Peroneus brevis tendon injury is a condition in which you develop longitudinal splits or tears in your peroneus brevis tendon. It is typically a chronic condition that develops over time due to repetitive damage to your tendon. This condition usually results from overuse of muscle that results in a tear of the tendon. Ankle sprains and repetitive subluxation causes the tendon to slip out of its normal groove and it also contributes to peroneal tendon injuries.
Peroneus brevis muscle arises from the outer surface of the fibula (outer bone of the lower leg), below the peroneus longus tendon. The muscle ends in a tendon that is inserted in your hindfoot below the lateral malleolus. Function of this muscle is to evert the foot and move it away from your leg. Peroneus brevis tendon is present directly beyond the fibula and is more prone to injury.
The peroneus brevis tendon injury is common in people over 40 years of age. It is more common in athletes who play sports that involve a lot of ankle movements. People who have tight tendons and high arches in their feet are also prone to develop this condition.
In this article, you will find appropriate information about the causes and symptoms of peroneal tendon injuries and the measures that you can take to prevent this condition.
Peroneus brevis tendon injury signs and symptoms
You will feel pain and swelling on the outside of the ankle whether your condition is acute or chronic. Acute injuries cause redness and weakness of movements and chronic injuries lead to lateral ankle instability. Some other symptoms of this condition include:
- Pain: You will experience foot pain or lower leg pain if you have peroneal tendon subluxation or tendon rupture. The peroneus muscle is supplied by the peroneal nerve. This nerve also supplies the skin on the lower lateral side of the leg all the way to the lateral side of the foot. When the tendon is damaged, it irritates the nerve and causes pain along the distribution of the nerve.
- Swelling: Swelling is another sign that you will see if you have tendon injury(1). Tearing of fibers in the tendon also leads to rupture of blood vessels. This causes the blood to move from blood vessels out into the surrounding tissues. Due to this, swelling takes place. Swelling usually occurs at the ankle on the lateral side of your lower leg.
- Instability: You will feel instability when you stand on your foot with peroneus brevis tendon tears. The peroneus brevis is one of the main peroneal muscles involved in the inversion and eversion of the foot. It is also involved in maintaining the stability of your ankle. When this tendon is damaged, then these movements will not take place properly and the joint will become unstable.
- Popping sound: If you hear a sudden popping(2) sound during an ankle sprain, and afterward, you are unable to perform the normal movements at the ankle joint, there is a chance that your peroneus brevis tendon is damaged.
Causes of tendon injuries
Peroneal tendon inflammation (tendinitis) can develop with repetitive overuse of the tendons or it may happen suddenly due to an ankle injury. The tendons or the lubricated tendon sheaths around them can swell, making it hard for them to move smoothly. Some other causes include:
Overuse is the most common cause of peroneus brevis tendon injury(3). A sudden increase in training levels or poor training techniques put an additional strain on your peroneus brevis tendon. Sudden repetitive movements at the ankle cause the tendon to rub against the bone and the friction thus produced can lead to tearing of fibers or dislocation of your tendon.
You are more likely to develop this condition if you have damaged your ankle or suffered from an ankle sprain. The peroneus brevis along with the peroneus longus is commonly injured during a lateral ankle sprain and the tendon of the peroneus brevis muscle is the most commonly dislocated tendon.
Running on uneven surfaces also increases your risk of developing this condition. The peroneal muscles normally adjust foot position when you stand on an uneven surface. Running on such a surface puts additional stress on your tendon resulting in damage to the tendon.
Damage to ligaments supporting the ankle joint also increases the chance of peroneus brevis tendon damage. The lateral ankle ligaments include the anterior tibio-fibular ligament (ATFL) and the calcaneofibular ligament (CFL). These ligaments are damaged during an ankle sprain. This puts an additional strain on the peroneus brevis tendon to maintain joint stability and therefore leads to tendon damage.
If your injury has occurred suddenly, then you may either have a simple tendon tear or you may have an avulsion strain (fracture). An avulsion strain occurs when the tendon tears and also pulls a small piece of the bone with it. It most commonly occurs along the fifth metatarsal bone.
Treatment of peroneus brevis tendon injury
The immediate treatment of the tendon injury (tendinopathy) includes the proper first aid in order to avoid further damage and speed up the healing process. Further treatment options include:
Stop doing any kind of movement for at least 2 days after injury because it can make the damage worse and delay your recovery. Apply the ice pack for about 15 to 20 minutes after every 2 to 3 hours for 2 days(4). Compression of the affected area is also effective in reducing swelling. You can also use elastic bandages, casts, and splints to support your ankle. The last one includes the elevation in which you need to raise your foot above the heart level. This improves blood flow and has a pain relief effect.
The first step in the recovery process is to modify the position and limit the activities in order to reduce pressure on the tendon and thus reduce pain. Your physiotherapist will play an important role in this aspect and help to provide you with these specific recommendations that will have positive effects on your recovery process. Massage by a Physiotherapist promotes muscle relaxation and improves blood supply.
For severe tendon damage or an avulsion strain, a plaster cast may be used for immobilization while the injury properly heals. This reduces the range of motion and allows the natural healing process to take place properly. For mild injuries, an ankle brace is required as it helps protect your foot.
Orthotics for a peroneus brevis tendon injury
Congenital abnormalities in the foot shape are the cause of tendonitis, wearing inserts in your shoes often helps to correct the condition. You should consult a podiatrist for proper management. Using wrong insoles may worsen the condition.
It involves the use of painkillers to relieve pain. These include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen(5). These painkillers are easily available and are very effective in reducing pain. The administration of cortisone or other steroid injections is also effective in reducing pain and swelling.
If the condition is not improving with the conservative treatment, then surgical treatment is inevitable. You must undergo X-rays and magnetic resonance imaging (MRI) prior to surgery to determine the exact location and extent of tendon damage. The doctor performs a physical examination as well as a radiographic examination before the surgery. The orthopaedic doctor then joins the torn parts of the tendon through sewing for tendon repair. Usually, the patients recover within 4 months after the surgery.
Preventive measures for a peroneus brevis tendon injury
Following are some of the measures that should be taken in order to avoid peroneus brevis tendon injuries
Exercise regularly. Exercise has positive effects on almost all the muscles of your body as it promotes muscle stretching and increases the flexibility of muscles(6). However, do not exercise vigorously as it can damage your muscles and tendons.
If you are suffering from ankle pain, immediately report your doctor for proper diagnosis and treatment. Never push through ankle pain as it can damage other tendons and therefore worsen the condition.
Maintaining a healthy body weight is a critical thing that you need to do to prevent peroneal tendonitis. This is because the peroneal tendons are weight-bearing structures. 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.
Peroneal tendon disorder is a condition that affects your daily activities. You will feel difficult to maintain your gait if you have lateral ankle pain. 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 injuries or lesions, it is critical that you follow the guidelines of your orthopedic 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.
- Selvanetti, A., Cipolla, M., & Puddu, G. (1997). Overuse tendon injuries: Basic science and classification. Operative Techniques in Sports Medicine, 5(3), 110–117. https://doi.org/10.1016/s1060-1872(97)80031-7
- Spindler, K. P., & Wright, R. W. (2008). Anterior Cruciate Ligament Tear. New England Journal of Medicine, 359(20), 2135–2142. https://doi.org/10.1056/nejmcp0804745
- Niek van Dijk, C., Scholten, P. E., & Kort, N. P. (1997). Tendoscopy (tendon sheath endoscopy) for overuse tendon injuries. Operative Techniques in Sports Medicine, 5(3), 170–178. https://doi.org/10.1016/s1060-1872(97)80039-1
- van den Bekerom, M. P. J., Struijs, P. A. A., Blankevoort, L., Welling, L., van Dijk, C. N., & Kerkhoffs, G. M. M. J. (2012b). What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults? Journal of Athletic Training, 47(4), 435–443. https://doi.org/10.4085/1062-6050-47.4.14
- Hertel, J. (1997). The role of nonsteroidal anti-inflammatory drugs in the treatment of acute soft tissue injuries. Journal of Athletic Training, 32(4), 350–358. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320354/
- Buchanan, C. I., & Marsh, R. L. (2002). Effects of exercise on the biomechanical, biochemical and structural properties of tendons. Comparative Biochemistry and Physiology Part A: Molecular & Integrative Physiology, 133(4), 1101–1107. https://doi.org/10.1016/s1095-6433(02)00139-3