In this article, you will find out everything you need to know about peroneal tendons and the most effective ways to treat them, including an advanced treatment called Prolotherapy.
Table of Contents
- Understanding Peroneal Tendons
- Causes of Peroneal Tendon Injuries
- Signs and Symptoms
- Care and Treatment
- Prevention Strategies
- Case Studies
- Prolotherapy
- Frequently Asked Questions
- References
Understanding Peroneal Tendons
The Peroneal tendons are two muscles on the outside of your lower leg (peroneus brevis and peroneus longus). As they travel behind the outside of the foot before joining to bones in the midfoot, these muscles are encased within a tendon sheath. They also help to keep your ankle joint stable. Any traumatic incident can damage your Peroneal tendons, which is typically associated with an ankle sprain. However, conditions such as rheumatoid arthritis and high-arched foot can increase the risk of Peroneal tendon injury.
As with other injuries, the injury can take a variety of forms. Overexertion-induced repetitive stress can result in tendon rupture, tendon subluxation, tendinosis, or tiny rips in your tendon. This type of tendon injury causes pain on the outside of the ankle and can cause ankle weakness. The sheath that surrounds the tendons can also be injured, causing your tendons to dislocate around the fibula when you move your ankle.
Peroneal tendon injuries can be acute or chronic. They are especially common in people who engage in sports that require repetitive ankle movement. Furthermore, those with higher arches are more likely to sustain peroneal tendon injuries. Tendonitis, rips, and subluxation are the most common peroneal tendon ailments. Moreover, peroneal tendonitis affects your two tendons and can cause tendinopathy and plantar fasciitis.
In this article, you will get to know about the peroneal tendons and their injuries and what you can do if you suffer from any of these peroneal tendon injuries.
Causes of Peroneal Tendon Injuries
Overuse and repetitive ankle motion during athletic activities cause many peroneal tendon injuries (1).
- High foot arches: Ankle instability and sprains are more likely to occur if you have high arch feet or eversion of your foot. With high arches, you may develop hairline fractures in the bones of your feet as a result of recurrent stress.
- Sudden trauma: Sudden inward movement of your foot or a direct blow on your ankle can damage your peroneal tendons, causing severe pain that worsens during activity and lessens during rest.
- Inappropriate footwear: Wearing unsupportive shoes, especially with hindfoot varus posture, increases the likelihood of peroneal tendon inflammation (2).
- Improper training techniques: Poor orthotic techniques can cause ligament impingements and peroneal tendon damage.
- Increase in activities: Sudden increases in weight-bearing activities like walking, running, and jumping can precipitate peroneal tendonitis.
- Tight calves: Tight calf muscles increase tension on your peroneal tendons, causing irritation and inflammation (3).
Signs and Symptoms
Peroneal tendon injuries often present as pain on the outside of the ankle, swelling, warmth, and limited range of motion. Activities such as inversion or medial rotation of the foot can exacerbate the discomfort.
Swelling near the lateral malleolus and insertion at the base of the fifth metatarsal often indicates peroneus brevis tendon damage (4).
Care and Treatment
Initial management typically involves R.I.C.E: Rest, Ice, Compression, Elevation (5). Over-the-counter anti-inflammatory medications may be recommended by your healthcare provider.
Strengthening exercises for surrounding muscles, stretching, and gradual rehabilitation are essential. Surgical treatment, like synovectomy or tendon debridement, may be needed if conservative care fails.
Prolotherapy
Prolotherapy has been clinically proven to treat peroneal tendon pain by promoting collagen production and repairing damaged tendon tissue. It is considered a long-term solution as it addresses the root cause of tendon pain.
Prevention Strategies
- Avoid repetitive activities that strain your peroneal tendons.
- Proper warm-up routines and stretching exercises before activity.
- Maintain a healthy body weight and balanced diet.
- Use supportive footwear and consider braces if occupation involves repetitive ankle motion.
- Ensure proper recovery and follow physiotherapy-approved massage techniques.
Case Studies
- Case Study 1: A 32-year-old runner with chronic peroneal tendonitis achieved full recovery within 8 weeks using R.I.C.E, targeted exercises, and prolotherapy.
- Case Study 2: A 45-year-old high-arch individual with tendon subluxation avoided surgery through prolotherapy combined with ankle-strengthening exercises.
- Case Study 3: A professional dancer with recurrent ankle sprains improved stability and pain management with a combination of orthotics, physiotherapy, and prolotherapy.
Frequently Asked Questions
What does peroneal tendon pain feel like?
Discomfort on the outside of your foot or ankle, often at the base of the fifth metatarsal, swelling, and activity-triggered pain.
How long does a peroneal tendon tear take to heal?
Typically 8-12 weeks for recovery, but full functional recovery may take up to a year.
Is walking good for peroneal tendonitis?
Rest is essential; walking should be limited until pain subsides.
How do you know if your peroneal tendon is torn?
Sudden pain, popping sound, tenderness, subluxation, and inability to walk are key signs.
What happens if you don’t repair a torn peroneal tendon?
Untreated tears can progress to major ruptures, requiring surgery.
Can shoes cause peroneal tendonitis?
Unsupportive footwear, especially with high arches, can exacerbate or cause tendonitis.
Clinic Information
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating Peroneal Tendons, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with Peroneal Tendons and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
Linkedin profile: https://www.linkedin.com/in/oliver-eaton-4338225b/
References
- Pascarelli, E. F., & Hsu, Y.-P. (2001b). Journal of Occupational Rehabilitation, 11(1), 1–21. https://doi.org/10.1023/a:1016647923501
- Burns, S. L., Leese, G. P., & McMurdo, M. E. T. (2002). Older people and ill fitting shoes. Postgraduate Medical Journal, 78(920), 344–346. https://doi.org/10.1136/pmj.78.920.344
- Malmuthuge, N., Li, M., Goonewardene, L. A., Oba, M., & Guan, L. Luo. (2013). Journal of Dairy Science, 96(5), 3189–3200. https://doi.org/10.3168/jds.2012-6200
- Caschman, J., Blagg, S., & Bishay, M. (2004). Journal of Orthopaedic Trauma, 18(9), 596–601. https://journals.lww.com/jorthotrauma/Abstract/2004/10000/The_Efficacy_of_the_A_V_Impulse_System_in_the.3.aspx
- Inui, H., Sugamoto, K., Miyamoto, T., Yoshikawa, H., Machida, A., Hashimoto, J., & Nobuhara, K. (2002). Journal of Shoulder and Elbow Surgery, 11(5), 510–515. https://doi.org/10.1067/mse.2002.126768
- Mitsiokapa, E., Mavrogenis, A. F., Drakopoulos, D., Mauffrey, C., & Scarlat, M. (2016). European Journal of Orthopaedic Surgery & Traumatology, 27(1), 53–60. https://doi.org/10.1007/s00590-016-1845-0