Peroneal
Tendonitis

How to Treat Peroneal Tendonitis

Everyday activities are hard on us and, one day, we wake up and feel a strange pain in the foot. Typically, there are two ways people react to this problem:

Usually they ignore the trouble and wait till it heals itself. If not, maybe it is fear or laziness to visit a doctor. This very situation is conjecture.

They discover pains in the ankle and, immediately, call their doctor. After meticulous examination doctor has a diagnosis. When he says it’s Peroneal tendonitis, you might be not familiar with the name of the diagnosis. If this is the case and you are not familiar with it the following will give you important information you need to know.

Definition

Tendonitis is probably not the most accurate term to describe this condition. The ending of the word itis implies that there is inflammation. However this is very far from the truth. There is non inflammatory swelling (thickening) and degenerative process in the tissue of the tendon. This occurs due to repetitive overuse, poor ankle stability, and poor proprioception. Sometimes this disease can be misdiagnosed as an ankle sprain. Peroneal tendon injuries can be of two clinical types:

Acute

Acute forms that are caused by “overuse and load on muscles” include tear, rupture, tendinitis, and dislocation. The cause of this ankle injury is a powerful contraction of the peroneal muscles with a spontaneous dorsiflexion of foot. The injury is common in people ages 20-35.

Chronic

Chronic forms are associated with weak and unstable ankles that also have issues with the peroneal tendons. Chronic injuries are not only connected with aging, they also have a close relation to overuse, poor foot mechanics, balance, propriception, and motor control.

Epidemiology

Peroneal tendonitis is common in athletes whose activity involves running, such as ice-skating, basketball, football, and others. When there is sudden increase in mileage or other sporting activity with excessive ankle motion which exceeds the tissue tolerance, the tendon tissue fails. The fibers then separate and loose optimal integrity necessary for optimal load resistance and function.

Symptoms

If you sprained your ankle, a mild pain or pains during stepping are very noticeable during the first stage. Your ankle may get swollen. When you sprain the tendons of peroneus longus and peroneus brevis their irritation causes pain during pronation and supination. With peroneal tendinosis the patient feels pain on the side or on the back of the ankle. Sometimes the pain feels like its wrapping around the ankle joint. Occasionally pain may radiate up the leg.

What Does Sprained Ankle Look Like?

Pain in the foot is seen as swelling in the foot area and debilitation of the ankle in the area where the fibula bone has connection with peroneus tendons.

The main peroneal tendinitis symptoms are:

  • • Pain in the outer ankle with walking
  • • Pain during rest (also at night)
  • • Pain during the physical load on the foot
  • • Increased pain when the pronation and supination are used.
  • • Clicking and snapping sounds could be heard
  • • Progressed disease symptoms:
  • • Decreased strength of the foot and ankle
  • • Continuous spontaneous pain around the clock
  • • Pain with any type of activity involving the leg.

Diagnosis

Due to several conditions which could mimic peroneal tendinosis, dignostic ultrasound or MRI (Magnetic Resonanse Imaging) must be used.

Cause

Peroneal tendinitis occurs during the extreme overuse of physically loading the ankle. Examples of this are: sudden movements while working out without warm-up, improper training of the muscles for the appropriate physical load etc.

However, biomechanics plays a role in injury.

  • • Foot anomalies should be completely assessed and accounted for. Excessive inversion may put pressure on the peroneal tendons as they travel between fibula and tibia
  • • Extreme deviation into varus in the knee can be a cause
  • • Impingement of the ankle leads to peroneal tendinitis
  • • Fibular hyper mobility or hypo mobility
  • • Bad equipment quality or footwear, for instance, high-top shoes, ice skates, soccer cleats, can be a factor in peroneal tendinitis
  • • Cross over gait

Treatment

Physiotherapy/Non-surgical method

For the acute form, ankle injuries should be kept in rest, ice, compression, and elevation. Non-steroidal anti-inflammatory drugs may be prescribed to reduce irritation and pains. If the swelling and pain continue a thorough exam may be needed. Once the initial treatment is finished physical therapy is then prescribed. The physical therapy must include: strengthening of peroneal tendons, flexibility training, and correction of any biomechanical faults or accomodation for structural deformitoes with orthotics may be necessary. The goal is to return the pronation and supination movements back to normal. Occasionally there is weakness of the hip which can cause shift in center of mass in such a way that the ankle is inverting excessively.

Treatment at DNR

At DNR we use gait or running analysis for precise diagnosis of biomechanical causes. We use diagnostic ultrasound to diagnose. We use state of the art rehab treatments and ESWT (extracorporeal shockwave therapy) for treatment of peroneal tendinitis.



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Peroneal Tendinitis

How to Treat Peroneal Tendinitis

Everyday activities are hard on us and, one day, we wake up and feel a strange pain in the foot. Typically, there are two ways people react to this problem:

  1. Usually they ignore the trouble and wait till it heals itself. If not, maybe it is fear or laziness to visit a doctor. This very situation is conjecture.
  2. They discover pains in the ankle and, immediately, call their doctor. After meticulous examination doctor has a diagnosis. When he says it’s Peroneal tendonitis, you might be not familiar with the name of the diagnosis. If this is the case and you are not familiar with it the following will give you important information you need to know.

Definition

Tendonitis is probably not the most accurate term to describe this condition. The ending of the word itis implies that there is inflammation. However this is very far from the truth. There is non inflammatory swelling (thickening) and degenerative process in the tissue of the tendon. This occurs due to repetitive overuse, poor ankle stability, and poor proprioception. Sometimes this disease can be misdiagnosed as an ankle sprain. Peroneal tendon injuries can be of two clinical types:

  1. Acute.Acute forms that are caused by “overuse and load on muscles” include tear, rupture, tendinitis, and dislocation. The cause of this ankle injury is a powerful contraction of the peroneal muscles with a spontaneous dorsiflexion of foot. The injury is common in people ages 20-35.
  2. Chronic.Chronic forms are associated with weak and unstable ankles that also have issues with the peroneal tendons. Chronic injuries are not only connected with aging, they also have a close relation to overuse, poor foot mechanics, balance, propriception, and motor control.

Epidemiology

Peroneal tendonitis is common in athletes whose activity involves running, such as ice-skating, basketball, football, and others. When there is sudden increase in mileage or other sporting activity with excessive ankle motion which exceeds the tissue tolerance, the tendon tissue fails. The fibers then separate and loose optimal integrity necessary for optimal load resistance and function.

Symptoms

If you sprained your ankle, a mild pain or pains during stepping are very noticeable during the first stage. Your ankle may get swollen. When you sprain the tendons of peroneus longus and peroneus brevis their irritation causes pain during pronation and supination. With peroneal tendinosis the patient feels pain on the side or on the back of the ankle. Sometimes the pain feels like its wrapping around the ankle joint. Occasionally pain may radiate up the leg.

What Does Sprained Ankle Look Like?

Pain in the foot is seen as swelling in the foot area and debilitation of the ankle in the area where the fibula bone has connection with peroneus tendons.

The main peroneal tendinitis symptoms are:

  • Pain in the outer ankle with walking
  • Pain during rest (also at night)
  • Pain during the physical load on the foot
  • Increased pain when the pronation and supination are used.
  • Clicking and snapping sounds could be heard
  • Progressed disease symptoms:
  • Decreased strength of the foot and ankle
  • Continuous spontaneous pain around the clock
  • Pain with any type of activity involving the leg.

Diagnosis

Due to several conditions which could mimic peroneal tendinosis, dignostic ultrasound or MRI (Magnetic Resonanse Imaging) must be used.

Cause

Peroneal tendinitis occurs during the extreme overuse of physically loading the ankle. Examples of this are: sudden movements while working out without warm-up, improper training of the muscles for the appropriate physical load etc.

However, biomechanics plays a role in injury.

  • Foot anomalies should be completely assessed and accounted for. Excessive inversion may put pressure on the peroneal tendons as they travel between fibula and tibia.
  • Extreme deviation into varus in the knee can be a cause.
  • Impingement of the ankle leads to peroneal tendinitis.
  • Fibular hyper mobility or hypo mobility
  • Bad equipment quality or footwear, for instance, high-top shoes, ice skates, soccer cleats, can be a factor in peroneal tendinitis.
  • Cross over gait

Treatment

Physiotherapy/Non-surgical method

For the acute form, ankle injuries should be kept in rest, ice, compression, and elevation. Non-steroidal anti-inflammatory drugs may be prescribed to reduce irritation and pains. If the swelling and pain continue a thorough exam may be needed. Once the initial treatment is finished physical therapy is then prescribed. The physical therapy must include: strengthening of peroneal tendons, flexibility training, and correction of any biomechanical faults or accomodation for structural deformitoes with orthotics may be necessary. The goal is to return the pronation and supination movements back to normal. Occasionally there is weakness of the hip which can cause shift in center of mass in such a way that the ankle is inverting excessively.

Treatment at DNR

At DNR we use gait or running analysis for precise diagnosis of biomechanical causes. We use diagnostic ultrasound to diagnose. We use state of the art rehab treatments and ESWT (extracorporeal shockwave therapy) for treatment of peroneal tendinitis.