Peroneal tendinopathy is pain arising from the tendons around the outside of the ankle. It is often misdiagnosed as an ankle sprain and can be an acute injury or more of a chronic injury.
The Peroneals comprise of two muscles – Peroneus Longus and Peroneus Brevis that originate around the top of the fibula bone (thin bone next to the shin bone) and run down the outside of the leg before wrapping around the back of the ankle and attaching to the outside and sole of the foot – Brevis and Lognus respectively. Their main function is to support the ankle and move the foot out to the side (eversion).
Pain is often associated with activity and may stop a person doing their activity. There could be signs of local swelling or inflammation around the area. It is also associated with sports that require quick changes of direction such as netball, skiing and even horse riding. The pain can be around the ankle or refer into the outer part of the foot or lower leg. Symptoms often improve with rest but re-occurs with activity. There may also be some stiffness following periods of immobility until the tendon has a chance to get warmed up.
Injury can come about through prolonged bouts of activity such as running or dancing whereby the tendon(s) is/are overloaded over a period and starts to become sore. One of the main contributing factors to developing to Peroneal tendinopathy is poor foot biomechanics due to weakness around the ankle and foot. This can cause the foot to move more than it is happy to when it lands or force is put through it, leading to overload. It can also develop from an ankle sprain when the person returns to sport or activity too soon without strengthening around the ankle following their injury.
Your Physiotherapist will take a full history of your symptoms followed by a physical examination to provide you with a timely and definitive diagnosis. An accurate diagnosis ensures the most effective treatment and management strategy can be put in place. Your Physio will discuss what activities are important to you for individualised goals to be made that will direct treatment. Regular re-assessment will ensure you are making progress towards achieving your goals and will allow any modifications to be made.
Management for this condition comprises of activity modification and strength training. Peroneal Tendinopathy is managed akin to other tendon issues. The tendons should be exposed to high-load training on an alternating daily pattern to augment the response to loading whilst allowing for recovery and adaptation to take place. Your Physio will teach you how to manage your symptoms and how to make adjustments to your exercise activity to allow your symptoms to settle whilst maintaining your fitness. They can also discuss useful strategies that may help reduce pain and discomfort and methods that can help you gradually return to full activity.
To favour loading the Peroneal tendons, resisted exercise with theraband is recommended as it allows it to be exposed to load in an easy way. Your Physiotherapist will prescribe a personalised and progressive strengthening programme which may be given for 12 reps for 3 sets with a degree of pain/discomfort.
On a scale of 0-10 (10 being the most severe pain imaginable) you should not exceed 5/10 after performing the exercise or 24 hours following a ‘loading’ day. Alternating between a loading day followed by a rest day allows you to gauge the irritability of the tendon whilst also establishing the ‘sweet spot’ for load that it responds positively to. With this patterning, we also recommend that you plan your physical activity on the same day as loading so that you can the most explicit ‘on’ and ‘off’ days within practical limits. If this is managed well, you should find that your symptoms will progressively decrease as your activity levels increase.
Our skilled Physiotherapist at Pure can work with you to develop a personalised activity modification and strength training protocol to effectively alleviate your symptoms and restore your function. At Pure, we can help decipher factors that may play a role in your development of this issue so that you can negate the chances of this re-occurring. We will assist in equipping you with the skills and knowledge to manage you condition and take back control.