What is Peroneal Tendinopathy?
Peroneal tendinopathy is a progressive, overuse injury affecting the outside of the foot and ankle. It can present acutely as peroneal tendinitis or become chronic and develop into a tendinopathy over time. Classically this condition is seen in runners. However, it is also common in sports requiring repetitive jumping or a change of direction on the outside of the foot e.g. basketball, skiing, dancing, ice skating.
This blog will cover what peroneal tendinopathy is including symptoms and diagnosis. You can skip ahead to treatment for peroneal tendinopathy here.
Where are the peroneal muscles?
The peroneal muscles (or peronei) are two important muscles deep in the outside part of your calf. They consist of peronus longus and peronus brevis. They originate at the back, upper, outside part of the calf and run down towards the ankle where the tendon begins.
Each tendon wraps round the back of the ankle. The peroneal brevis tendon then attaches to the outside of the heel bone. The peroneal longus tendon continues to the outside of foot and passes underneath the sole to the big toe. Peroneal tendinopathy symptoms often occur at the two points where the tendon wraps round the ankle/foot bones.
The peronei play an essential role in supporting the arch of the foot, stabilising the ankle and creating propulsion for walking, running and jumping.
Tendinopathy or Tendinitis?
These terms are often used interchangeably but there is an important difference. To understand how to use this terms appropriately, it is important to understand what’s going on in the tendon when an injury occurs.
What’s going on?
Tendons (and in general all soft tissues) are in a constant continuum of healing. When a tendon becomes painful in the first 3-6 weeks, be it a first time episode or a flare up of a persistent problem, we class this as the ‘reactive phase’. Typically when symptoms are more acute and irritable. For example, each step when walking or going up/down stairs. During this phase, we often use the term ‘tendonitis’ as there can be an inflammatory component.
Over time the condition becomes more degenerative in nature due to persistent overload and an inability of the tendon to be able to repair itself. This is termed as ‘disrepair’. In other words, the healing process has stalled. We tend to use the term ‘tendinopathy’ to describe chronic tendon problems. In this phase pain often gets worse over time when walking or trying to run.
What are the common causes of peroneal tendinopathy?
As peroneal tendinopathy is usually an overuse or repetitive strain injury. Below is a list of commonly provocative activities and risk factors:
- Running or jumping
- Sports with a quick change of direction
- Walking long distances
- Increased levels of training
- Returning to sport/activity after a prolonged period off
- Walking on uneven terrain
- Using less supportive footwear e.g sandals
- Post injury e.g. ankle sprain, foot fracture
- Chronic ankle instability
What are the symptoms of peroneal tendinopathy?
Commonly reported symptoms of peroneal tendinopathy include:
- Aching/burning pain around the outside of the ankle/foot
- Swelling over the outside ankle/foot
- Pain when running or jumping
- Pain on first few steps in the morning
- Pain with stairs
- Pain wearing flat shoes
- Ankle pain +/- stiffness
- Inability to raise onto your toes
- Weakness/instability around the ankle
Diagnosis
One simple way to establish what stage of healing the peroneal tendons are in and provide diagnosis confirmation is via a diagnostic ultrasound scan. Take a look here for more information on our specialist diagnostic ultrasound service.
Our next blog explains the best treatment options for peroneal tendinopathy.
If you’re suffering with foot or any pain, follow this link to book an appointment with one of our experienced team members. For any further information please call us on 0114 267 8181 or email [email protected].
