What is Peroneal Tendonitis?
Peroneals are two muscles that go down the outer part of our lower leg. They’re attached on top of the Fibula (the smaller one of the two bones in our lower leg) that goes down the outer leg. The Peroneus Brevis inserts into the 5th Metatarsal’s base (the long bones in our foot) with the Peroneus Longus running under the foot sole attached to the first metatarsal as well as other tarsals.
Peroneal muscles evert the foot and help calf muscles with plantarflexion. Supination or Eversion is the action of turning the ankle so the sole faces outwards. In fact, this is the opposite of pronation or inversion.
Peroneal Tendonitis is actually an overuse injury that gradually develops through repetitive strains on the tendon. For your information, the word “tendonitis” refers to an inflammatory cause (‘itis’ = inflammation) though research has indicated this is not the actual case. It’s more about a degenerative condition, which is why the phrase “tendinopathy” would be more accurate.
To break things down, peroneal tendons are situated in the foot where they attach muscles to the bone. Mainly, they assist stability and bearing weight.
In each of our legs, there are two peroneal tendons that run parallely down the fibula or lower leg bone and also on the outside of the ankle( lateral malleolus) at the back of a hard lump.
One peroneal tendon is attached to the outside of the foot, right along the base of the fifth metatarsal or little toe. Another tendon extends under the foot and attaches to the inside of the arch.
Peroneal tendons typically stabilize the ankle whenever it is bearing weight and prevents it from spraining. Other functions of the tendons include enabling the foot to turn and stabilizing the arch while walking.
Peroneal tendon foot injuries generally occur all of a sudden without any prior hint or aggravates over time. Individuals who actively participate in sports where the ankles are repeatedly used face this problem most commonly. Other than that, individuals who have higher arches are more prone to developing this or other painful condition.
The injuries occur as a result of an inflammation of either one or both of the tendons. Usually, the inflammation is the consequence of repeated or overused tendons. An abrupt trauma such as a sprained ankle may also be a contributing factor.
Other reasons could be:
- A sudden increase in training and typically activities that involve jumping, running and walking
- Inappropriate techniques of training
- Footwear that is improper or unsupportive
Apart from these factors, other issues that can enhance the chances of peroneal tendonitis are:
- Higher than normal foot arches
- Lower limb joints and muscles that don’t work well together
- Muscles that are imbalanced in the lower limbs
- Redness and swelling
- Difficulty in moving the joint
Acute Tears (occurs due to repeated trauma or activity)
- Instability or weakness in the foot and ankle
Over time, what these tears do is that they alter the shape of the foot as a result of which the arch becomes higher.
The distinctive trait of degenerative tears is the strain that is produced on the tendons over the years. In this case, the tendons become similar to taffy that has become frail and thin as an aftermath of being stretched numerous times.
Some symptoms are:
- Sporadic pain on the outside of the ankle that occurs from time to time
- Instability or weakness in the ankle
- A raise in foot arch height
Subluxation defines a scenario where a single or together both the tendons slip out of their definite positions. It’s not necessary that subluxation occurs solely as something that happens gradually in life.
In certain cases, people are born with a variation in their muscle or bone shape due to which subluxation is an inherent condition. For other cases, it is an injury which follows after a trauma like an ankle sprain. If anyhow damage is inflicted upon the tissues that help to stabilize tendons, a chronic tendon subluxation is likely.
Some symptoms are:
- Tendons around the ankle bone may give a feeling of snapping
- Sporadic pain behind the exterior ankle bone
- Weakness or instability in the ankle
During a diagnosis, to begin with, doctors discuss the patient’s medical history with them. Increased activity, overuse or other causes will be pointed out as reasons for peroneal tendonitis.
However, it is vital to determine that the pain is actually in the peroneal tendons. If by mistake the pain is indicated in the fibula, it would mean a completely different problem.
Using an array of techniques, the doctor or physiotherapist will examine the patient to look for symptoms. It will involve moving around the ankle and foot to various positions and applying pressure.
An MRI scan, ultrasound or X-ray may be used besides to identify any abnormalities, breaks, swellings or scar tissues. This further aids the diagnosis.
By now, it is evident that overuse of tendons is one of the leading causes of peroneal tendon foot. So there is no doubt that resting is crucial for a speedy recovery.
In order to reduce the pain, the injured individual must avoid walking as much as possible besides any activity that may aggravate the pain and hamper recovery. Some of the common non surgical treatments are:
preventing the ankle and foot from moving by wearing a boot or suitable support.
drugs such as Ibuprofen help reduce inflammation and overall swelling and pain.
3. Physical therapy
Ultrasound therapy, heat and ice minimizes swelling and pain. After the symptoms are gone or improved, exercises that increase muscle strength besides motion and balance should be introduced.
Braces are a good source of support for people who are involved in activities that repeatedly require motion in the ankle.
5. Cortisone injection
Doctors suggest cortisone injections in extremely rare cases since they are powerful. If cortisone is injected, there is a good chance that a rapture could occur.
Generally, surgery is considered as a last resort for peroneal tendonitis. If non-surgical methods completely fail to reduce the pain, only then should surgery be considered. In the surgical procedure, using a method called tendon release, tissues that cause irritation are removed. Tears that occur due to overused peroneal tendons can be repaired with the help of tendon repair surgeries.
However, non-surgical treatments could last almost for a year before surgery needs to be considered.
Preventing peroneal tendonitis is not something fairly difficult. By following some healthy ‘foot-habits’ such as wearing appropriate footwear, not training on uneven or sloped surfaces and by avoiding fast pivoting movements, it’s not difficult to save oneself from this agonizing injury.
Refraining from overtraining and not returning to exercise soon after a sprain are also wise decisions to prevent peroneal tendonitis.
There’s nothing to lose hope of recovering fully from peroneal tendonitis. But it must be considered that it will take time.
It is crucial not to return to work or movement soon after an injury. In case of a prescribed rehabilitation, it is mandatory to complete the session to ensure complete recovery from both acute and chronic injuries. For athletes, it’s definitely possible to return to their sports after healing. But, it’s absolutely vital that they follow rehabilitation instructions properly.
Lastly, it’s extremely important to treat peroneal tendonitis as soon as possible. Because if left untreated, tears can result which in turn will induce nerve damages and sprained ankles.
Risks and Complications
Like all surgeries, there is the risk of wound infection. Nerve damage, especially of the surgical nerve is also possible.
1. What would happen if my peroneal tendonitis is not treated?
Ans. If your tendonitis isn’t addressed right away, this could lead to tearing of the tendon. Also, if your tendons are weak, ankle sprains and chronic ankle instability won’t be uncommon either. This can easily damage the cartilage inside the ankle joint.
2. Can I walk with peroneal tendonitis?
Ans. Usually, you will be able to walk, although you may have a limp.If the tendonitis is too crucial, it can prevent patients from taking part in dynamic sports where changing directions suddenly now and then is a common requirement.
3. How long does it take for the peroneal tendon to heal?
Ans. Usually, patients who take a timely treatment begin to improve within a time span of two to four weeks. But if no improvement shows with the general treatment after about one to two months, an MRI will be better able to evaluate the condition of the tendon and the ligament structure that surrounds it.