Peroneal tendonitis and tendinopathy: causes, symptoms, treatment, and prognosis

What are the peroneal muscles and tendons?


The peroneal muscles and tendons are located at the outside of the lower leg. They help point the toes down and move the ankle outwards. They also help stabilize the ankle.

Peroneal tendon pathology can be classified into three categories.

  • Peroneal tendonitis is acute inflammation of the tendon. This occurs after an injury or trauma.

  • Peroneal tendon tears can occur after severe injuries.

  • Peroneal tendinopathy is chronic overuse or overload of the tendon. This usually occurs after prolonged repetitive and overuse activities. Read more about tendinopathy here.


How does peroneal tendonitis and peroneal tendinopathy occur?


Peroneal tendonitis can occur after an inversion injury in which the ankle rolls inwards. This motion stretches and damages the peroneal tendons. High impact activities can also cause inflammation of the tendon. People with peroneal tendonitis can usually pinpoint a specific activity or injury that triggered the symptoms.


Peroneal tendinopathy results from repeated stress of the peroneal tendon. Common aggravating activities include running on uneven surfaces, making quick side to side movements, and changing directions quickly. Those with peroneal tendinopathy tend to have pain that gets worse over the course of days to weeks.


Peroneal tendonitis and peroneal tendinopathy symptoms


Peroneal tendon pain is usually located on the outside of the ankle. Moving the toes downward and outward reproduces the pain. Symptoms can be worse with standing or walking. Swelling may be present.


Diagnosis of peroneal tendonitis and peroneal tendinopathy


Peroneal tendon dysfunction can be diagnosed by performing a physical exam. Swelling may be present around the outside of the ankle. There can be tenderness along the distribution of the peroneal tendons. Testing ankle range of motion may provoke pain. Strength testing may also reproduce pain.


X-rays may be necessary in the setting of injury or trauma to rule out fracture.

Ultrasound can look for inflammation and assess the integrity of the tendon.


Peroneal tendinopathy treatment


Initial treatment involves resting and protecting the ankle. Avoid or modify activities that exacerbate pain. Once pain improves, gradually increase physical activity.


Acute pain

  • Icing the area can help reduce pain and swelling. Apply ice 15-20 minutes at a time. Do this every 4 hours for the first two to three days or until pain improves.

  • Oral or topical anti-inflammatory medications can help decrease inflammation and control pain.

  • Prescription nitroglycerin patches can help those with significant pain.


Supportive devices

  • Compression sleeves or ankle braces provide support and comfort.

  • Severe pain may require a walking boot or crutches to help immobilize and offload the ankle.


Persistent symptoms

  • Patients with persistent symptoms may need injections. This study showed platelet rich plasma injections can help tendon healing.


Peroneal tendon rehabilitation


The goal of rehabilitation is to return to activity as quickly and as safely as possible. Returning too soon can exacerbate symptoms. It can also weaken the tendon and lead to tendon tears.


A home exercise program will help improve range of motion, stability, and strength. Some people choose to participate in physical therapy. Physical therapists assess, guide, and teach you exercises and stretches. They also individualize a training program for you and your body.


Here is a link to a great example of a home exercise program for peroneal tendinopathy:

Peroneal tendinopathy stretches and exercises


Try to do your home exercise program twice a day. When pain is severe, focus on stretching and range of motion. Include strengthening exercises as pain improves.


Recovery for peroneal tendon problems


Recovery is determined by the duration and severity of the injury. The longer you have symptoms, the longer it will take to get better. Use symptoms as a guide for progression. Avoid using time in days or weeks as a marker for recovery.


Decrease the frequency of your home exercise program as your symptoms improve. For example, if doing the exercises twice a day, decrease to once a day. Do this for about one week.


Many people choose to incorporate these exercises into their weekly workout routine. This can help prevent reinjury as well as maintain strength, mobility, and range of motion.


-----

Disclaimer: Pictures were taken without permission from the Sports Medicine Patient Advisor. They are intended for educational purposes only.