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Sports Injury Prevention & Rehabilitation

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Peroneal Tendinitis

(Also known as Peroneal Tendinopathy, Peroneal Tendonitis, Peroneal Tendinosis)
Note -  Although recent research suggest that 'peroneal tendinopathy' is the more appropriate term to describe overuse injuries to the peroneal tendon, we will use the term 'peroneal tendinitis' in this document as it is more widely known.

What is peroneal tendinitis?
There are several muscles which lie on the outside of the lower leg and are collectively known as the peroneal muscles. These originate from the outer lower leg bone (fibula) and travel down along the outside of the leg where they insert into various bones in the foot via the peroneal tendons.
The peroneal muscles are responsible for moving the foot and ankle away from the midline of the body (eversion). Whenever the peroneal muscles contract or are placed under stretch, tension is placed through the peroneal tendons. If this tension is excessive due to too much repetition or high force, damage to the peroneal tendons may occur. Peroneal tendinitis is a condition whereby there is damage to the peroneal tendon with subsequent degeneration and inflammation.

Causes of peroneal tendinitis

Peroneal tendinitis typically occurs following excessive walking or running (especially on slopes or uneven surfaces) or during sporting activities requiring frequent change of direction and or jumping such as dancing, basketball, football or volleyball.

Signs and symptoms of peroneal tendinitis
Patients with this condition typically experience pain at the outer aspect of the ankle, foot or lower leg during activities placing stress on the peroneal tendons (or after these activities with rest, especially upon waking in the morning). The pain associated with peroneal tendinitis tends to be of gradual onset which progressively worsens over weeks or months with the continuation of aggravating activities. Patients with this condition may also experience pain on firmly touching the peroneal tendons.

Diagnosis of peroneal tendinitis
A thorough subjective and objective examination from a doctor is necessary to diagnose peroneal tendonitis. Diagnosis may be confirmed with an MRI scan or ultrasound investigation.

Treatment for peroneal tendinitis

The vast majority of patients with peroneal tendinitis heal well with an appropriate rehabilitation program. The success rate of the rehabilitation program is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Once chronic, healing slows significantly resulting in markedly increased recovery times. Immediate appropriate treatment in all patients with this condition is vital to ensure an optimal outcome.
RICE with regular icing and anti-inflammatory medication may help to significantly reduce inflammation in the initial phase of this condition. A graduated flexibility, balance and strengthening program under direction from a therapist is vital to ensure an optimal outcome.

Contributing factors to the development of peroneal tendinitis
There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a doctor and may include:
  • poor flexibility
  • inappropriate training
  • poor foot biomechanics
  • inappropriate footwear
  • muscle weakness
Rehabilitation for peroneal tendinitis
Rehabilitation treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • stretches
  • joint mobilization
  • taping
  • bracing
  • the use of crutches
  • ice or heat treatment
  • exercises to improve strength, flexibility and balance
  • education
  • activity modification advice
  • biomechanical correction
  • footwear advice

Prognosis of peroneal tendinitis

Most patients with this condition heal well with an appropriate therapy program. This, however, can be a lengthy process and may take several months in patients who have had their condition for a long period of time. Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Early therapy treatment is vital to hasten recovery and ensure an optimal outcome.

Other Intervention for peroneal tendinitis

Despite appropriate therapy management, a small percentage of patients with this condition do not improve adequately. When this occurs the treating doctor can advise on the best course of management. This may involve further investigation such as an X-ray, Ultrasound, CT scan or MRI, corticosteroid injection, autologous blood injection, pharmaceutical intervention or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. A review with a podiatrist for the prescription of orthotics and appropriate footwear advice may also be indicated.