The peroneal brevis and peroneal longus are two tendons that originate as muscles in the lateral compartment of the leg. The peroneal tendons course around the outside of the ankle behind the lateral malleolus. The peroneal brevis tendon inserts into the 5th metatarsal base while the peroneal longus tendon inserts into the1st metatarsal base. The peroneal tendons are responsible for everting the foot. They also help to stabilize the foot and ankle and protect against ankle sprains.
Peroneal tendinitis occurs when there is inflammation along one or both of the tendon sheaths and/or tears along a portion of the tendon. This can result in ankle instability, pain, or elevation of the arch of the foot.
- Pain can be felt along the entire course of the tendons
- Tenderness along the involved tendon
- Heightening of the arch of the foot
- When there is an injury to the peroneal fascia, the tendons can subluxate. This felt as a popping or dislocation of the tendons along the outside of the ankle
Diagnosis is made by a comprehensive foot and ankle exam by Dr. Stewart along with x-rays of the foot. Imagining studies such as ultrasound and MRI are sometimes required to determine the extent of tendon injury.
- Overuse, which means there is too much physical activity. This commonly occurs in runners and/or walkers and in such sports as soccer, lacrosse, basketball, tennis, and football
- Individuals with a high arch foot are at greater risk of rolling the ankle therefore injuring the peroneal tendons
- Although less common, the condition can occur acutely in weekend warriors
- Overweight or obesity
- Inappropriate shoe gear including flats, flip-flops, or backless shoes
- Barefoot walking
- In conjunction with ankle sprains
- Inversion of the foot secondary to pain on the inside of the foot
Peroneal tendinitis generally takes 6-8 weeks to improve and early activity on a healing tendon can result in a set back in recovery. Non-compliance can double the recovery time and can be very frustrating for patients.
Early and aggressive conservative treatment is recommended to prevent further tendon injury. Dr. Stewart terms peroneal tendinitis a pro-active condition. Although we can never offer a 100% guarantee, the majority of Dr. Stewart’s patients improve with conservative (non-surgical care).
Conservative treatment for peroneal tendinitis includes:
- Immobilization of the foot and/or ankle. Depending on the severity of the condition, this may require cast immobilization with crutches, a walking boot, a hinged ankle foot orthosis with supportive shoe gear, a multi-ligamentous ankle brace with supportive shoe gear, or custom foot orthotics with supportive shoe gear
- Modification of physical activity including avoidance of walking, jogging, running, and the elliptical for exercise; recommended exercises include circuit training, swimming, and bicycling
- Stretching and strengthening exercises with a Theraband
- Compression therapy generally with prescription compression stockings
- Physical therapy
- Weight loss and dieting
- Medications including anti-inflammatory medications (NSAIDs), Tylenol, oral steroids, and in some cases narcotic pain medication
- Ice along the tendons 2-3 times per day for 20 minutes at the area of maximum tenderness. Elevation is recommended while icing
- Avoidance of flip-flops, flats, and barefoot walking
- Supportive shoe gear including a motion control running shoe such as Brooks, Asics, New Balance, or Saucony; Keen and Merrell style shoes are also recommended
- Custom foot orthotics
- Steroid injections into foot and/and or ankle joints
If all conservative intervention fails, then surgical intervention maybe required. Dr. Stewart will determine which procedure is best for you.
Surgical treatment for peroneal tendinitis includes:
- Tendon debridement and repair
- Tendon transfer
- Repair of the peroneal fascia and peroneal groove on the fibula
- Cutting of the fibula bone and fixation with screws or plates