What is peroneal tendonitis?
Peroneal tendonitis, also known as peroneal tendinopathy, is the medical term for tissue damage to and inflammation of the peroneal tendon. The tendons in the body connect muscles to bones. Their structure is very similar to a rubbery, stretchy cord making it strong, durable and flexible. Where the tendons attach to the bone they are covered in a sheath that is lubricated on the inside allowing the tendon to move in and out effortlessly. Joint movement is the end result of the muscle fibres contracting and pulling on the tendon which in turn tugs at the bone producing the movement. The tissue damage and inflammation that cause tendonitis occur around the tendon itself, any damage to the tendon sheath is termed tenosynovitis, although it is very common for both conditions to be present at the same time. Tendonitis makes any movement of that tendon very painful and stiff.
Why & when does peroneal tendonitis happen?
Peroneal tendonitis is a common injury and affects people of all ages. However it is normally seen in individuals who partake in athletic sports involving repetitive or forceful eversion of the ankle and foot. The peroneal muscles consist of several muscles situated on the outside of the lower leg that originate around the fibula bone, run down the side of the leg, wrap around the outside of the foot and insert into the foot via the peroneal tendons. The peroneal muscles are responsible for eversion of the foot and ankle (tilting the foot and ankle so that the sole of the foot points outwards), overuse of these tendons through repetitive, high force and traumatic eversion of the foot and ankle will lead to peroneal tendonitis. Typically weak ankles and recurring ankle sprains can lead to peroneal tendonitis. There are also a few activities, for example running and dancing, that involve fast pace change of directions that trigger the onset. The most common trigger is walking on an uneven surface where the foot has to stay in eversion to keep you steady, like walking on a hill or on rough terrain.
What does peroneal tendonitis feel like?
Peroneal tendonitis begins as a dull ache around the outside of the ankle that gradually worsens over a course of 2-3 weeks. In some cases the discomfort is only felt on ankle eversion when the peroneal tendon is stressed and with others it is felt once resting after an activity that involves ankle eversion. Stiffness and dull aches are normally experienced during the night and are most intense early in the morning. The pain and discomfort is not always restricted to the side of the ankle and is often reported to radiate up into the lower leg or down into the sole of the foot. The outside of the ankle will be tender to touch and pressure from tight shoes, on occasion there may be minor swelling around the area.
How long does peroneal tendonitis take to heal?
Mild cases of peroneal tendonitis can recover in as little as 3 days to 2 weeks with treatment, whereas moderate or chronic cases of tendonitis take much longer. As long as the aggravating ankle eversion has been avoided during recovery then most cases of peroneal tendonitis will have fully healed within six weeks. If you experience pain for longer than six weeks it is advisable to attend your GP.
How will peroneal tendonitis be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis.
What treatment options are available for peroneal tendonitis?
Your GP will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. You will be advised to follow the R.I.C.E protocol. The R.I.C.E protocol involves resting your ankle, try not to walk about on it too much and most importantly avoid all ankle eversion movements. Ice, applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the icepack regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and make sure to take it off at night. Elevation, keep your foot raised on cushions or a stool to help limit the swelling.
Your GP or therapist will be able to provide you with exercises to strengthen the ankle ligaments and stretch the peroneal muscles to aid the healing process and prevent reoccurring injury. Many people find massage therapy helpful to loosen the affected peroneal muscles, manipulative therapies such as physiotherapy, chiropractic and osteopathy are thought to help through mobilisation treatment of the ankle, working to reduce any stiffness levels and return the joint back to its normal movement.
If your GP has mentioned or if in-fact you feel that there is some element of foot or ankle dysfunction that has predisposed you to this injury then it is very important that you see a podiatrist who can fully examine your feet and determine whether you need orthotics for your shoes. Often inappropriate and unsupportive running shoes are a factor in the development of ankle or foot tendinitis. The failure to do this may result in recurring cases of tendonitis.