Peroneal Tendonitis

Peroneal tendonitis is an injury in which muscle fibers or tendons that run behind the lateral maleolus are stretched causing inflammation and pain along the tendon. The peroneal muscles are on the outer side of the lower leg and their tendons run down behind the bony bit on the side of the ankle and attach to the foot. These muscles and tendons help move your foot to the outside. A strain of these muscles can affect walking, running, and jumping activities.  A peroneal tendon injury can result in pain and loss of function for weeks to months depending on the severity of the injury.

During an injury when the foot and ankle are rolled inward, a movement called inversion, the peroneal tendons may be stretched causing pain and loss of function. They also may be injured when your foot is forced upward toward your shin. Peroneal tendonitis can result from running on sloped surfaces or running in shoes with excessive wear on the outside of the heel.

Peroneal Tendonitis Symptoms: You will have pain on the outer side of your lower leg and ankle. You will notice increasing pain and tenderness around the outside aspect of your ankle. You may have swelling around your ankle as well.

How Is It Diagnosed? Your doctor will examine your ankle and lower leg. He or she will move your ankle and leg to test these tendons. X-rays may be taken to see if there is a break in your ankle or in one of the bones in your feet.

Treatment of Peroneal Tendonitis:

Treatment may include:

• 1. Applying ice packs to your ankle for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain goes away
• 2. Elevating your ankle to help the swelling go away by lying down and placing your foot and ankle on a pillow
• 3. Wrapping an elastic bandage around your ankle to help keep the swelling down
• 4. Wearing a peroneal tendonitis brace or splint (such as an Aircast or Gelcast) or a lace-up ankle brace as prescribed by your doctor
• 5. Doing exercises to strengthen your peroneal muscles and tendons and to strengthen your ankle joint.

While you are recovering from your peroneal tendonitis, you will need to change your sport or activity to one that will not make your condition worse. For example, you may need to bicycle or swim instead of run.

Returning to Sports or Activity: To get over this injury requires rest and rehab exercise. The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from peroneal tendonitis at a different rate. Return to your sport or activity will be determined by how soon your ankle recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

• 1. You have full range of motion in the injured leg compared to the uninjured leg.
• 2. You have full strength of the injured leg compared to the uninjured leg.
• 3. You can jog straight ahead without pain or limping.
• 4. You can sprint straight ahead without pain or limping.
• 5. You can do 45-degree cuts, first at half-speed, then at full-speed.
• 6. You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
• 7. You can do 90-degree cuts, first at half-speed, then at full-speed.
• 8. You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
• 9. You can jump on both legs without pain and you can jump on the injured leg without pain.

Peroneal Tendonitis Exercises: You may start these exercises when you can stand comfortably on your injured leg with your heel resting on the floor and your full weight evenly distributed on both legs.

• 1) Towel stretch: Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and pull the towel toward your body, stretching the back of your calf muscle. Hold this position for 30 seconds. Repeat 3 times. When you don't feel much of a stretch using the towel, you can start standing calf stretch.
• 2) Standing calf stretch: Facing a wall, place your hands against the wall at about eye level. Keep the injured leg back and the uninjured leg forward and the heel of your injured leg on the floor. Turn your injured foot slightly inward (as if you were pigeon-toed). Slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 30 to 60 seconds. Do this 3 times.
• 3) Thera-Band exercises A) Resisted dorsiflexion: Sitting with your leg out straight and your foot near a door, wrap the tubing around the ball of your foot. Anchor the other end of the tubing to the door by tying a knot in the tubing, slipping it between the door and the frame, and closing the door. Pull your toes toward your face. Return slowly to the starting position. Repeat 10 times. Do 3 sets or 10. B) Resisted eversion: Sitting with both legs outstretched and the tubing looped around both feet, slowly turn both feet upward and outward. Hold this position for 5 seconds. Repeat 10 times. Do 3 sets of 10.
• 4) Toe raises: Stand in a normal weight-bearing position. Rock back on your heels so that your toes come off the ground. Hold this position for 5 seconds. Repeat 10 times. Do 3 sets of 10.
• 5) Single leg balance: Standing without support, attempt to balance on your injured leg while maintaining a good arch in your foot and not curling your toes. Begin doing this exercise with your eyes open and then attempt to do it with your eyes closed. Repeat 3 times. 6.
• 6) Jump rope: Jump rope landing on both legs for 5 minutes, then only on the injured leg for 5 minutes.

How To Prevent Peroneal Tendonitis:

• 1. Keep your ankles and peroneal muscles strong.
• 2. Wear high-top athletic shoes or a supportive ankle brace.
• 3. Warm up properly before starting your sport or activity. 4) When running, choose level surfaces and avoid rocks or holes.

All material provided is designed for information purposes only and should not be used to replace the care of a health care professional. Do not rely on any of the information for diagnosis or treatment. It is recommended that you visit a qualified health care professional for individual and personal attention.