Lower Extremity Tenosynovitis

What is lower extremity tenosynovitis?

  • Lower extremity tenosynovitis is a condition affecting the tendons of a lower extremity (limb). It also affects the lining of the sheath around the tendon (synovium). Tendons are cords of tissue that connect muscles to the bones. With lower extremity tenosynovitis, the sheath and the synovium of the flexor (bending) muscles become inflamed (swollen). The tendons may become thickened and have a hard time moving through the swollen covering. The tendons and synovium of the muscles of the foot, heel, ankle, or tibia (shin bone) may be affected. Over time, this may cause pain and tenderness when moving the affected leg or foot, especially the ankle and heel areas. Lower extremity tenosynovitis usually affects athletes, ballet dancers, and people of middle age or older.

  • Lower extremity tenosynovitis may be an acute or chronic (long-term) condition. It may also be caused by an infection due to a wound or trauma to the tendon. Bacteria (germs) spreading from other parts of the body through the blood may also cause lower extremity tenosynovitis. A sudden bacterial infection of the tendon coverings is usually the cause of an acute infectious tenosynovitis. A chronic infectious tenosynovitis may happen as a result of a long-term mycobacterial (germ) or fungal infection. With treatment, such as medicines, a splint, rehabilitation, or surgery, you may be able to resume your normal daily activities.

What causes lower extremity tenosynovitis?

The exact cause of most lower extremity tenosynovitis remains unknown. The following are possible causes or conditions that may increase your risk of getting lower extremity tenosynovitis:

  • Impingement: Incorrect leg or foot movements, or weak flexor muscles may cause the tendon to become trapped. This may also happen in people who overtrain or have a sudden change in leg or foot activity.

  • Infections: Germs, such as bacteria or fungi, may often cause lower extremity tenosynovitis. The infections may result from wounds, bites, wounds from plant thorns, or intravenous (IV) drug abuse.

  • Steroid use: Steroid medicines may cause weakening of the tendon and its covering. This increases your risk of irritation and swelling of the tendons in your lower extremity.

  • Tendon overuse: Lower extremity tenosynovitis may be caused by frequent, repeated movements, such as hopping or jumping. This usually occurs among ballet dancers and athletes, such as gymnasts, ice skaters, swimmers, soccer players, or distance runners.

  • Trauma: An ankle sprain, in which the ankle turns inward, may cause lower extremity tenosynovitis. A direct blow to the extremity or leg or foot surgeries in the past may also damage the tendon. This may cause scar tissue to form and make the tendon thick and unable to stretch or move very well.

  • Weak immune system: The immune system is the part of your body that fights infection. A problem with the immune system sometimes makes your body weak and unable to fight infections. A wound infection or an immune problem, such as spondyloarthropathy, may make you more likely to develop lower extremity tenosynovitis.

  • Other conditions: These conditions may include hypertension (high blood pressure), diabetes, rheumatoid arthritis, gout, or problems with the thyroid gland. Obesity (being overweight) and tendon changes due to aging may also cause lower extremity tenosynovitis.

What are the signs and symptoms of lower extremity tenosynovitis?

There is usually redness, swelling, or pain of your affected leg or foot. The pain or tenderness usually occurs when you move or bend the affected part, such as while running or walking. Over time, the pain may become worse and may be present even at rest. You may also have any of the following:

  • Clicking, locking, or snapping of toes or ankles.

  • Develop a flatfoot.

  • Grating sound or feeling when the leg or foot is touched or rubbed.

  • Nodule (bump) may be present or your toes may look like sausages.

  • Stiffening of the leg, ankle, or foot.

  • Weakness and limited movement of the affected part.

How is lower extremity tenosynovitis diagnosed?

You may need any of the following:

  • Physical exam: Your caregiver may have to move your legs and feet in certain directions. He will check to see if you have any pain, weakness, or movement problems. He may also check your other lower extremity for any pain, weakness, or movement problems.

  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

  • Biopsy and culture test: A biopsy may be done by taking fluids out through a needle. Your caregiver may also do a biopsy by surgically opening one or more tendons. The fluid or the tendon biopsy will then be taken to a lab and tested.

  • Imaging tests: You may be given dye before the pictures are taken in some of these tests. The dye is usually given in your IV. The dye may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.

    • Arthrogram: An arthrogram is an x-ray that is taken after dye is injected into your affected joint. This test is used to view the structures of your joint such as muscles, ligaments, tendons and cartilage. The dye helps your caregiver see the structures better. People who are allergic to iodine or shellfish (lobster, crab or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish or have other allergies or medical conditions.

    • Computerized tomography scan: This is also called a CT or CAT scan. A special x-ray machine uses a computer to take pictures of your lower extremity.

    • Magnetic resonance imaging scan: This is also called an MRI. An MRI uses magnetic waves to take pictures of the leg, thigh, knee, ankle, or foot area. This may help your caregiver decide if you have lower extremity tenosynovitis, or another condition that is affecting your limb.

    • Ultrasound: An ultrasound is a simple test that looks inside of your body. Sound waves are used to show pictures of your organs and tissues on a TV-like screen. Caregivers may also look for fluid near the area of your pain and redness. You may also be able to hear your blood flow during this test.

    • X-rays: You may need x-rays of your lower extremities to check for broken bones or other problems. X-rays of both your painful and non-painful lower extremities may be taken.

How is lower extremity tenosynovitis treated?

Treatment will depend on your symptoms and the length of time you have had them. Your caregiver may want you to limit movement of your affected lower extremity to decrease stress on the tendon. This may help prevent further damage, decrease pain, and promote tendon healing. You may also have one or more of the following:

  • Aiding devices: You may need any of the following:

    • Crutches: Caregivers may have you use crutches to decrease stress and strain on your lower limbs.

    • Orthotics: Orthotics are shoe inserts that help decrease pain, relieve stress on the tendons, and make your foot and ankle more stable.

  • Immobilization: Immobilization is an important treatment that allows the tendon and its covering to heal. A brace, splint, walking boot, or cast may be used on the affected part to immobilize it. This helps to decrease pain and prevent the tendons from being damaged further.

  • Medicines: Your caregiver may give you medicine to decrease the pain and swelling in your leg, ankle, or foot. Other medicines, such as antibiotics or anti-fungals, may be given to fight infections.

  • Surgery: You may need surgery if your symptoms do not go away with other treatments. Surgery may also be done if your pain gets worse or is so severe that it affects your daily activities.

  • Rehabilitation: This is a program that may include physical and occupational therapy to help your condition heal faster. When the swelling has gone down, you may be given exercises to do. These exercises will bring back the normal range of motion of your lower extremities and strengthen your tendons. Your caregiver may also ask you to make changes in your activities to decrease stress on the tendons. These changes may also prevent this condition from happening again.

  • Ultrasound therapy: A device that uses ultrasound with heat may be used to massage the swollen or irritated lower extremity. This may help relieve pain and swelling.

Where can I find support and more information?

Having lower extremity tenosynovitis may make it hard for you to continue your usual activities. It may make things difficult for both you and your family. Contact the following for more information:

  • American Academy of Orthopaedic Surgeons
    6300 North River Road
    Rosemont , IL 60018-4262
    Phone: 1- 847 - 823-7186
    Web Address: http://www.aaos.org/

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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