Peroneal tendinopathy affects the tendons of the Peroneal muscles, located along the outer side of the lower leg. These muscles, the Peroneus Longus and Peroneus Brevis, help stabilise the ankle and foot during activities like walking and running. When the tendons become irritated or overloaded, it results in pain and weakness around the ankle. This condition is common in athletes, especially runners, and people who frequently experience ankle sprains.
Signs & Symptoms
Symptoms of Peroneal tendinopathy can range from mild to more severe and typically include:
- Pain along the outer side of the ankle: Pain usually worsens with activities like walking, running, or jumping, especially when placing weight on the foot or during foot eversion (outward turning).
- Swelling and tenderness: Inflammation may lead to swelling and tenderness behind the bony bump (lateral malleolus) on the outer side of the ankle.
- Weakness or instability in the ankle: The ankle may feel weak or unstable, particularly during activities that involve changing direction or sudden stops.
- Stiffness: Some individuals report stiffness in the ankle after periods of rest, such as in the morning or after sitting for an extended time.
- Popping or snapping sensation: A popping or snapping feeling may occur, especially if the tendons slip out of their normal position (subluxation).
Causes and Contributing Factors
Peroneal tendinopathy is typically caused by repetitive strain or overloading of the peroneal tendons. Common contributing factors include:
- Overuse: Engaging in repetitive activities, such as running or jumping, places excessive strain on the tendons.
- Ankle sprains: Repeated ankle sprains, particularly on the outer side (lateral sprains), can weaken the tendons, increasing the risk of tendinopathy.
- Foot biomechanics: Certain foot shapes, like high arches (pes cavus) or flat feet (pes planus), may increase stress on the tendons, making injury more likely.
- Improper footwear: Wearing shoes that lack proper support, especially during high-impact activities, can lead to increased tension on the tendons.
- Training errors: A sudden increase in physical activity, such as extending running distances too quickly, can overload the tendons.
- Age: Tendons naturally lose elasticity and flexibility with age, making them more prone to injury.
Prognosis
The recovery time for peroneal tendinopathy varies, depending on the severity of the condition and how early treatment begins. In mild cases, recovery may take 6 to 8 weeks with the appropriate management. More severe cases can take several months, especially if left untreated. Early diagnosis and treatment help speed up recovery, and adhering to a physiotherapy plan is essential for restoring strength and preventing recurrence.
Treatment
Treatment of peroneal tendinopathy focuses on relieving pain, promoting healing, and restoring ankle strength and stability. Non-surgical approaches are generally effective for most cases.
Non-Surgical Treatments
- Rest and activity modification: Reducing or stopping activities that aggravate symptoms, such as running or jumping, allows the tendons to heal. Rest is particularly important in the early stages to prevent further irritation.
- Physiotherapy: A physiotherapist will create a customised treatment plan that focuses on strengthening and restoring function in the ankle. Key physiotherapy strategies include:
– Strengthening exercises: Exercises targeting the peroneal muscles and tendons, such as calf raises and resistance band work, are essential for rebuilding strength and stability.
– Stretching: Gentle stretching of the Peroneal and Achilles tendons helps improve flexibility and reduce stiffness in the ankle
– Proprioception and balance training: Exercises to enhance balance and ankle stability reduce the risk of future injuries by improving how the tendons and muscles respond to sudden movements
– Manual therapy: Soft tissue massage and joint mobilisation techniques can be used to decrease stiffness and promote circulation, aiding the healing process
– Shockwave therapy: Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment option that uses sound waves to stimulate healing in the tendon. It can help reduce pain and inflammation while promoting tissue repair
– Orthotics: Custom orthotics or supportive footwear can help address foot biomechanics issues, such as high arches or flat feet, which may be contributing to excessive tendon strain. Proper arch support and cushioning can reduce stress on the tendons and promote healing. - Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can be recommended to manage pain and reduce inflammation, particularly in the early stages of the condition.