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.
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).
Other causes include:
- 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 trauma can also damage your peroneal tendons. Sudden inward movement of your foot or a direct blow on your ankle can damage your peroneal tendons. In this case, you will experience severe pain that worsens during activity and lessens during rest.
- Inappropriate footwear: If you use inappropriate footwear, it is very likely that you may develop peroneal tendon inflammation. It is more common in people who also have a hindfoot varus posture. So, if you wear flip-flops for long periods of time, you may experience peroneal tendinitis(2).
- Improper training techniques: If you try improper training techniques on particular joints, you will develop impingements of your ligaments and peroneal tendons. These conditions are mainly caused by poor orthotic techniques.
- Increase in activities: A sudden increase in training, particularly weight-bearing activities, such as walking, running, and jumping is a potent cause of peroneal tendonitis.
- Tight calves: Tight calf muscles increase the tension on your peroneal tendons and cause them to rub more which can cause peroneal tendonitis (3). If you have recurrent ankle sprains or ankle pain, you are more likely to develop peroneal tendonitis because your ankle is now weaker around the injury.
Signs and symptoms
The Achilles tendon, which joins the calf muscles to your heel bone becomes irritated, resulting in pain in the back of your ankle. Overuse of peroneal muscles can cause it, which happens a lot when you start a new sort of exercise or increase your activity time. The discomfort is the worst when you’re doing anything active or standing up, and it becomes better when you’re resting.
You will feel severe pain when you execute inversion or medial rotation of your foot if you are having peroneal tendon injury. This is because your peroneal tendons are stretched within your inferior retinaculum. You may experience tendon dislocation while doing this sort of movement.
Because of repetitive or excessive use of the ankle by jumping, running, or walking (4), you feel swelling towards the back of the ankle because of a limited range of motion. When your foot is pointed inwards or when you stand on it and rotate inward, the area will be warm to touch. The lateral malleolus insertion at the base of the fifth metatarsal is frequently symptomatic of peroneus brevis tendon damage.
Care and treatment
If you suspect you have tendinitis, consult your physiotherapy doctor. For pain management, your doctor may recommend R.I.C.E: Rest, Ice, Compression, and Elevation. You should take complete bed rest. Apply cold packs to the affected area. To relieve pain and inflammation, apply an elastic bandage to the affected area. Maintain an elevated position for the joint(5).
To keep the foot and ankle from shifting, wear a boot or support to avoid foot pain. Your healthcare provider may recommend over-the-counter sports medicines such as aspirin or ibuprofen. These may also help with the treatment of your soft tissue pain. Consult with your healthcare provider before using any anti-inflammatory drugs for this ailment, especially if it’s your first time.
Start exercising to strengthen the muscles around your aching joint if your healthcare provider gives you the advice. Warm up your body to reduce the tissue stress. Then try working with an elastic workout band or lift modest weights. Take it easy at first. Then gradually increase as your strength improves. Stretching is also an important element for your recovery process. Repeat 3 to 5 times, holding each stretch for 20 to 30 seconds each time(6).
If conservative therapy fails to alleviate your symptoms, you need to undergo operative treatment or surgical treatment (ankle surgery). During a treatment known as a synovectomy, your surgeon removes the damaged outer layers of tissue from your peroneal tendons. Peroneal tendon debridement takes almost four months to heal completely.
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat peroneal tendon pain.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to repair the damage and help peroneal tendon pain.
As prolotherapy is helping to treat the root cause of peroneal tendon pain, it is deemed to be a permanent fix, preventing the symptoms from returning.
Prevention
To prevent peroneal tendonitis, you should avoid such activities which place excessive stress on your tendons, especially for a long period of time. And if an activity is causing pain then replace it with another one.
Maintaining a healthy body weight is a critical thing that you need to do to prevent peroneal tendonitis. Take a balanced diet to keep your BMI (body mass index) within the required range. Excessive body weight puts pressure on the tendons of your foot while you walk and this increases the chances of tendon damage.
If you have such an occupation that demands repetitive ankle motion, you may require the use of a brace. To prevent peroneal tendinitis, wear appropriate footwear that properly supports your foot and ankle.
If you get an injury, then wait for proper recovery. Moreover, try improved and authentic massaging techniques which are confirmed by physical therapy instructors.
Conclusion
Peroneal tendon disorder is a condition that affects your daily activities. It disturbs your gait and you will feel difficult to walk if you have this condition. These patients typically recover completely, but it takes time. It’s critical not to jump right back into activities after your injury is recovered. Acute injuries heal faster than chronic ones, although rehabilitation is essential in both circumstances. To lessen the likelihood of recurrent injury, it is critical that you follow the guidelines of your orthopaedic doctor.
However, if you do not take care of yourself and leave this condition untreated, it can lead to the tear of your peroneal tendons. As a result, the treatment of your condition becomes difficult. This may also damage your associated nerves. And in most circumstances, you need to undergo surgery for the treatment of your peroneal tendon tear. So, it’s critical to get it addressed as soon as possible and stick to a treatment plan.
Frequently Asked Questions
What does peroneal tendon pain feel like?
You will experience discomfort on the outside of your foot or ankle, either at the base of the fifth metatarsal or in the lateral ankle. Swelling in the affected area is also prevalent. The pain is frequently triggered by physical activity (such as jogging) and goes away with rest.
How long does a peroneal tendon tear take to heal?
The time it takes to recover the peroneal tendon tear depends on the severity of your injury and the amount of rest you take. Typically, Peroneal tendon tear can take 8-12 weeks to recover. But to achieve full functioning capacity, it may take time up to a year.
Is walking good for peroneal tendonitis?
Peroneal tendonitis is caused by overuse of the tendons, thus rest is essential to help them heal. Until the pain subsides, you should refrain from walking or engaging in any other activities that may worsen your injury. Your tendonitis will take some time to heal, and the pain will fade over time.
How do you know if your peroneal tendon is torn?
If you feel sudden pain and popping sound at the time of injury, chances are great that your peroneal tendon is torn. You may feel the subluxation of your tendons. Tenderness of the foot and inability to walk are the potent signs that your peroneal tendon is torn.
What happens if you don’t repair a torn peroneal tendon?
If left untreated, minor tendon rips can turn into major ruptures, obliterating the link between your bones and muscle. And if your tendon ruptures, it becomes very difficult for you to walk even and you must undergo surgery for the treatment of your condition.
Can shoes cause peroneal tendonitis?
Your improper shoes can cause peroneal tendonitis or at least worsen your condition if you are already suffering. If you have high arches of your feet and you continue to wear shoes, you become more vulnerable to tendonitis because shoes put additional strain on your peroneal tendons while you are walking.
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). Effect of calf starter feeding on gut microbial diversity and expression of genes involved in host immune responses and tight junctions in dairy calves during weaning transition. Journal of Dairy Science, 96(5), 3189–3200. https://doi.org/10.3168/jds.2012-6200
- Caschman, J., Blagg, S., & Bishay, M. (2004). The Efficacy of the A-V Impulse System in the Treatment of Posttraumatic Swelling Following Ankle Fracture: A Prospective Randomized Controlled Study. 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). Three-dimensional relationship of the glenohumeral joint in the elevated position in shoulders with multidirectional instability. 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). Peroneal nerve palsy after ankle sprain: an update. European Journal of Orthopaedic Surgery & Traumatology, 27(1), 53–60. https://doi.org/10.1007/s00590-016-1845-0