Peroneal tendonitis - Sports Podiatry

Peroneal tendonitis when running or partaking in other high impact activity is more common than you might think. Pain usually starts as a dull ache one the outside of the ankle but can quickly turn into severe discomfort if activity is continued.

Peroneal tendonitis 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. They are used in sporting activity to help in the toe off phase of gait. It is as this point that overuse and resulting peroneal tendonitis is likely to occur.

Symptoms of peroneal tendinitis

The symptoms of peroneal tendonitis in runners include pain on the outside edge of the foot and sometimes in the instep area of the foot and swelling along the course of the tendon. The athlete with peroneal tendonitis 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 with peroneal tendonitis may experience pain when exercising or even just walking, steadily worsening toward the end of the day. In severe cases of peroneal tendonitis 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 (turning the foot inwards) or arching of the foot. In some cases of peroneal tendonitis the tendon may actually rupture or tear, due to weakening of the tendon by the inflammatory process.

Causes of peroneal tendonitis in runners

Increase in training levels.

Increased hill training.

Lack of shock absorbency in the trainers worn.

Worn running shoes.

Poor biomechanics.

Weight gain.

Peroneal tendonitis - Treatment in the acute phase

P - R - I - C - E

Peroneal tendonitis - Restoring 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 along the peroneal tendon then stop and re commence P.R.I.C.E

Peroneal tendonitis - eccentric exercises

The eccentric peroneal tendonitis stretching exercises below require the use of a theraband.

Begin eccentric exercise program 7-10 days after pain has subsided Start with toes pointed, giving resistance through the theraband, slowly allow your foot into dorsiflexion (upward position). Warning: There should be no peroneal tendonitis pain when doing this exercise. If there is stop!

 

Below is a video showing the uses for the rehab band (whole body).

Peroneal tendonitis - stretching exercises

Begin stretching regimen for gastrocnemius and soleus complex. Warning: There should be no pain in the peroneal tendon when doing this exercise. If there is stop!

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 peroneal tendon pain when doing this exercise. If there is stop!

Peroneal tendonitis - leg strengthening 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 peroneal tendonitis pain when doing this exercise. If there is stop!

 

Ankle strengthening exercises

 

Wobbleboard

 

Use of a wobbleboard is a brilliant way to strengthen muscles in the foot ankle and leg. Aim to do 5-10 minutes a day!

 

 

Theraband exercises

 

Frequency:

Three sets of 20 repetitions, 5-7 days per week

Front of Shin Basic - Push Out With your foot flat on the floor, push it outward against a wall, file cabinet or bookcase. Hold for three seconds.

Front of Shin Advanced - Band Tie the band to a desk or dresser. Sit with your foot and knee in line and loop the band over the outside of your foot. Push your foot out against the band.

Inner Shin Basic - Push In With your foot flat on the floor, push it inward against your other foot. Hold for three seconds.

Inner Shin Advanced - Band Tie the band to a desk or dresser. Sit with your foot and knee in line, and loop the band over the inside of your foot. Push your foot in against the band.

Front of Shin Basic - Push Up Place the heel of your other foot on top of the injured one. Push down with the top heel while trying to push up with the injured foot. Hold for three seconds.

Front of Shin Advanced - Band Tie the band to a desk or dresser. Sit with your leg straight and loop the band over the top of your foot. Slowly pull your foot back against the band.

to help prevent peroneal tendonitis from occurring

Remember that virtually all peroneal tendonitis problems happen at the contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. It is therefore vital to strengthen the ankle and control biomechanical forces.

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 be achieved by wearing a good shoe (see our shoe guide) with orthotics (foot beds), ankle strengthening and ankle support.

1. Check your footwear

Are your running shoes worn and in need of replacing? If so change them. Peroneal tendonitis is made worse by high impact forces so a good shock absorbing shoe is a must. For more advice on running trainers our running shoe advice page is worth reading. Read more->

Below are a selection of trainers that are ideal for athletes.

Trainers for a neutral or under pronating foot type

Trainers for over pronators

2. rectify Poor biomechanics with orthotics

The way your foot strikes the ground and the forces that are placed on it can have a direct effect on causing peroneal tendonitis and also delaying healing times. Check our biomechanics page for detailed information. Read more->

3. Ankle strengthening

The single best exercise to improve the strength of the muscles around the ankle is eccentric loading. This is usually done none weight bearing, however the use of a wobbleboard is an excellent way to strengthen muscles around the foot and ankle in a controlled gentle manner. Whilst our clinicians have found it a brilliant way to strengthen ankle muscles, traditionally a wobbleboard was used to help balance (proprioception). Proprioception is the nerve connection from the brain to the foot. This is often damaged/ disrupted after injury and can increase the chances of injury from re occurring It can also significantly delay recovery.

Use of a wobbleboard therefore has a dual benefit in the treatment of peroneal tendonitis.

4. Ankle support

Usually an athlete who has damaged their ankle only needs minimal support post injury, such as the support given by a neoprene brace. However with peroneal tendonitis we recommend an ankle brace when partaking in sporting activity.

Peroneal tendonitis injury prevention checklist summary

returning to sporting activity after peroneal tendonitis has subsided

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 peroneal tendonitis injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Returning to your activity is determined by how soon your tendonitis 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.

WANT A PRINTER FRIENDLY VERSION OF THIS CLICK HERE