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.

In order to avoid treatment for the wrong condition precise diagnosis is best way to deal with this type of injury. High-resolution diagnostic ultrasonography is readily available and is preferred. Another option is an MRI .

MULTIFACETED
APPROACH

What does successful treatment
of tendinopathy requires:

  • • Patient/athlete education
  • • Inflammation control if inflammation is present
  • • Regenerative treatment (ESWT)
  • • Gradual tendon strenghtening
  • • Loading optimisation (loading and unloading)
  • • Improvement in biomechanics and motor control
  • • Improvment in kinetic chain relationships
  • • Motor variability
  • • Landing or running mechanics
  • • Ergonomics
  • • Training errors
  • • Reversing sensory motor adaptation
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. Tendonitis is not exactly the most accurate term to describe the underlying condition. This words ending implies there is inflammation. That is not the exact truth though. There is non inflammatory swelling (thickening) as well as a degenerative process within tendon’s tissue. This occurs due to repetitive overuse, no ankle stability, due to poor proprioception. Sometimes peroneal tendon is misdiagnosed as a simple sprain.There are two clinical types of tendon related injuries:

  • Acute
    Acute forms of tendonitis origin from ‘overuse and load on muscles’. The following injuries fall under “acute tendonitis” umbrella: fractures of all kinds, tears, tendinitis, tendon dislocation.
    When peroneal muscles contract suddenly and powerfully – ankle trauma occurs. People aged 20 through 35 are most commonly injured.
  • Chronic.
    Chronic forms are thought to origin from weak or unstable ankles. Sometimes peroneal tendon issues can be hereditary. The tendon can be chronically injured. It is not only connected with aging. This also has a close relation to overuse, poor foot mechanics, balance, proprioception, and motor control.
    Epidemiology Peroneal tendonitis is common in athletes whose activity involves running, ice-skating, basketball, football, and others. A sudden increase in mileage including excessive ankle motion prompts the tendon tissue to fail. Fibers then separate, losing optimal integrity necessary for optimal load resistance and function.

If you sprained your ankle, a mild pain or pains during stepping can be noticeable at first. Your ankle may get swollen. When you sprain tendons of peroneus longus or peroneus brevis their irritation causes aching sensation during pronation or supination motion. Peroneal tendonitis manifests itself with side aching of the ankle area. Sometimes pain feels like its wrapping around the ankle joint. Occasionally pain may radiate upwards.

What Does Sprained Ankle Look Like?

Foot pain is seen as swelling of the area, debilitation of the area where fibula bone connects with peroneal tendons.
Peroneal tendonitis symptoms can be recognized as follows:

  • Aching sensation on the outside of the ankle when walking
  • Night time or daytime aches in the area
  • Pain during the physical load on your feet
  • Increased aching sensation when pronation or supination motion happens
  • Clicking, snapping sounds could be heard
  • Progressed disease symptoms
  • Ankle’s or foot’s weakness
  • Continuous spontaneous aching sensation in the area

Diagnosis

In medical practice there are medical conditions that are peroneal tendinosis lookalikes. In the case of possible misinterpretation a magnetic resonance imaging is to be used.

Cause

Peroneal tendinitis occurs during the extreme overuse of physically loading ankle zone.
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 irregularities for instance.
Excessive inversion usually puts excessive pressure on peroneal tendons (while moving between fibula and tibia).
Extreme deviation into varus in the knee
Ankle Impingement can cause peroneal tendinitis.
Calf bone hyper mobility or hypo mobility
factors adding up to the diagnosis: bad quality or footwear, for instance, shoes with high tops, ice skates, soccer cleats.
Cross over gait

Treatment Physiotherapy/Non-surgical method

In case of acute peroneal tendonitis, injured ankles must be kept in rest, ice, compression and in an elevated position. You can get prescription for Non-steroid anti-inflammatory drugs (NSAIDs) from your doctor that will help you with irritation and pains.
In case the area continues to swell up and the pains persist further examination may be necessary.
Upon finalization of initial treatment, physical therapy is prescribed. The complete PT treatment must include: peroneal tendon strengthening, flexibility training, correction of biomechanical faults or accomodation for structural deformities with orthotics. Physical Therapy aim is to get back pronation and supination movements back to normal. Weakness of hip joint can prompt the shift of mass center as well as continuous ankle inversion.

To successfully treat a tendinopathy it is necessary to have or complete:

  • Sports physical therapy education
  • Be able to control inflammation
  • Regenerative treatment (extracorporeal shockwave therapy)
  • Cautious and slow strengthening of the tendon
  • Loading optimisation (loading and unloading)
  • Improvement in biomechanics and motor control
  • Improvement in kinetic chain relationships
  • Motor variability
  • Landing or running mechanics
  • Ergonomics
  • Training errors
  • Reversing sensory motor adaptation.

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: 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.

Treatment at NYDNR

At NYDNR the most modern gait analysis systems are used to efficiently diagnose the problems within your walking habits. We use numerous ultrasound to diagnose. Latest word of medical science rehabilitation treatments are used to treat peroneal tendinitis, including extracorporeal shockwave therapy.
If you are physically active in sports or exercise, or if you work at a physically demanding job, you are no stranger to muscle pain. More often than not, you rest it, ice it, pop some NSAIDs and ignore it, and it eventually goes away.

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