ANATOMY |
The peroneal muscles (peroneus brevis and peroneus longus) lie in the lateral (outside) part of the lower leg. They form tendons which lie within a sheath which restrains them as they pass behind the outer bone of the ankle joint (fibula) before attaching to bones in the foot. The peroneal tendons are responsible for pulling the foot downwards and outwards and contribute to stabilising the ankle joint.
SYMPTOMS |
The symptoms of peroneal strain include pain on the outside edge of the foot and sometime in the instep area of the foot and swelling along the course of the tendon. The athlete may also experience pain and swelling right behind the outer ankle bone. There is usually pain when the area is touched along the course of the peroneal tendon behind the outer ankle. There may also be burning, shooting, tingling, stabbing pain often because the main nerve is inflamed along the outside of the ankle. Athletes experience pain when exercising or even just walking, steadily worsening toward the end of the day. In severe cases there is significant pain when the athlete moves his/her foot, as well as pain upon passive stretching of the peroneal tendon, and on inversion or arching of the foot. In some cases the tendon may actually rupture or tear, due to weakening of the tendon by the inflammatory process.
TREATMENT ACUTE PHASE |
P - R - I - C - E
Protection - Your ankle may be splinted, taped or braced to prevent further injury.
Rest - You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping.
Ice - Place a plastic bag with ice on the peroneal area for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications.
Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold.
Elevate - Make sure to elevate the ankle above heart level (hip level is acceptable).
IF SYMPTOMS PERSISTS OR NUMBNESS/ DISCOLOURATION OF THE FOOT OCCURS CONSULT A MEDICAL PROFESSIONAL IMMEDIATELY.
TO RESTORE NORMAL FUNCTION
As we get older the risk of any type of tendon rupture goes up dramatically especially if we embark on high impact sporting activities. However it must be emphasised that the risk is still small but when recovering after any injury it is vital that when stretching or performing any exercise that there should be no pain. If any tenderness is elicited then stop and re commence P.R.I.C.E
Technique: Sit with your knee straight and hold the foot position as long as possible. Do as frequently as possible for the first 3-10 days.
Pullback
- Flex your foot back toward your body.
Technique: Hold each exercise 30seconds at a gentle stretch. Do not bounce!
Frequency: 6-10 repetitions/exercise, 5-7 days per week
Begin stretching regimen for gastrocnemius and soleus complex.
Warning: There should be no pain when doing this exercise. If there is stop!
STRETCHING EXERCISES
Technique: Hold each exercise 30seconds at a gentle stretch. Do not bounce!
Frequency: 3 sets 10 repetitions/exercise, 5-7 days per week progressing to 3 sets of 15
Begin eccentric exercise program 7-10 days after pain has subsided
Start with toes pointed, giving resistance through the thera-band, slowly allow your foot into dorsiflexion.Warning: There should be no pain when doing this exercise. If there is stop!
Technique: Hold each exercise 20seconds at a gentle stretch. Do not bounce!
Frequency: 6-10 repetitions/exercise, 5-7 days per week
Perform a toe raise on a 4-6 inch box or step with both legs. Once on your toes, lift the uninvolved leg and lower yourself slowly into dorsiflexion (heel down, toe up).
Warning: There should be no pain when doing this exercise. If there is stop!
STRENGTHENING EXERCISES
Technique: Hold each exercise 30 seconds at a gentle stretch. Do not bounce!
Frequency: 3 repetitions/exercise, 5-7 days per week, and incorporate into warm up and cool down exercises.
Perform a toe raise on a 4-6 inch box or step with both legs. Once on your toes, lift the one leg and lower yourself slowly into dorsiflexion (heel down) with the other. Repeat on the other side
Warning: There should be no pain when doing this exercise. If there is stop!
TO HELP PREVENT RE-INJURY
Remember that virtually all peroneal problems occur at contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. No amount of exercising will influence what happens at the point of heel strike, mid-stance and toe off phases of gait. It is therefore vital to improve your biomechanics with orthotics designed for your chosen sport.
Golden rule- Don't ignore the problem, it won't go away!
The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured. What you can do however is control lower limb biomechanics by altering foot position during the contact phase of gait. This can only be done by wearing a good shoe (see our shoe guide) and with orthotics (foot beds). This is the cheapest and most cost effective way for any athlete to reduce the risks of injury from occurring and from helping to prevent re-injury. Overall costs for the average athlete will run into pennies per mile/hour of sport. Orthotics are designed to alter the biomechanics during the time the foot is on the ground. They are also used to provide increased shock absorbency working in harmony with the sport shoe worn.
*please see terms & conditions
RETURNING TO SPORTING ACTIVITY
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your achilles recovers, not by how many days or weeks it has been since your injury occurred.
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:You have full range of motion in the injured leg compared to the uninjured leg.
You have full strength of the injured leg compared to the uninjured leg.
You can jog straight ahead without pain or limping.
You can sprint straight ahead without pain or limping.
You can do 45-degree cuts, first at half-speed, then at full-speed.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
You can do 90-degree cuts, first at half-speed, then at full-speed.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
You can jump on both legs without pain and you can jump on the injured leg without pain.
