Peroneal tendonitis is a common overuse injury affecting the tendons on the outer side of the ankle and foot. These tendons stabilize the foot and ankle during movement, making them susceptible to irritation. This condition can cause pain and limit mobility, often developing gradually over time. The following information provides guidance on how to manage and heal peroneal tendonitis.
Understanding Peroneal Tendonitis
Peroneal tendonitis involves inflammation or irritation of the two peroneal tendons, the peroneus longus and peroneus brevis, which run behind the bony prominence on the outer ankle. These tendons connect muscles in the lower leg to bones in the foot, helping to control foot position during walking and enabling foot eversion, the outward movement of the foot. The condition typically arises from repetitive forces and overuse, leading to an inflammatory response.
Several factors can contribute to its development, including a sudden increase in physical activity, improper training techniques, or inadequate footwear. Biomechanical issues, such as high-arched feet or misaligned heels, can also increase repetitive stress on the tendons. Symptoms commonly include pain along the outside of the ankle and foot, which often worsens with physical activity and may be present as “startup pain” in the morning. Swelling, warmth, and tenderness along the tendon path can also occur, sometimes accompanied by a feeling of ankle instability.
Initial Steps for Relief
Immediate management of acute peroneal tendonitis pain and inflammation often involves the RICE protocol: Rest, Ice, Compression, and Elevation. Rest prevents further aggravation, though prolonged inactivity can hinder healing as the tendon needs some loading to adapt. Activity modification, such as reducing activities that worsen pain, is usually recommended.
Applying ice to the affected area for 15-20 minutes every 2-3 hours during the initial 24-48 hours can help reduce pain and swelling. Compression with an elastic bandage can also decrease swelling and provide support, ensuring it is snug but not overly tight. Elevating the injured foot above heart level helps reduce swelling by encouraging fluid drainage. Wearing appropriate footwear that offers good support or using an ankle brace can also provide stability and reduce irritation during daily activities.
Rehabilitation and Strengthening
A structured rehabilitation program is important for long-term healing and preventing the recurrence of peroneal tendonitis. This involves gradually introducing gentle stretching and progressive strengthening exercises. Controlled stretching helps improve flexibility and prepares the tendons for strengthening. Examples of gentle stretches include towel stretches, pulling toes towards you with a towel, and calf stretches, targeting lower leg muscles.
Once pain subsides, progressive strengthening exercises can be incorporated to build resilience in the peroneal tendons and surrounding muscles. Resistance band exercises are effective for ankle eversion, pushing your foot outwards against the band. Calf raises, both standard and eccentric (focusing on the lowering phase), also strengthen the calf and peroneal tendons. Single leg balance exercises challenge ankle stability and muscle coordination, reducing stress on the tendons. Consistency and listening to your body are crucial to avoid overstressing healing tendons.
When Professional Help is Needed
While home care can be effective, there are instances when professional medical attention becomes necessary for peroneal tendonitis. If pain persists despite several weeks of home treatment, worsens, or significantly impacts your ability to bear weight or perform daily activities, seeking medical advice is advisable. A sudden snapping or popping sensation in the ankle, or the presence of skin discoloration, warrants immediate medical evaluation, as these may indicate a more severe injury like a tendon tear or subluxation.
A doctor or physical therapist can conduct a thorough physical examination to accurately diagnose the condition. They may also recommend imaging tests, such as X-rays or MRI, to rule out other conditions like fractures or significant tendon tears. Treatment options from a professional might include a prescription for physical therapy, customized orthotics to correct biomechanical issues, or in some cases, immobilization with a walking boot or cast to allow the tendons to heal. In rare cases where conservative treatments fail or tendon damage is severe, surgery may be considered.