Peroneal tendonitis is an overuse injury causing inflammation and degeneration of the peroneal tendons. It causes pain on the outside of the ankle and can make walking uncomfortable. The peroneal muscles consist of peroneus longus, peroneus brevis and peroneus tertius. All originate in the lower leg and run along the outer side of the leg/ankle to insert into the foot. Tendonitis is an inflammation of tendons. For our purposes, we will be talking mostly about peroneal longus inflammation.
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Symptoms
Symptoms of peroneal tendonitis include:
• Pain and swelling on the outside of the ankle, just below the lateral malleolus (outside ankle bone)
• Pain is often worse during activity, but improves with rest
• Tenderness when pressing on the outside of the ankle
• Increased pain with inversion of the ankle (this stretches the peroneus muscles) -
Causes
Activity or overuse are culprits in inciting inflammation/irritation of the peroneal tendons. Running along slopes, for example at the side of a road causes your foot to roll out more (evert). This increases tension in the peroneal tendon making you more susceptible.
Poor flexibility or not stretching before activity is another risk factor. Tight calf muscles will increase the tension in the peroneal tendon, causing it to rub on the ankle bone more. Overtraining is also a contributory factor, particularly in dancers or basketball players. Lower limb biomechanics can put someone at greater risk for a peroneal injury, such as overpronation or oversupination in gait. -
Treatment
PRICE is the acronym used to manage peroneal tendonitis – protect the tendon (with a splint, or brace), rest it (take time away from activity to heal), ice it to reduce inflammation, compression minimizes swelling, and elevating your foot does as well. People who tend to evert or invert their rearfoot more than others, should seek orthotics to correct this excess motion which will put the peroneals at risk of injury. Supportive shoes combined with stretching and strengthening the tendons are also good practice. Anti-inflammatory medications can help manage acute pain and inflammation as well. Your primary care professional may also want to seek an x-ray or MRI to better understand the damage if these items are not helping. Where a tear in the tendon exists, sometimes surgery is the best option.
