bit of advice, no matter how tempting it is to try and run in your first 10K, if it still hurts please don't run on it!

I did the GNR when I shouldn't have and am stil suffering now!

Read this months star letter in Runner's World magazine!

Off to the Gym now to play on the Cross Trainer!

Hope you get better soon,


In My Satin Tights, Fighting For Our Rights!

Posted: 02/11/2002 at 15:29

*sob* I've been out for 3 1/2 weeks with this & no sign of improvement - did nearly a WHOLE MILE last night & it was getting worse & worse all the way round. Someone please give me hope!
Posted: 17/03/2005 at 19:49

just a word of caution re sports physios etc

my sports physio told me I had degenerative joint disease and advanced arthritis in my hip joints and that I should stop running and would need a hip replacement by the time I was mid 40s.

needless to say I was distraught by this and questioned his judgement. I pushed to be seen by a hip specialist, had x-rays and mri scans and it turned out to be soft tissue damage due to a recent riding accident and there were no changes/degeneration of the hip joints.

if you are at all concerned get a second opinion
Posted: 17/03/2005 at 20:38

peritendinitis is often confused with tendinosis.
Both have similar symtons but treated differently.
peritendinitis is treated with rest but tendinosis is treated aggresivley with exercise and stretching.

It is possible to have both at the same time. Which is obviously a bit of a bugger to treat.

Do you know why, how or what brought it on? I had the 'itis one the other day and noarrowed it down to my cross country trainers. I went out on the road in my other trainers and it was fine.

Posted: 18/03/2005 at 06:31

Duck girl, it will get better with rest, ice and I saw a physio too. I know this is V V Depressing, (am about to withdraw from marathon because of iliotibial band syndrome, tears have been flowing!), but ultimately, what do we like doing? Running. So, if we want to carry on and have to stop for the shortest period of time, we have to rest. Sorry to be school mamish, but you know its true. It does get better and is definitely not the end of being able to run. Frustrating I know.
Posted: 18/03/2005 at 08:25

I've had an achillies tendon niggle for almost 2 years & have run 3 marathons through it without any problem, but having stopped running for 4 weeks due to illness, when I started again, my niggle(which used to disappear after 500m) suddenly became intrusive. The injured tendon is clearly thicker than than the other one. I have been running for 15 years. Any advice? I've cut back my milage by 80% & turned to the bike while I work out what to do next.
Posted: 25/08/2005 at 23:17

Ice and physio I'm afraid. But it works! Good luck.
Posted: 26/08/2005 at 08:14

Can any give me any advice, I noticed a swelling of my achillies tendon after i ran a 10k race over three weeks ago, since then i have had a one session of ultra sound, and complete rest from running. Last few days i have been doing some light cycling and some swimming. I am thinking of running again (just a couple of easy miles) as the sweling has clearly gone down, the only worries i'm having is that  when i bend / stretch my foot forwards and backwards i'm still getting that horrible cracking feeling (Crepitus) i think its called right on my achillies. I am getting no pain in the achillies itself but that cracking feeling is worrying me ? Wondered if anyone out there can shed any light on this for me.

Posted: 12/07/2009 at 13:04

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