How To Treat Peroneal Tendinopathy
Steps To A Successful Recovery
Peroneal tendinopathy treatment is made very simple and effective in a few easy steps. As reported in our previous blog ‘What is peroneal tendinopathy?’, it is a very common place, overuse condition, especially among runners.
Ankle/foot pain when running and walking, as well as when using unsupportive footwear are all classic characteristics. The diagnosis is the easy part – the key question then is how do we treat it?
Stretching alone will not cure peroneal tendinopathy!
Loosely speaking, there are three steps to peroneal tendinopathy treatment. The exact formula for recovery and the specifics of each stage will be individual to you and will be outlined by your physiotherapist. The duration and severity of your symptoms will guide how you progress through the steps outlined below.
Peroneal Tendinopathy Treatment
Step 1- Reduce Pain
In an acute pain episode or flare up, follow the ‘POLICE’ protocol in the initial 48-72 hours:
- Protect > using good supportive footwear, taping or a short-term insole with medial arch support
- Optimal Load > general rest and offloading for the next few days, before steadily reintroducing movement as pain allows
- Ice > cold compress for 10-15mins every 2-3 hours to aid pain relief and reduce inflammation
- Compression > compress the injured area with an elastic, tubular bandage to slow the swelling
- Elevation > raise and support the injured area above the level of your heart to reduce swelling
Step 2- Reset
Extracorporeal Shockwave Therapy (SWT) is a relatively new intervention that has scientifically proven, excellent results with specific conditions including peroneal tendinopathy. Shockwave therapy owes its heritage to lithotripsy, a treatment that’s been around since the 1970s. Lithotripsy uses focused shockwaves to break apart kidney stones so they can be passed. A number of years later, a bit of lateral thinking and a strong evidence base now presents SWT as a ‘gold standard’ treatment for chronic tendinopathy.
As noted above, symptoms of tendinopathy fail to improve due to the stalled healing process in which the tendon is in a state of disrepair (more commonly called scar tissue). SWT as part of peroneal tendinopathy treatment aims to agitate or shock the injury back to its acute phase of healing. It uses acoustic energy – almost like pressing the ‘reset’ button. This can produce a noticeable reduction in pain which in turn can expedite a return to activity. Alongside SWT it is vital to introduce progressive load to the tissues to ensure optimum recovery.
Step 3- Strengthen
As we know the peroneal tendons play a crucial role in absorbing and producing force when walking, running and jumping. As a result, part of peroneal tendinopathy treatment should focus on regaining localised strength of the deep calf muscles, as well as improving any weak links in the kinetic chain further up.
A study published in 2023 showed that a tailored, progressive strengthening programme should be part of peroneal tendinopathy treatment.
Research has shown that shockwave therapy, in combination with a tailored strengthening programme, gives the most significant improvements in common lower limb tendinopathies.
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