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Ankle Pain

Peroneal Tendonitis

Minute Read


Posted 1 year ago


Last updated: 03/12/2022


by James McCormack

What is Peroneal Tendonitis?

Peroneal Tendonitis is characterized by inflammation and degeneration of the peroneal tendons due to overuse or biomechanical issues. There are several intrinsic and extrinsic causes of Peroneal Tendonitis, which we will cover in detail in this article, alongside information on how to treat Peroneal Tendonitis, which is more commonly known in the UK as Peroneal Tendinopathy.

Picture Diagram of the Peroneal Tendons

What are the Peroneal Tendons?

There are 3 Peroneal tendons; Peroneal Longus, Peroneal Brevis and Peroneal Tertius. All 3 of these originate on the outer side of the shin bone. They pass down through the lateral ankle, connecting to the outside and underside of the foot.

The primary functions of the Peroneal Tendons are to turn the foot outwards and downwards while also acting as a key stabiliser of the ankle. The Peroneal Tendons are active throughout the gait cycle and contract to give additional stability with changing direction or when someone missteps and rolls their ankle. This article will explore Peroneal Tendonitis causes, symptoms, and treatment.

Related Article: Anatomy and Function of the Ankle Tendons

Peroneal Tendonitis Symptoms

Peroneal Tendonitis in the acute phase leads to constant pain on the outer side of the ankle and foot that is painful when walking or turning the foot outwards. There may be a clicking noise or crepitus with the ankle’s movement, which usually occurs for an initial 0-72 hours post-injury.

Symptoms of chronic Peroneal Tendonitis include pain and stiffness on the outside of the ankle first thing in the morning when stepping out of bed that can last for up to 1 hour. Peroneal Tendonitis can be painful when walking after sitting for some time and activities such as running may be stiff and painful at the beginning but ease as it warms up.

The location of the pain is on the outside of the ankle and onto the foot’s outer side when the peroneal tendons attach to the fifth metatarsal. If this is inflammation of the Peroneal Longus Tendon, there may be pain on the foot’s underside.

Peroneal Tendonitis Causes

Peroneal Tendonitis is caused by a repetitive overload of the Peroneal Tendons. When running or walking, poor biomechanics can overload the lateral ankle leading to overuse of the Peroneal Tendons. This overuse causes inflammation, irritation, and pathological changes within the tendons, leading to Tendonitis.

Repetitive ankle sprains can result in Peroneal Tendonitis. The lateral ligaments become stretched, leading to instability of the ankle. The Peroneal muscles compensate by working harder to provide additional stability to an ankle, causing an overload.

Flat feet and adult-acquired flat feet can lead to excessive foot movement when walking or running, overloading the Peroneal Tendons and causing Tendonitis.

Other causes include poor footwear, sudden walking or running speed or volume increases, foot deformities, and hypermobility.

Peroneal Tendonitis Diagnosis

It is important to see a medical professional such as a Physical Therapist for a clinical diagnosis of your pain. After collating your medical history and onset of symptoms they will usually carry out a physical examination including a clinical test for Peroneal Tendonitis that requires the patient to dorsiflex and evert the foot against the resistance of the practitioner’s hand. A positive test provokes pain in the Peroneal tendons.

An x-ray is a useful form of imaging to rule out other potential causes of lateral ankle pain such as ankle osteoarthritis but cannot be used to correctly diagnose Peroneal Tendonitis. MRI and Ultrasound are the most accurate forms of imaging to clinically diagnose Peroneal Tendonitis and the results should be correlated alongside a clinical assessment.

There are a number of conditions that present with similar symptoms to Peroneal Tendonitis on the outside of the ankle and foot such as:

Peroneal Tendonitis Diagram

Physical Therapy for Peroneal Tendonitis

Physical Therapy is the best and most effective form of treatment for Peroneal Tendonitis. Physical therapy includes a variety of treatments such as strengthening exercises, stretches, massage, taping, and insoles where necessary.

Peroneal Tendonitis Treatments

Strengthening Exercises are a fundamental aspect of treatment for Peroneal Tendonitis. It is essential to condition the Peroneal Tendon to absorb load from impact activities such as running, walking, and jumping. A tendon can become tight, inflamed, and painful when fatigued. Strength training, therefore, plays a significant role in increasing the tendon’s capacity, alleviating pain, and reducing the risk of recurrence. As a tendon becomes fatigued, the muscles attaching to the tendon can become tight, leading to further irritation and discomfort. Peroneal stretching can help reduce this tension and provide symptomatic pain relief.

Massages such as sports and deep tissue massage for Peroneal Tendonitis aren’t classified as a primary form of treatment. Still, a massage or a massage gun can provide pain relief from Peroneal Tendonitis. Foam rolling is another form of self-massage that can be used for pain relief. Peroneal Tendonitis Taping involves applying a rigid taping to the ankle can help reduce Peroneal Tendon pain levels as it shortens the tendon. As a result, it doesn’t have to work as hard. KT Tape has been shown to have minimal to no effect on Peroneal Tendonitis.

Peroneal Tendonitis Brace has a similar role to rigid ankle taping as it reduces movement at the ankle’s subtalar joint. As a result, the Peroneal Tendons don’t have to work as hard to stabilise the tendon. The benefit of a brace over taping is that it is a more permanent fixture, while the downside is it can be obtrusive. Dry needling can be an effective form of treatment for pain relief, but it does not address the cause of the issue while Peroneal Tendonitis Insoles are recommended for individuals who have poor ankle stability. Following a gait analysis, a foot specialist can create custom insoles that fit into your shoes.

There can be enough rationale for a steroid injection in very irritable cases. A Sports Medicine Doctor usually carries this out, and it is an ultrasound-guided injection. The benefit includes reductions in pain and inflammation levels, however there is some evidence that it may contribute to the degradation of the tendon over time. A walking boot may be recommended for highly irritable cases for 1-2 weeks, which decreases pain levels, or they are recommended post-injection to allow the steroid to take full effect.

Surgery for Peroneal Tendonitis surgery is rare. The most common type of surgery performed by a Foot & Ankle Orthopaedic Consultant for this is a Peroneal tendon debridement. When it is recommended, this is generally for very painful tendonitis that has failed all other forms of treatment. It is usually followed by 6-8 weeks of Physical Therapy.

Physiotherapy with James McCormack

This is not medical advice and we recommend a consultation with a medical professional such as James McCormack to achieve a diagnosis. He offers Online Physiotherapy Appointments for £45.

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