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 change of direction on the outside of the foot e.g. basketball, skiing, dancing, ice skating.
What are the Peroneals?
The Peroneal muscles are 2 important muscles lying deep, outside part of your calf. The Peroneal Longus muscle, and the Peroneal Brevis muscle. Starting at the back, upper, outside part of the calf, each runs down towards the ankle where the tendons begin.
Each tendon raps round the back of the ankle. The Peroneal Brevis tendon attaching 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 2 points where the tendon raps round a bone.
They 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?
As used in many medical terms, ‘itis‘ is latin for inflammation. So Peroneal tendinitis basically means inflammation of the tendon. ‘Opathy’ is latin for ‘disorder of’, which better describes the overall injury as over time it will go through different stages. Hence the term Peroneal tendinopathy. Due to a poor blood supply and repetitive strain nature, tendons take time to heal. Usually months.
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.
Have patience
Over time the inflammation becomes more degenerative in nature due to a build up of scar tissue. This is termed as a ‘disrepair’ of the natural healing process. Peroneal tendinopathy symptoms in this phase include pain that is worse when walking over time or trying to run.
What are the common causes of Peroneal Tendinopathy?
As Peroneal tendinopathy is usually an overuse or repetitive strain injury there are certain common activities which can cause pain or even after other injuries:
- Running or jumping
- Sports with quick change of direction
- Walking long distances
- Increased levels of training
- Returning to sport/activity after prolonged period off
- Walking on uneven terrain
- Using less supportive footwear e.g sandals
- Post injuries e.g. ankle sprain, foot fracture
- Chronic ankle instability
What are the symptoms of Peroneal Tendinopathy?
- Aching/burning pain around the outside of the ankle/foot
- Swelling over the outside ankle/lower calf
- Pain when running or jumping
- Pain on first 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 tibialis posterior tendon is in, and provide diagnosis confirmation is using ultrasound scans. Take a look here for more information on our specialist diagnostic ultrasound service.
Our next blog explains the best treatment options for Peroneal tendinopathy.
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