What Is Peroneal Tendinitis?

The peroneal tendon runs along the outside of your ankle bone, right about where the bony part sticks out.  It also runs near the fibula which is the bone in the lower portion of your leg.  Overuse or injury to the peroneal tendon can lead to peroneal tendinitis.

Peroneal tendinitis happens when the peroneal tendon becomes inflamed.  Inflammation can occur if the peroneal rubs against the bone.  If the rubbing occurs for a prolonged amount of time, the tendon will thicken to help manage the overuse or load the tendon bears.  

As the tendon thickens the entire peroneal tendon tightens and causes pain on the outside of your ankle.  Athletes are more prone to peroneal tendinitis because of overuse of ankle tendons and repetitive motions.   

The Symptoms of Peroneal Tendinitis

Peroneal tendinitis is either acute or chronic.  Acute peroneal tendinitis occurs suddenly with no warning whereas the chronic version is persistent and prolonged. The most common symptom of peroneal tendinitis is outside ankle pain.  Some people might actually feel the tendon rubbing across the ankle bone or other ankle tendons.

There also tends to be a good deal of swelling on the outside of the ankle, especially if the pain has been happening for a while.  Most people with peroneal tendinitis also tend to have worse pain as they are active but find relief once they rest their foot.  Athletes that are very active, such as runners, might find they have continuous pain even if they rest.

It might also hurt to rotate your foot in or out, and it could be hard to bear weight.  Because of inflammation, your ankle might feel warm to the touch.  Swelling can also start to travel up your leg if it’s left untreated for long enough.  

The Causes of Peroneal Tendinitis

People that most often have cases of peroneal tendinitis are athletes that do a lot of repetitive motions.  Runners, cyclists, and even kickers tend to be the most common.  These repetitive actions such as running or kicking a football lead to overuse of the ankle tendons.  The overuse then leads to inflammation and pain.  

People might also experience peroneal tendinitis if they start to pick up the frequency or intensity of their workouts.  For people that are just beginning a workout routine, the change in pressure and stress of exercise can lead to overuse.  While things like yoga or Pilates might not affect the peroneal tendon, weight-bearing exercises such as running, weight-lifting, or plyometric workouts can aggravate the tendon.  

Improper technique while exercising or playing a sport can also cause this type of tendinitis.  If you overpronate as you run or walk, or misuse your ankle, you might be compressing the peroneal.  That compression will also lead to inflammation and pain.  Along with improper technique, bad shoes that are worn out or not meant for your specific activity can lead to tendonitis.  Your shoes should adequately support your arches.

People with higher foot arches might also experience higher rates of peroneal tendinitis.  Higher arches tend to stretch the peroneal tendon and cause it to work harder leading to friction and inflammation.  Other cause of peroneal tendinitis could include:

  • Lower body muscles are not syncing correctly with joints in the hip, knee, or ankle.
  • A muscle imbalance where one muscle is stronger or more developed than others.
  • Previous ankle injuries and improper rehabilitation.

Anyone who has had a previous ankle injury should be extra cautious, especially if you didn’t complete your rehab.  Your ankle is more prone to peroneal tendinitis because there is already scar tissue in that area.  The scar tissue can weaken the tendon and make it more likely to tear in the future.

How Is Peroneal Tendinitis Diagnosed?

If you notice that you have pain on the outside of your ankle, sustained an injury to your ankle, or suspect you might have peroneal tendinitis, you should visit your doctor.  Your primary care doctor should be able to refer you to a podiatrist or other specialist who is an expert in this area.  If you have a physical therapist, he or she might also be able to refer you to a specialist.

At your appointment, the doctor will take a medical history and try to pinpoint if and when you damaged the peroneal tendon. Athletes should try to recount the past few weeks of games and practices to help the doctor figure out what happened.  More than likely, the history will point to an issue of overuse or increased activity.

Once they have your medical history, the specialist will perform a physical examination.  This part of the visit will include the specialist moving your ankle and leg in different ranges to pinpoint the origin of the pain.  The specialist does this to ensure the pain is in the peroneal tendon and not the fibula which could be a different problem.

Usually, there will be a diagnosis at this point and no further tests.  In some cases, though, the doctor might order an X-ray, MRI, or ultrasound to rule out a break or fracture.  These tests can also show the extent of the swelling and help the doctor figure out the best course of treatment for your case.  

Treatments for Peroneal Tendinitis

The most important thing anyone with peroneal tendinitis can do to help heal is to rest.  Because this problem is an issue of overuse, getting off your feet as much as possible will help the inflammation to go down and the pain to stop.  There are a few other treatments that could help.

Immobilization with a Boot

Your doctor might have you wear a boot or inflatable cast to help immobilize your foot.  If the way you walk or your arches cause the inflammation, restricting movement can help in the short term.  A boot will also help take weight off your ankle so that it can heal.

Medication

Over-the-counter painkillers can help with swelling and pain.  You should consult with your doctor first to make sure the meds won’t interact with anything else you take or cause further damage.  In most cases, these meds can help a lot.

Physical Therapy

Once the inflammation has gone down, physical therapy might be able to help prevent peroneal tendinitis from coming back.  At first, a doctor might prescribe the RICE treatment.  This protocol includes rest, icing the area, compression, and elevation.  Your doctor or physical therapist will show you how to do this at home.

After RICE, you might have some exercises you need to do to strengthen the area or help fix the problem that caused the tendonitis in the first place.  These exercises can help with any muscle imbalances, joint issues, overpronation, gait problems, and balance.  You won’t have to do these exercises for the rest of your life, just until the initial problem which caused your peroneal tendonitis is corrected.  

Ankle Brace

For most people, an ankle brace won’t be necessary.  For athletes though, ankle bracing might be a helpful way to protect the peroneal tendon.  This is a standard practice for athletes that do the same repetitive motion, such as kicking.  Some athletes choose to tape their ankle to brace the area or purchase a special ankle brace.  If you do decide to use tape, make sure a physical therapist, doctor, or athletic trainer shows you the proper way to brace the ankle to prevent further injury.

Cortisone Injection

In rare instances, a doctor might use a cortisone injection to deliver anti-inflammatory medication directly to the tendon.  This does not happen often though because a cortisone injection could cause the tendons to rupture and lead to even bigger problems.  A shot is usually only used if a patient is in extreme pain.  

Surgery

Surgery is another rare solution to peroneal tendonitis.  It is often the last solution if all other treatments have not helped the problem.  For this procedure, a surgeon will make small incisions near the ankle and do a tendon release to alleviate the rubbing and irritation.  Surgery might also be necessary if the peroneal tendon is torn.  The surgeon will go in and perform a tendon repair to the peroneal.  

Can Peroneal Tendinitis Be Prevented?

You can take some steps now to prevent peroneal tendinitis from ever happening.  You can:

  • Wear the proper shoes that provide plenty of support.
  • Stretch the area.  Only do this under the direction of a doctor or physical therapist.
  • Increase exercise or training gradually instead of all at once.
  • Athletes should maintain a certain level of activity in the off-season to prevent overuse problems when the regular season starts up again.  

Overall peroneal tendinitis is not a major issue, and most people will make a full recovery.  The key is to make sure you catch it early enough before extensive damage occurs.  Recovery will also take some time, and you shouldn’t rush it because that will only hinder your progress.  Continue with the prevention methods above even after you have recovered, so you don’t have to worry about it recurring.  

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