Tendonitis vs. Tendinosis: Why the Distinction Matters for Treatment

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Two Different Conditions — One Frequently Misnamed

The terms “tendonitis” and “tendinosis” are frequently used interchangeably, but they describe fundamentally different pathological processes in tendons that require different treatment approaches. Using anti-inflammatory treatment for tendinosis (a degenerative condition with minimal inflammation) explains why many tendon conditions don’t respond to NSAIDs and corticosteroid injections as expected. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we distinguish tendinopathy types to direct the most effective treatment for each patient.

Tendonitis: Acute Inflammatory Phase

True tendonitis — tendon inflammation — occurs in the acute phase after overuse injury or sudden load increase. The tendon experiences microscopic fiber damage, triggering the classic inflammatory response: increased vascularity, prostaglandin release, inflammatory cell infiltration, and tissue edema. This phase produces classic inflammation signs — warmth, swelling, pain with activity. True tendonitis typically lasts 2-6 weeks. During this phase, anti-inflammatory treatment is appropriate: relative rest, ice, NSAIDs, and potentially a brief course of corticosteroid (with caution — steroids inhibit the early healing phase but reduce the inflammatory symptom burden). Physical therapy in the acute phase focuses on reducing load and promoting vascular healing.

Tendinosis: Chronic Degenerative Phase

Tendinosis is the state that develops when a tendon injury fails to adequately heal — or when chronic repetitive injury exceeds the tendon’s healing capacity over time. Histologically, tendinosis shows: disorganized collagen fiber arrangement, increased ground substance (proteoglycans), neovascularization (new dysfunctional blood vessel ingrowth), neural ingrowth (explaining the chronic pain), and absence of acute inflammatory cells. This degenerative tissue does not respond to anti-inflammatory treatment — there is no inflammation to suppress. Studies show that chronic Achilles and plantar fascia tendinopathy samples have essentially no inflammatory cells on biopsy, even in highly symptomatic patients.

Treatment Implications for Tendinosis

Tendinosis treatment focuses on stimulating organized collagen synthesis and remodeling of the disorganized degenerative tissue. Eccentric exercise programs — loading the tendon through its lengthening phase — are the most evidence-supported rehabilitation approach for tendinosis (Alfredson protocol for Achilles, similar approaches for plantar fasciitis and peroneal tendinopathy). PRP (platelet-rich plasma) injection provides growth factors that promote tendon healing in degenerative tissue. Extracorporeal shockwave therapy stimulates mechanical remodeling and neovascular disruption. Collagen-stimulating treatments (prolotherapy, dry needling) aim to initiate a controlled inflammatory response in degenerative tissue to restart healing. Contact Balance Foot & Ankle at (810) 206-1402 for accurate tendinopathy diagnosis and targeted treatment.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist

If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.

Call Balance Foot & Ankle: (810) 206-1402  ·  Book online  ·  Offices in Howell & Bloomfield Hills

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.