Peroneal Tendinopathy

What is Peroneal Tendinopathy

Peroneal tendinitis is a condition that can be acute or become chronic (peroneal tendinopathy) whereby there is irritation to one or both peroneal tendons with subsequent degeneration and inflammation.

The actions of the peroneus longus and brevis are plantarflexion and eversion of the foot in open kinetic chain motion. During weight bearing, the peroneus longus acts as a stabilizer of the transverse arch of the foot, as well as stabilizer of the first ray during propulsion

Location

Signs & Symptoms

• Pain in the posterolateral aspect of the ankle along the course of the tendons
• Occasionally swelling & warmth
• Tenderness on palpation to peroneus brevis insertion at the base of the 5^th metatarsal
• Pain with turning the foot in or out
• Pain exacerbated by rising onto the ball of the foot
• Pain with activities such as running, cutting, jogging or even walking on uneven surfaces

Risk Factors

• @ risk population groups
  • Endurance running athletes
  • Young Dancers
  • Ice skaters
  • Sports requiring frequent change of direction or jumping = basketball & netball
• Tight calf muscles
• Weakness of the peroneal muscles
• Inappropriate training loads (training surface, poor recovery or too quick an increase in intensity or duration)
• Poor foot biomechanics
• Inappropriate footwear
• Following acute ankle sprains, chronic ankle instability or post fractures of the ankle

Physiotherapy Management

• RELATIVE rest from aggravating activities (complete rest is actually detrimental to tendon remodelling)
• Swelling and pain management = ice, massage, dry needling, taping
• Ankle bracing or taping during contact sports
• Heal raise inserts to offload the tendon
• Progressive rehabilitation program including
  • Stretching
  • Strengthening
  • Joint Mobilisation and manipulation
  • Propripcetive exercises
• Assessment of running technique and implement strategies to improve Running Biomechanics
• PROGRESSIVE TENDON STRENGTHENING PROGRAM (The Gold Standard Treatment)
• Structured Running program focusing on appropriate loading principles

Adjunctive Treatment Options 

• Orthotics prescribed by our ModPod Podiatrists
• Imaging
• CSI if a tenosynovitis is present
• Platelet-Rich-Plasma (PRP) Injection

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