Inflammatory changes in the tendon sheaths behind the malleoli may give rise to pain at the sides of the ankle joint. Tenosynovitis may follow unusual excessive activity or be associated with degenerative changes, flat foot or rheumatoid arthritis. There is puffy swelling in the line of the tendons, with tenderness extending often for several centimetres along their length. Tibialis posterior and peroneus longus are most frequently involved, and stretching of these structures during inversion and eversion of the foot gives rise to pain. Spontaneous rupture is not uncommon. Symptoms generally respond to immobilization for short periods in a below-knee walking plaster or an orthosis.
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