Peroneal Tendonitis

There are two peroneal tendons in the foot and they run parallel, down from the calf muscles and behind the ankle bone on the outside of the foot. One peroneal tendon inserts onto the outer bones in the middle of the foot while the other attaches to the underside of the arch. The role of these tendons is to stabilize the ankle and foot to prevent sprains and strains. Peroneal tendonitis is the inflammation of one or both of these tendons.

The Cause of Peroneal Tendonitis

The cause of peroneal tendonitis is over-use of the ankle, or excess stress placed on it, particularly when a repetitive action is involved. It is generally a problem experienced by people who play a lot of sport that involves this repetition of movement.

Racquet sports, basketball, skiing, hiking are some of the sports that present a greater risk for peroneal tendonitis. Some types of manual work, running or walking on uneven surfaces can also be the cause of this type of tendonitis.

Older age is another common cause of peroneal tendonitis. This is because the tendons lose some of their elasticity and become brittle with age, making them more prone to injuries, including tendonitis. People with high arches may also be at risk of peroneal tendonitis.

The Symptoms of Peroneal Tendonitis

Peroneal tendonitis can be described as either acute or chronic. It is acute when the injury happens suddenly and inflammation occurs immediately; this is likely to be an accident or a single incident like turning the ankle. Chronic tendonitis develops over a period of time and this type is more likely to be caused by repetitive movements which gradually increase the damage to the tendon.

The symptoms of peroneal tendonitis, both acute and chronic, are pain and swelling. Both these symptoms are caused by inflammation of the tendon, which is the result of micro tears that the injury has caused in the tendon fibers.

Acute tendonitis will also be diagnosed by the instability and weakness of the ankle or foot. Chronic tendonitis will show redness of the skin and some heat in the area of the peroneal tendons, as well as the other symptoms.

Peroneal tendonitis pain will be felt along the tendon, close to the ankle and foot. It can be experienced during or after activity at first but will develop into more continuous pain, which is especially bad at night and in the morning. The foot may feel stiff and movement, especially stretching, will be painful.

The Treatment of Peroneal Tendonitis

As with all types of tendonitis, prompt treatment of peroneal tendonitis is best, to achieve fast healing. The longer you delay treatment, the worse the condition becomes. The following at-home, conservative treatment options are all that most cases require:

  • Rest and immobilization of the foot and ankle is necessary to allow the tears to heal. Sitting or lying with the leg elevated is a good strategy for the first few days.
  • Ice packs, applied every two or three hours help to reduce the swelling and ease the pain.
  • NSAIDs or anti-inflammatory medication will address the inflammation and help to ease pain. These can be simple ibuprofen or aspirin preparations or your doctor can prescribe a stronger NSAID. For severe pain, or if these drugs are ineffective, cortisone injections may be considered.
  • Once the initial intense pain has subsided, it is a good idea to do some gentle stretching exercises to prevent muscle stiffness. Your doctor may recommend you see a physical therapist for these exercises.
  • When you return to work or sport, you might benefit from wearing a support or brace on the foot. It is important to continue to strengthen and stretch the ankle and foot and not rely on the brace for too long.
  • Surgery is a last resort treatment option for peroneal tendonitis and is only considered when there have been on-going recurrences of the problem.
  • Tendons heal slowly so you must be patient and not try to return to sport too soon. Expect weeks of rest and rehabilitation and avoid any movement that causes you pain during this time.

The Prevention of Peroneal Tendonitis

Wearing the correct shoes for the sport or exercise you are doing is really important to protect yourself from injury of your feet and ankles. To help prevent peroneal tendonitis, you need strong, supportive shoes that give good heel support and cushioning. Avoid walking in bare feet or wearing slippers or flip-flops.

If you run or walk for recreation and health, avoid uneven ground and hard surfaces. Alternate the type of surface you run on to lower the risk of turning your ankles. If you are in training, try non-weight-bearing exercise like swimming and cycling to maintain your fitness without risking your ankles and feet.

When you return to exercise after an injury, ease back into it gradually; stop if you experience pain. Always warm-up and stretch thoroughly before exercise, to prepare your ligaments, muscles and tendons. Stretch to cool down afterwards.

This information will help you understand how peroneal tendonitis can impact your life and activity and will give you a better idea of how to prevent it occurring.

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4 Responses to “Peroneal Tendonitis”

  1. Iris Reyes #

    I was diagnosed with peroneal tendonitis, my podiatrist also wants an MRI done because he saw “something” in the xray. I haven’t done the MRI yet. It developed over summer 3-4 months ago the pain is getting increasing worse. most shoes are [painful. My problem is that my physical activity is karate. I spent the summer preparing for my black belt test and could not rest my foot. I wrap it when I workout but after it’s incredibly painful. I exercise barefoot so I don’t have the benefit of a good sneaker.

    Should I see a sports medicine doctor instead of a podiatrist? My podiatrist has so far only recommended ice and ankle wrap,

    October 19, 2012 at 2:15 am Reply
  2. Brooke #

    I would recommend a spots physician/ orthopedic surgeon that specializes in ankles. Even though I say surgeon that doctor should recommend non-surgical treatments first – unless there is something wrong in which can only be corrected with surgery. I have had peroneal tendonitis and dislocation for 10 years now. I have had two surgeries – one in 2002 and one in 2008. I am (once again) at the point where just walking my ankle will give out due to the tendons dislocating. Sometimes this even results in sprains. It’s awful and I do understand what you are going through.

    I know this isn’t something you want to hear; karate needs to be put on hold for now. Not properly giving your ankle time to rest and repair will cause more damage in the long run. Also, non-surgical treatment often starts with physical therapy. The exercises are specialized to strengthen your ankle and give it stability.

    October 20, 2012 at 2:00 am Reply
  3. Michael #

    I would recommend getting the MRI just to be safe, and if it’s fiscally possible. What the podiatrist probably thought they saw in the X-Ray was an extra bone behind the Achilles called an Os Trigonum. This is an irregularity found in a little more than 10% of the population. It can exist with no issues, going completely unnoticed, but when it causes issues it’s known as “Os Trigonum syndrome”. Basically the bone can disrupt the paroneal tendon along with others, causing inflamation, and tendonitis/tendonosis. An MRI confirms the sevarity of the inflamation, because if you have something like tendonosis, you get to wear a boot for about 6 weeks because it takes forever for that to heal. At which point, you’re probably going to have to wear a brace (something inconspicuous that slips into a shoe) or some custom orthotics to correct the bio-mechanics of your walk.

    December 27, 2012 at 6:24 pm Reply
  4. Green L #

    I have the same problem and had it all the time. My podiatrist gave me a pair of temporary insoles made by Superfeet because I had no insurance and couldn’t afford the custom molded orthotics. Anyway, I never had the problem again. REI carries Superfeet insoles (make sure its the lime green ones).

    May 2, 2013 at 10:36 pm Reply

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