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Foot Pain

Peroneal Tendonitis

Minute Read

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6 months ago

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by james

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

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. Their functions involved turning the foot outwards, downwards, and stabilising the ankle. They are active throughout the gait and contract to give additional stability with changing direction or on occasions when someone missteps and rolls their ankle. In this article, we will explore Peroneal Tendonitis causes, symptoms, and treatment.

Picture Diagram of Peroneal Tendons

Causes of Peroneal Tendonitis

Peroneal Tendonitis is caused by a repetitive overload of the peroneal tendons. When running or walking, an altered gait 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 movement of the foot when walking or running, overloading the Peroneal Tendons and causing tendonitis.

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

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 movement of the ankle and this 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. This peroneal tendon pain can last for up to 1 hour. It can be painful when walking after sitting for a period of time. With exercises such as running it may be stiff and painful at the beginning but ease as it warms up.

The location of pain is on the outside of the ankle and onto the outer side of the foot when the peroneal tendons attach to the fifth metatarsal. If these is inflammation of the Peroneal Longus Tendon, there may be pain located on the underside of the foot. There is not usually any bruising with Peroneal Tendonitis.

Peroneal Tendonitis

Diagnosis and Similar Conditions

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

The clinical test for Peroneal Tendonitis requires the patient to dorsiflex and evert the foot against the resistance of the practitioners 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. This 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 Tendon Tear
  • Peroneal Tendon Longitudinal Split
  • Peroneal Tendon Subluxation
  • Medial Malleolus Fracture
  • Navicular Stress Fracture
  • Peroneal Nerve Entrapment

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: It is important to condition the peroneal tendon to absorb load from impact activities such as running, walking, and jumping. When a tendon fatigues, it can become tight, inflamed, and painful. Strength training, therefore, plays a significant role in increasing the capacity of the tendon, alleviating pain, and reducing the risk of recurrence.

Stretching: When a tendon becomes fatigued the muscles attaching to the tendon can become tight. This can lead to further irritation and discomfort. Peroneal stretching can help reduce this tension and provide symptomatic pain relief.

Massage: Sports and deep tissue massage for peroneal tendonitis aren’t classified as a primary form of treatment but 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: Applying a rigid taping to the ankle can help reduce Peroneal Tendon pain levels as it shortens the tendon and 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: Ankle bracing has a similar role to rigid ankle taping as it reduces the amount of movement at the subtalar joint in the ankle. As a result, the peroneal tendons don’t have to work as hard to provide stability to the tendon. The benefit of a brace over taping is that it is a more permanent fixture while the downside is they 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.

Insoles: Peroneal Tendonitis Insoles are recommended for individuals who have poor ankle stability. Following a gait analysis, a foot specialist will create custom insoles that fit into your shoes.

Peroneal Tendonitis Injections: In very irritable cases, there can be enough rationale to have a steroid injection. This is usually carried out by a Sports Medicine Doctor and it is an ultrasound-guided injection. The benefit includes reductions in pain and inflammation levels while 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 allows pain levels to decrease or they are recommended post injection to allow the steroid to take full effect.

An Ace Bandage has little to no benefit in the treatment of Peroneal Tendonitis.

Surgery: Peroneal Tendonitis surgery is rare. When it is recommended, this is normally for very irritate tendonitis that has failed all other forms of treatment. The most common type of surgery performed by a Foot & Ankle Orthopaedic Consultant for this is a Peroneal tendon debridement. It is normally 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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