Peroneal Tendinopathy

What is it?

Peroneal tendinopathy refers to inflammation and swelling within the peroneal tendons as they pass around the bony bump on the outside of the ankle.

How does it happen?

Peroneal tendinopathy results from the overuse of the person’s tendons. The function of the peroneal tendons is to transmit forces produced by the peroneal muscles to the bones in the foot. The peroneal muscles run down the outside of the lower leg to attach with the peroneal tendons. The peroneal tendons then travel around the bony bump on the outside of the ankle to attach to the bones in the foot. Repetitive use of the peroneal muscles and, therefore, the peroneal tendons can lead to microscopic tears within the substance of the tendon. To repair these microscopic tears, the body commences an inflammatory response. This inflammation within the tendons is tendinopathy.

How does it feel?

Peroneal tendinopathy results in pain within the tendons as they pass around the bony bump on the outside to the ankle. This pain typically develops gradually. Initially, the tendons may only be painful following exercise. For example, it may be first felt on rising the day following exercise. Associated with the pain may be a feeling of stiffness or tightness in the ankle. Typically, these initial signs of peroneal tendinopathy are ignored, as they disappear quickly with walking about or applying heat (i.e. a hot shower) over the outside of the ankle. However, as you continue to exercise, the tendinopathy progresses and the pain within the tendons becomes more intense and more frequent. For example, it may begin to be present during exercise. In the earlier stages, this pain during exercise may initially disappear as you warm up, only to return when you cool down. However, as you continue to exercise, the tendinopathy worsens and your pain may begin to be present for longer periods during exercise until it is present all of the time. This may interfere with your performance.

What should you do?

Peroneal tendinopathy generally does not get better on its own if the cause is not addressed and you continue to participate. If you have or suspect you have the peroneal tendinopathy, you should consult your Sports & Exercise Physiotherapist. In the meantime, you can begin initial treatment. This should consist of icing following exercise. Icing should consist of applying crushed ice wrapped in a moist towel for 15-20 minutes, or ice in a paper cup massaged up and down over the outside of the ankle until the skin is numb.

What shouldn’t you do?

If you have or suspect you have the peroneal tendinopathy, you shouldn’t ignore the problem. Your pain may get better as you exercise; however, the exercise you are doing may be interfering with the healing process and causing further damage. This can lead to your injury getting worse such that your pain does not ‘warm up’ and you feel it throughout exercise. If this occurs, your recovery may be prolonged and it may take a number of months for you to return to full activity and sport.

Could there be any long-term effects?

Peroneal tendinopathy does not produce any long-term effects, as long as it is properly diagnosed and appropriately treated. If not, it can lead to prolonged pain on the outside of the ankle and a prolonged lay-off from activity and sport.

Management

The assistance of a Sports & Exercise Physiotherapist is important in the treatment of peroneal tendinopathy. Initially, they can assist in diagnosing the problem and establishing its severity. This may require the use of imaging techniques such as ultrasound or MRI. From this, the Sports and Exercise Physiotherapist will be able to determine an appropriate treatment plan. This may involve activity modification, soft tissue treatment such as massage and stretching, correction of your biomechanics using orthoses, and the progression through a series of specific strengthening exercises. The sports medicine professional will also be able to assess and determine why you developed peroneal tendinopathy and address this during your recovery to prevent a reoccurrence when you return to full activity and sport.

Tom is a physio in Balgowlah who is highly trained in the assessment and management of all foot and ankle conditions. For a complete understanding of your foot and ankle, you will need an assessment face-to-face. To see the most highly regarded physio in Balgowlah, book here.

Brukner & Khan (2012) Clinical Sports Medicine.