Peroneal tendonitis is a common condition affecting the ankle and foot, often leading to pain and discomfort along the outer aspect of the lower leg. This irritation can significantly impact daily activities and physical pursuits. Understanding the condition and implementing appropriate strategies can lead to significant relief and a successful recovery.
Understanding Peroneal Tendonitis
Peroneal tendonitis involves inflammation or irritation of the peroneal tendons, two cord-like structures running down the outside of the lower leg, behind the ankle bone, and into the foot. These tendons, peroneus longus and brevis, stabilize the ankle for eversion (outward foot movement) and plantarflexion (pointing the foot downwards). When stressed or overused, tiny tears can develop, leading to inflammation and pain.
Common symptoms include pain along the outer ankle, worsening with activity like pushing off or rotating the ankle outwards. Swelling and tenderness along the tendon’s path behind the ankle bone are also observed. Pain can range from a dull ache to a sharp, burning sensation, often feeling worse after rest or in the morning. This discomfort can make walking, running, or standing for extended periods challenging.
The condition often arises from overuse, such as a sudden increase in running mileage or intensity, or repetitive ankle movements. Other factors include improper footwear, ankle instability, or anatomical variations like high arches. Minor ankle sprains that have not fully healed can also contribute.
Immediate Relief and Self-Care
Immediate steps for managing peroneal tendonitis at home involve the RICE method:
- Rest the affected foot by avoiding activities that exacerbate pain, such as running, jumping, or prolonged standing.
- Apply ice to the outer ankle for 15-20 minutes every few hours to reduce inflammation and numb the pain.
- Compression, via an elastic bandage or compression sleeve, helps minimize swelling.
- Elevating the foot above heart level further assists in reducing swelling.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can manage pain and reduce inflammation. Follow dosage instructions carefully.
Modifying activities involves temporarily ceasing or significantly reducing movements that aggravate the tendon. This might mean switching from high-impact exercises to lower-impact alternatives like cycling or swimming. Supportive footwear with good arch support and cushioning can alleviate stress on the peroneal tendons. A temporary ankle brace or walking boot may also provide stability and limit ankle movement, allowing the tendons to rest and heal.
Strengthening and Flexibility Exercises
Once acute pain has subsided, gradually introduce strengthening and flexibility exercises. Ankle eversion exercises, targeting the peroneal muscles, are recommended. Perform these by sitting with legs extended, looping a resistance band around the foot, and anchoring the other end. Slowly move the foot outward against the band’s resistance, hold for a few seconds, then return to the start, performing several repetitions.
Calf stretches improve ankle flexibility and reduce lower leg tension. A common calf stretch involves standing facing a wall, placing hands on the wall, and stepping one foot back while keeping the heel on the ground and knee straight. Leaning forward gently stretches the calf. Another variation involves bending the back knee slightly to target the deeper soleus muscle.
Incorporating balance exercises enhances ankle stability and proprioception. Standing on one leg for increasing durations, or performing heel-to-toe walking, can challenge the ankle’s stabilizing muscles. As strength improves, these exercises can be made more challenging on an unstable surface, such as a folded towel or a balance board. Proper form is important during all exercises to avoid re-injury; movements should be slow and controlled, focusing on muscle engagement.
When to Consult a Professional
If pain persists despite several weeks of consistent home treatment, or if symptoms worsen, seek medical advice. Immediate medical evaluation is also needed for an inability to bear weight or signs of infection like redness, warmth, or pus.
A doctor or physical therapist can provide a precise diagnosis and tailored treatment plan. This often begins with a thorough physical examination of the ankle and foot to assess tenderness, swelling, and range of motion. Imaging tests like X-rays or MRI scans may be used to rule out other conditions or assess the extent of tendon damage.
Treatment Options
- Physical therapy: Involves specific exercises, manual therapy techniques, and modalities to reduce pain and inflammation.
- Custom orthotics: Shoe inserts prescribed to correct foot mechanics and provide better support, reducing stress on the tendons.
- Corticosteroid injections: May be considered to reduce severe inflammation, though often a temporary measure.
- Surgery: Rarely needed, typically reserved for severe, chronic cases unresponsive to conservative treatments, such as a significant tear or tendon instability.
Preventing Recurrence
Preventing future episodes of peroneal tendonitis involves adopting proactive measures for ankle health. Gradually increasing activity levels is a primary preventative strategy, especially when starting a new exercise regimen or increasing training intensity. Abrupt changes in activity can overload the tendons and lead to inflammation. Allow for adequate rest and recovery between workouts to avoid overexertion.
Wearing appropriate and supportive footwear is another significant step. Shoes should provide good arch support, adequate cushioning, and a stable base, particularly for activities with repetitive foot movements. Regularly replacing worn-out athletic shoes helps maintain support. Incorporating regular stretching and strengthening exercises for the ankle and lower leg muscles, even after recovery, helps maintain flexibility and muscle balance.
Maintaining a healthy weight can reduce the load and stress on ankle and foot structures. Addressing underlying biomechanical issues, such as flat feet or high arches, through appropriate footwear or orthotics can help distribute forces more evenly. These consistent practices contribute to long-term ankle health and reduce the likelihood of recurrence.
Citations
FootCareMD. Peroneal Tendonitis. Available at: https://www.footcaremd.org/conditions-treatments/ankle/peroneal-tendonitis. Accessed July 29, 2024.
Cleveland Clinic. Peroneal Tendinopathy. Available at: https://my.clevelandclinic.org/health/diseases/21482-peroneal-tendinopathy. Accessed July 29, 2024.
Mayo Clinic. Tendinitis: Self-care. Available at: https://www.mayoclinic.org/diseases-conditions/tendinitis/self-care. Accessed July 29, 2024.
OrthoInfo. Peroneal Tendon Injuries. Available at: https://orthoinfo.aaos.org/en/diseases–conditions/peroneal-tendon-injuries/. Accessed July 29, 2024.
Hospital for Special Surgery. Peroneal Tendonitis. Available at: https://www.hss.edu/condition-list_peroneal-tendonitis.asp. Accessed July 29, 2024.
Physiopedia. Peroneal Tendinopathy. Available at: https://www.physio-pedia.com/Peroneal_Tendinopathy. Accessed July 29, 2024.