According to researchers from the University of Sydney, 45.5% of Australians have experienced ankle injuries and pain.[1] International experts have agreed that anywhere between 11-38% of people may have injuries to their peroneal tendons.[2] However, whether these injuries are symptomatic or painful are currently unknown.
Many people can confuse peroneal tendonitis with ankle sprains because of the similar location of the pain. However, unlike sprains, this condition can appear without an apparent cause. Performing repetitive ankle activities, such as running and dancing, can gradually lead to peroneal injuries.
Read on to understand what you should know about peroneal tendonitis; the risk factors, treatment options and expected recovery time.
What is Peroneal Tendonitis?
Peroneal tendonitis (peroneal tendinopathy) occurs when the tendons of the peroneal muscle(s) become inflamed. These muscles run along the outside of the calf and eventually travel alongside the outer ankle as tendons. Pain usually occurs along these tendons on the outer ankle(s).
What are the symptoms of peroneal tendonitis?
The main symptom of peroneal tendonitis is pain along the outside of the lower leg that extends to the ankle. People may also experience pain that increases with activity, swelling and redness, as well as thickened tendons in the area.
Common symptoms of peroneal tendonitis
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Pain at the back and outside part of the ankle
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Pain when moving to foot inward and outward
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Swelling
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Instability of the ankle joint
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Tenderness on the ankle
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Pain that worsens when walking or running
What causes peroneal tendonitis?
Peroneal tendonitis is caused by overuse that usually develops over time, occurring most predominantly in athletes who do a lot of running, jumping or even walking. Other causes that may increase the risk include poor footwear or a rapid increase in training load.
Common causes of peroneal tendonitis
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High plantar arch
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Previous ankle injuries
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Poor shoes or footwear at work
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Over-pronation or inward rolling of the foot
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Tight calf muscles
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Inappropriate training
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Weakness of the peroneal muscles
Sports that increase the risk of peroneal tendonitis
Peroneal tendonitis is very common in running athletes due to intense, repetitive contraction of the leg muscle groups. Jumping and frequent sudden changes in direction can also cause tears on the peroneal tendons.
Here is a list of the most common sports that can result in peroneal tendonitis:
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Long-distance running
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Cycling
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Football
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Soccer
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Ice skating
There are a lot of factors that can increase the risk of having peroneal tendonitis. Poor foot and ankle mechanics can be hard to notice and may also be the cause of your pain. It is best to have your ankle assessed by a health professional as soon as possible.
How is peroneal tendonitis diagnosed?
Having peroneal tendonitis can be frustrating and affect your ability to participate in sports. Pain and inflammation may worsen by activity. However, prolonged immobilisation may cause further weakness of the leg muscle groups.
Therefore, it is vital to have your peroneal tendonitis assessed as soon as possible. One of the most preferred medical solutions is an assessment with a physiotherapist.
Physiotherapists are movement and rehabilitation experts that can effectively diagnose musculoskeletal injuries such as peroneal tendonitis and help achieve optimal recovery.
Just like a visit with your GP, a physiotherapist will start their assessment with a consultation. You will be asked for a detailed history of your foot and leg pain and any other relevant factors that may be contributing to your injury.
After establishing a background of your condition, your physio will perform specific movement screens and physical tests to determine the root cause of your pain and rule out other conditions.
After your evaluation, your physiotherapist will guide you through your treatment program.
This will include:
How is peroneal tendonitis treated?
The onset of peroneal tendonitis can be mild and manageable at first. However, if faulty biomechanics and improper training techniques are not corrected, it can lead to a much more painful and serious injury. Micro-tears in the tendon can accumulate and weaken your tendons over time.
If you are experiencing symptoms of peroneal tendonitis, it is vital to have your condition assessed and be treated as soon as possible to prevent worsening of your situation.
There are several options when it comes to treating peroneal tendonitis. One of the more common and the treatment option referred to by Australian GPs the most frequently is physiotherapy.
Peroneal tendonitis is one of the most common sporting injuries that physiotherapists encounter in the clinic. They are in the best position to provide quality care and treatment if you suffer from this condition.
Your treatment will focus on decreasing your pain, managing signs of inflammation, improving your mobility and strengthening your lower body muscles.
Depending on the severity of your peroneal tendonitis, a physiotherapist may provide you with a combination of the following types of treatments:
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Myofascial Release - Specific soft tissue mobilisation, reducing muscle tightness and improving movement for myofascial pain.
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Stretching Exercises - Techniques used to elongate shortened muscles and tendons that might be contributing to your injury.
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Strengthening Exercises - Progressive strengthening exercises of crucial muscles of your lower body to improve overall function.
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Ultrasound Therapy - Deep ultrasound waves can be used to penetrate the structures of your ankles and tendons to stimulate the healing process.
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Kinesio Taping - Specialised taping techniques used around the ankle joint to prevent excessive movement and allow for better biomechanics.
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Manual Therapy - Techniques used to improve joint mobility and decrease pain.
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Proprioceptive and Balance Exercises - Exercise techniques that are designed to improve balance and position sense of the ankle joint to prevent reinjury.
A typical physiotherapy session with your local physio will last anywhere between 30-60 minutes, and it is not uncommon for patients to feel the benefits in just one session.
Next step: Creating a treatment plan made for you
After your initial assessment, your therapist will formulate a specific treatment plan to help you maximise your recovery and return to a pre-injured state.
Self-care for peroneal tendonitis
If you think you have peroneal tendonitis, here are the best things you can do and avoid.
Things to do:
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Rest
Resting is an integral part of your healing process. Allow your body to heal correctly by taking a break for a few weeks from activities that aggravate your pain. However, it is essential to maintain a level of activity throughout recovery.
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Use Cold Compress
Swelling, redness and tenderness are all signs of inflammation. Apply a cold compress for 10-15 minutes at a time to help you manage the symptoms of inflammation.
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Immobilise your Ankle
You can use tape to limit the movement of your ankle joint and prevent stress on the peroneal muscles. This is of course, just a short-term strategy whilst you are in pain.
Things to avoid:
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Avoid High-intensity Sports
Avoid running for a couple of weeks to give time to your tendons to heal and let the inflammation subside.
Do I need a specialist or surgery?
A comprehensive assessment from a physiotherapist is enough to diagnose peroneal tendonitis effectively.
However, diagnostic imaging can confirm or rule out other conditions that may be causing your symptoms.
An X-ray can screen for arthritic lesions and bone abnormalities.
An MRI and ultrasound will be able to confirm and detect types of peroneal lesions.
In only the most severe cases, with multiple problems occurring, will your doctor consider more drastic options like surgery. It is best to begin with conservative management for peroneal tendonitis.
Your GP may refer you for physiotherapy for treatment and rehabilitation.
What is the recovery time / prognosis for peroneal tendonitis?
Recovery time is largely dependent on your proactiveness to seek professional treatment and the severity of your pain and injury.
A lot of people can achieve full recovery within 2 to 4 weeks of treatment. However, severe peroneal tendonitis can last for more than a month and may require extensive rehabilitation to ensure proper healing of the tendons.
Physiotherapists improve the overall outcome of patients with peroneal tendonitis. Consistency with your treatment program and rehab goals are the key to your recovery.
Important factors in recovery include:
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Focusing on your rehabilitation program daily
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Resuming your sports activity gradually
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Paying attention to pain, and resting as necessary.
Can peroneal tendonitis be prevented?
These tips can help you prevent peroneal tendonitis or maximise your recovery if you have already been diagnosed.
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Strengthen your peroneals - Maintaining an active routine and exercises that target the peroneal muscles can decrease the risk of tear and injury on this muscle group.
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Do stretching exercises – Stretching exercises can elongate the calf and peroneal muscles’ tight muscles, making them more resilient to stretch and injury.
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Pace your activity - Allow sufficient rest after sporting activities or during a game. Make sure that you are warming up and cooling down properly.
Outlook and the main takeaways
Peroneal tendonitis is a debilitating condition, especially for athletes. Mobility can be impaired and it can prevent you doing the things you love. It is vital to have proper rest and give your body time to heal. Book a consultation with a physiotherapist near you to have your condition assessed.
Anatomy of the peroneal muscles
The fibular or peroneal muscles are two muscles located at the outer part of your leg (fibular compartment).
- Peroneus longus - Originates from the head of the fibula on the lateral border and runs along the side of the leg passing through the lateral malleolus of the ankles and f inserts to the plantar side of the medial cuneiform and metatarsal bone.
It acts to bend (plantarflexion) and moves your ankle to the side towards your smallest toe (eversion). It also provides support to the arches of the foot.
- Peroneus brevis - Originates from the lateral portion of the side of the leg. It is located deep in front of the peroneus longus. It then runs down the foot, off a tendon inserting to the fifth metatarsal bone.
It primarily acts to evert your foot.
These two muscles act as a foot stabiliser to keep the ankle from rolling inward.
Repetitive stress can cause micro-tears on the tendon of these muscles resulting in chronic inflammation leading to pain and instability.
