CNY Orthopedic Sports Medicine, PC: Article: Peroneal Tendonitis


Peroneal Tendonitis
Evan Herold
Copyright 2000

What is peroneal tendonitis? Peroneal tendonitis is an inflammatory condition of the peroneal tendon, which runs along the outside of the lower leg, behind the ankle and under the foot. This condition is commonly seen in runners as an "overuse" condition. The Peroneal Muscles originate On the outer (lateral) side of the lower leg just below the head of the fibula (smaller, outer bone of the lower leg). Pass under the outer ankle bone (lateral malleolus) over the side of the foot bone (cuboid) under the foot and attach to the base of the big toe.

The peroneal tendon is encased in, or surrounded by, a synovial sheath that secretes fluid. This fluid allows the tendon to slide up and down without friction as the foot pronates and supinates (moves outward and inward).

How does peroneal tendonitis occur? Excessive pronation of the foot places stress on the peroneal tendon by causing the tendon to have to work to hard to provide foot stability. Foot stability occurs when the mid foot is "locked up" during the push-off phase of gait. The cuboid and other midfoot bones will be "unlocked" if pronation of the foot continues as the foot is pushing off. As the foot over-pronates, the tendon is over-stretched, resulting in inflammation and localized sharp pain.

What are the signs and symptoms of peroneal tendonitis? Typically, patients complain of pain and swelling located in one or two of three areas:

  • Base of the 5th metatarsal - the prominent long bone on the outer side of the foot.
  • In the cuboid tunnel (groove for the peroneus longus tendon) - location is proximal to the prominence of the 5th metatarsal.
  • Behind the outer ankle bone (lateral malleoli).
  • Progressive increase in intensity of pain with weight bearing.
  • Pain with inward movement of the foot (inversion).
  • Pain with resistance to outward movement of the foot (ankle eversion).

    How is peroneal tendonitis diagnosed? Your physician will ask you many questions about the pain in your foot. For example when it began, does the pain increase with activities, does anything seem to relieve the pain. The doctor will also examine your leg and probably take X-rays. X-rays can help rule out a stress fracture, a condition that can mimic the symptoms of peroneal tendonitis. Lastly, your physician may observe you walk so that your gait (low back, hips, knees and feet) may be observed for any unusual characteristics.

    How is peroneal tendonitis treated? Your immediate goal is to control pain, reduce inflammation and swelling, and protect the injured leg.

    REST: Rest is critical to recovering from peroneal tendonitis. It is important that you restrict or limit your activity. Decrease both the frequency and duration of your exercise routine. Increase the amount of time between workouts. Do not confuse this: some individuals have taken a few weeks off and then gone right back to the same routine. This will not provide your body the kind of rest it needs in order to recover.

    ICE: While resting, apply ice or cold therapy to limit the swelling and reduce the pain. This may be accomplished by using a cold pack, cold therapy device or ice massage. To massage, fill a paper cup with water. After freezing, tear back the top portion of the paper exposing the ice. Massage firmly over the injured area in a circular fashion. Repeat this for 15 minutes 3 or 4 times per day, especially before workouts or competition. Be careful not to overexpose the skin.

    NSAID: Your physician may prescribe an NSAID (non-steroidal anti-inflammatory medication) such as Advil or ibuprofen to help reduce the pain and inflammation.

    STRETCHING: Gradual progressive stretching increases flexibility and can prevent the injury from returning. Be sure to stretch both before and after all activities. Calf, Achilles, and peroneal stretching exercises may be performed 3-4 times per day. Consult your physician or physical therapist.

    CORRECTION OF FOOT PROBLEMS: If you have any abnormal biomechanical problems of the lower extremity, they must be addressed or the problem will recur. The type of running shoe you wear, arch supports and a foot strap should all be considered based on your individual gait evaluation. Consult a qualified therapist for a professional evaluation.

    The goal of rehabilitation is to return to your sport or activity as soon as medically possible. Everyone, especially athletes, is anxious to return to activity. Returning too soon can cause permanent damage. Follow your physician's advice regarding your activity level and date of return. Length of recovery will vary from person to person.


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