Peroneal Tendinopathy

Peroneal Tendinopathy


Article by John Miller


What is Peroneal Tendinopathy?

Peroneal tendinopathy refers to a condition where the peroneal tendon undergoes structural changes in response to excessive loading, which can result from overuse or other factors. Although people often use the term “peroneal tendonitis” interchangeably with peroneal tendinopathy, it can be misleading since inflammation is not always the primary feature of this condition. Instead, the tendon may become irritated and swollen due to the mechanical stresses placed on it, but without significant inflammatory response.

The term tendinopathy describes any disorder related to tendons that involves changes in the structure, composition, and mechanical properties of the tendon.In the case of peroneal tendinopathy, the tendon may thicken, degenerate, or develop small tears or nodules. These changes can lead to pain, weakness, stiffness, and instability of the ankle and foot, which can affect daily activities and sports performance.

If you suspect you have peroneal tendinopathy, it is important to seek medical advice from a qualified healthcare professional, such as a sports medicine physician, physiotherapist, or orthopaedic surgeon, who can provide an accurate diagnosis and appropriate treatment plan based on your specific condition and needs.

What are the Peroneal Muscles?

The peroneal muscles, also known as the fibular muscles, are a group of muscles located on the lateral side of the lower leg. They consist of the peroneus longus and peroneus brevis muscles, which originate from the fibula bone and run down to the foot, where they insert into various bones and joints.

The peroneal muscles are responsible for several important functions related to foot and ankle movement and stability. They help to turn the foot outward (eversion), which is essential for walking and running on uneven surfaces. They also provide lateral support to the ankle joint, helping to prevent ankle sprains and other injuries during weight-bearing activities.

The peroneal tendons are two thick fibrous cords that wrap around the lateral malleolus, the bony prominence on the outer side of the ankle, and attach to the bones and muscles of the foot. These tendons are constantly under tension whenever the peroneal muscles contract to control foot and ankle movements.

What Causes Peroneal Tendinopathy?

Peroneal tendinopathy is a condition that can develop gradually over time or occur suddenly due to various factors that affect the peroneal tendons and muscles. Some of the most common causes of peroneal tendinopathy include:

  1. Overuse or excessive loading: Activities that involve repetitive or prolonged weight-bearing on the foot and ankle, such as running, jumping, or cutting sports, can strain the peroneal tendons and lead to microtears, degeneration, or thickening of the tendon.
  2. Poor footwear or foot mechanics: Wearing shoes that do not fit properly or provide enough support, or having abnormal foot and ankle mechanics, such as flat feet, high arches, or ankle instability, can increase the stress on the peroneal tendons and muscles and make them more susceptible to injury.
  3. Muscle imbalances and weaknesses: Imbalances in the strength and flexibility of the lower leg muscles, particularly the peroneals, gastrocnemius, and soleus, can alter the way the foot and ankle move and distribute forces, leading to abnormal stress on the peroneal tendons.
  4. Previous ankle injuries: A history of ankle sprains, fractures, or other injuries can weaken the peroneal tendons and make them more prone to damage during subsequent activities.
  5. Other factors: Certain medical conditions, such as rheumatoid arthritis, gout, or diabetes, can affect the health of the tendons and increase the risk of peroneal tendinopathy.

What are the Symptoms of Peroneal Tendinopathy?

Peroneal tendinopathy is a condition that affects the tendons located on the outside of the ankle. The following are some of the common symptoms associated with this condition:

  • Gradual worsening of pain on the outer part of the ankle
  • Pain during or after weight-bearing activities, such as walking or running
  • Pain when turning the foot inward or outward
  • Ankle instability when bearing weight

If you experience any of these symptoms, it’s important to consult a medical professional for an accurate diagnosis and appropriate treatment.

How is Peroneal Tendinopathy Diagnosed?

Qualified healthcare professionals, such as physiotherapists or doctors, typically diagnose peroneal tendinopathy. They may conduct a series of tests to assess the affected area and rule out other potential causes of lateral ankle pain.

Along with physical tests, an ultrasound scan can confirm the diagnosis of peroneal tendinopathy. This non-invasive imaging test provides a detailed view of the tendons and surrounding tissues, ensuring a more accurate diagnosis.

If you’re experiencing symptoms of peroneal tendinopathy, it’s crucial to seek medical attention promptly. Timely and accurate diagnosis is essential to receive the appropriate treatment and prevent the condition from worsening.

Peroneal Tendinopathy Treatment

The treatment of peroneal tendinopathy depends on the severity and stage of the injury. In general, the earlier the condition is detected and treated, the better the prognosis.

During the acute phase, the focus of treatment is to reduce the load on the affected tendon and allow it to heal. This may include rest, ice, compression, and elevation (RICE), as well as the use of a brace or orthotic device to support the ankle. Once the pain subsides, a home exercise program may be prescribed to improve range of motion, strengthen the lower limb muscles, and enhance balance.

Chronic peroneal tendinopathies may take longer to recover, and the treatment approach is focused on active rehabilitation to improve the tendon’s ability to respond to load. This may include eccentric strengthening exercises for the peroneal muscles and lower limb, as well as exercises to improve balance, strength, and range of motion. In some cases, surgery may be required to repair or remove damaged tendon tissue.

It’s important to work with a qualified healthcare professional, such as a physiotherapist or doctor, to develop an individualised treatment plan that meets your specific needs and goals. Consistent adherence to the treatment plan and proper rehabilitation can help you recover from peroneal tendinopathy and prevent future injury.

Peroneal Tendinopathy Prevention

Peroneal tendinopathy can be a painful and debilitating condition, but there are steps you can take to prevent it from developing. Here are some tips for reducing your risk of peroneal tendinopathy:

  1. Wear supportive footwear that fits correctly, and is appropriate for your chosen activity. This doesn’t necessarily mean the most expensive or latest shoe on the market, but rather one that provides adequate support and cushioning for your foot type and activity level.
  2. Gradually increase your training load or exercise level. Sudden increases in activity can put stress on the tendons and increase the risk of injury. Increase your intensity, duration, or frequency of exercise slowly and incrementally over time.
  3. Maintain a level of activity in the “off-season” through cross-training or other low-impact activities. This can help you maintain your cardiovascular fitness and keep your muscles healthy, reducing your risk of re-injury when you return to your primary sport or activity.
  4. Improve your balance and ankle proprioception through exercises like single-leg balance drills, agility drills, or wobble board exercises. This can help improve the strength and stability of the ankle joint, reducing the risk of injury.

By incorporating these preventive measures into your routine, you can help reduce your risk of developing peroneal tendinopathy and enjoy a safe and healthy active lifestyle.

Return to Sports with Peroneal Tendinopathy

For athletes with peroneal tendinopathy, the goal of treatment is to manage pain and inflammation, restore normal function, and prevent further injury. With proper treatment and rehabilitation, most people are able to return to their previous level of sporting activity without any ongoing problems.

It’s important to note, however, that the recovery process can be lengthy and requires patience and commitment. You must follow your rehabilitation program as prescribed by your physiotherapist, as well as modifications to your training routine.

Returning to sports too soon or without completing your rehabilitation program increases the risk of re-injury, which can lead to chronic problems and longer recovery times. It’s important to seek professional treatment and guidance to ensure a safe and successful return to sports.

If you are experiencing symptoms of peroneal tendinopathy or any other musculoskeletal injury, seek the advice of a qualified healthcare professional, such as a physiotherapist or doctor. They can provide a proper diagnosis, develop an individualised treatment plan, and guide you through the rehabilitation process to help you return to your active lifestyle.

Tendinopathy FAQs

Common Ankle Injuries

Welcome to an exploration of common ankle injuries. The ever-present sprained ankle is at the forefront, accompanied by various sources contributing to ankle pain. Fractures, stress fractures, and tendinopathies are part of this landscape, each with implications. Ankle impingement and foot posture issues emerge, and biomechanical issues take centre stage, affecting alignment and eventually fast-tracking ankle arthritis. Even the younger population experiences heel concerns, with Severs disease impacting many young athletes' seasons. This article serves as a concise guide to understanding the complexities of ankle problems.

Sprained Ankles

The most common ankle injury is a sprained ankle, but ankle pain can have numerous sources.

Ankle Fractures

An ankle fracture occurs when there is a break in one or more of the bones. The most common ankle fractures are avulsion fractures of your distal fibula, which can be a side effect of an ankle sprain. All suspected fractures require medical investigation and professional management by your health professional to avoid long-term foot and ankle issues. If your healthcare professional suspects an ankle fracture, you will be referred for at least an X-ray and potentially an Orthopaedic Surgeon.

Ankle Tendinopathies

While muscle strains are more common in your legs, there are essential muscles that converge into tendons that wrap around your ankle to stabilise your ankle and foot to protect them from sprains and allow you to walk and run. These muscles and their tendon vitally provide a normal foot arch and avoid flat feet. Your muscles or tendons can become injured or inflamed due to overuse or trauma. The inflammation is called tendonitis. They can also tear, completely rupture, or sublux out of place. Medically tendon injuries are known as tendinopathies, and at the ankle may include:

Ankle Arthritis

Your ankle pain and dysfunction can lead to degenerative conditions such as ankle osteoarthritis. While arthritis usually is a chronic deterioration of your ankle joint, it is crucial to slow ankle arthritis progression. Would you please seek the professional advice of your ankle and foot health practitioner, e.g. physiotherapist or podiatrist?

Biomechanical Conditions

Biomechanical disorders may result in foot deformation, painful weight-bearing and potentially nerve compression. In simple terms, this is where your foot and ankle do not have normal bone alignment and motion control. Here are a few possible conditions related to poor ankle biomechanics.

Muscle Injuries

Nerve-Related Ankle Pain

Children & Youth Conditions

Systemic Conditions That May Cause Ankle Pain

Soft Tissue Inflammation

Other Useful Information

Foot, Ankle & Heel Pain FAQs

Welcome to our comprehensive FAQ guide on Foot, Ankle & Heel Pain. In this guide, we aim to address common questions and concerns related to foot, ankle, and heel pain. We will cover various topics, including ankle injuries, heel pain, Achilles pain, foot pain, shin pain, youth injuries, and balance and proprioception. Whether you're experiencing discomfort or seeking preventive measures, this guide will provide valuable insights and advice to help you understand and manage these conditions effectively.

Ankle Injuries

Heel Pain

Achilles Pain

Foot Pain

Shin Pain

Youth Injuries

Balance & Proprioception

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