What is peroneal tendonitis / tendinosis?
Peroneal tendonitis refers to inflammation of the peroneal tendons, while peroneal tendinosis refers to overuse and thickening of the peroneal tendons. The peroneal tendons are two muscles that originate on the outer bone of your lower leg called your fibula, and insert at adjacent bones of your feet. The first peroneal muscle is refereed to as the peroneal brevis muscle. The peroneal brevis muscle inserts into the base of the little toe bone also known as the fifth metatarsal, while the peroneal longus muscle starts higher up on the leg, runs underneath the foot and attaches to the first metatarsal of the big toe.
What is the role of the peroneal muscles?
The peroneal muscles are responsible for everting or turning your ankle and foot to the outside, away from the mid line of your body.
Causes of peroneal tendonitis / tendinosis?
Causes of these condition can be related to:
- Poor or inappropriate footwear
- Long walking and running: Running along slopes
- Improper training or rapid increases in training
- Rapid changing of direction as fund in high agility sports such as; football, gymnastics, basketball
- Patients with a hindfoot varus aka an inverted heel
- Poor foot biomechanics: high arches, overpronation, excessive eversion
- Recurrent ankle sprains due to weakness and injury around the ankle
- Tightness and weakness in the calf and peroneal muscles
Symptoms of peroneal tendonitis
The main symptom of peroneal tendonitis is a pain especially while turning your foot inward. Occasionally swelling and warmth around the back and outside of your foot and ankle. In cases of overuse, the pain increases gradually, gets worse with activities, and calms with rest. The area is often tender and the affected tendons may ache more if the pressure is exerted on them. There is also decreased strength and flexibility of your ankle tendons.
Physiotherapy for peroneal tendonitis / tendinosis
The goals of Physiotherapy treatments are to ease the pain, restore mechanics, and return to desired activity participation. Your Physiotherapist may utilize a combination of the following:
- Rest: Refraining from any aggravating activities such as strenuous movements in sports
- Icing: Reducing the swelling of the injured area
- Compression: Compression bandage, support braces, or kinesio taping
- Elevation: Ankle higher than the heart, while performing ankle pumps
- Medications: May advise over the counter NSAIDs to reduce pain and inflammation
- Custom Orthotics: Especially in cases where the patient has a very high arch or the heel is inverted
- Laser Therapy may aid in reducing pain and inflammation
- Ultrasound may help reduce inflammation and promote healing
- Strengthening and stretching exercises
- Proprioception regimen to reduce the chances of recurrence
- Joint mobilizations and manipulation of the ankle joint
- Shockwave therapy: uses acoustic waves to induce a healing process by improving blood flow to the area, and breaking down tight or painful scar tissue and muscle adhesions. Shock wave therapy is becoming a common treatment of choice for athletes with chronic peroneal tendonitis or tendinosis.