Peroneal Tendinopathy

Peroneal tendinopathy, or peroneal tendonitis, refers to overuse injury affecting the peroneal tendons. There are two peroneal tendons located on the outer side of the ankle that play a key role in controlling foot movement, particularly eversion (outward turning of the foot). The tendons start in the outer shin and run behind the bony prominence on the outside of the ankle, eventually attaching to the foot’s outer side.

Symptoms

The primary symptoms of peroneal tendinopathy include swelling, pain, and tenderness along the outer flank of the ankle and foot. The pain tends to worsen with weight-bearing activities like walking or running and generally gets better with rest. Additional symptoms may include:

• Difficulty walking or running on uneven surfaces
• Trouble walking up or down stairs
• A sensation of instability in the ankle

Causes

Repetitive ankle movements can cause peroneal tendons to rub against the bone, resulting in irritation and inflammation. Additionally, sudden overload, such as during an ankle sprain, can result in peroneal tendon inflammation or even tears.

Also, peroneal tendinopathy is more likely to develop due to:

• A sudden increase in activity or load on the ankles
• Wearing improper footwear during physical activities
• Overtraining or using inappropriate techniques
• Having a high foot arch
• Muscle imbalances
• Weakness in the lower limbs
• Inadequate rehabilitation after an ankle sprain

As activity levels and load increase, the tendons may thicken in response, but scar tissue can also develop. This makes them more susceptible to tears.

Diagnosis

Physicians at The Joint Pain Clinic often diagnose peroneal tendinopathy through medical history review, physical examination and imaging tests. The physical exam focuses on identifying pain, tenderness, and swelling on the outer edge of the ankle. Resisted testing, which involves pushing the foot outwards against resistance, can be done to check for pain.

Imaging tests that may be used are:

• Ultrasound: This can reveal a thickened, disorganized form of the peroneal tendons as well as detect fluid in the tendon sheath.
• X-ray: This can help rule out other conditions, like fractures or bone spurs, that might be contributing to pain.
• MRI: Provides detailed pictures of the soft tissues surrounding the ankle, showing inflamed or damaged areas in and near the peroneal tendons.

Treatment

Our doctors may advise you to limit walking and other activities that exacerbate your symptoms to allow the tendons time to rest and heal.

Conservative treatment options may include:

• Anti-inflammatory medication
• Cortisone injections
• Ankle immobilization using a cast, splint, or boot
• Bracing
• Physical therapy

Although surgery is rare, it may be recommended if the surrounding tissue irritates the tendons. Additionally, surgery may be necessary if the inflammation is linked to a tear that can be repaired.

Prevention

To prevent peroneal tendinopathy, your doctor may recommend the following:

• Wearing footwear that is suitable for your specific activity
• Stretching the calf and ankle before engaging in any physical activity
• Progressively increasing your training intensity as well as workload
• Maintaining some level of activity during the offseason or recovery periods to keep the ankles strong and flexible

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