What is Peroneal Tendinopathy?

Peroneal Tendinopathy is a condition that affects the peroneal tendons on the outer side of your ankle and foot. [1] Peroneal tendinopathy is caused due to continuous and repetitive use of the peroneal tendon, which is crucial for foot stability. Overuse, ankle instability, or prior injuries can contribute to structural changes in the peroneal tendon, like collagen breakdown and changes in the matrix, causing pain, weakness, and degeneration, often and sometimes swelling. [1, 2]. Diagnosis involves physical examinations and imaging. [2]. Treatment includes rest, ice, compression, elevation, physical therapy, orthotics, and sometimes surgery. [2, 3]. Prevention involves supportive shoes, gradual activity increases, and addressing foot problems early. [3]. Early diagnosis and treatment are key for managing this condition effectively.

Factors that can contribute to its development include:

• Overuse: Repeatedly stressing the tendon through activities like running, jumping, dancing, or even standing for a prolonged period.
• Sudden increase in activity: Doing exercise too quickly without proper conditioning, lack of warm-up, or using incorrect form during exercise or sports.
• Poor footwear: Shoes that don't provide adequate support or fit poorly, and prolonged wearing of high heels.
• Foot structure: Having high arches or flat feet can put extra strain on the peroneal tendons.
• Ankle instability: Previous ankle sprains or weak ankles can lead to overcompensation by the peroneal tendons.
• Uneven surfaces: Regularly walking or running on sloped or uneven ground.
• Tight calf muscles: Can increase stress on the peroneal tendons.
• Age: Tendons become less flexible and more prone to injury as we get older.
• Medical conditions: Certain conditions like diabetes, being overweight, or rheumatoid arthritis can increase risk.

How do I know that I have peroneal tendinopathy?

The most common symptom of peroneal tendinopathy is pain along the outer part of the ankle, especially during or after physical activity. You might also experience swelling, tenderness, stiffness, and a feeling of weakness or instability in your ankle. [1]

How Does the Doctor Treat Peroneal Tendinopathy?

If you suspect you have peroneal tendinopathy, it's important to consult an Orthopaedic surgeon. Your doctor can only diagnose and treat this accurately. They will likely examine your foot, assess your gait and movement, and may recommend imaging tests like X-rays, ultrasound, or MRI to rule out other conditions. [2]

Treatment for Peroneal Tendinopathy

Treatment focuses on reducing pain and inflammation while promoting healing. Common approaches include:

• Rest and activity modification: Reducing or altering activities that hurt the peroneal tendon is crucial for initial pain relief.
• Ice and heat therapy: Applying ice packs to the affected area can help reduce inflammation, while heat therapy can improve blood flow to the tissues surrounding the peroneal tendon and promote healing.
• Compression: Using an elastic bandage or compression sock can help reduce pain, support the ankle, and reduce swelling.
• Proper Footwear: Wearing shoes with good support or fit, for better foot alignment.
• Stretching and strengthening exercises: Specific exercises or gentle massage targeting the peroneal tendon along the outer side of the foot can improve flexibility and strength, supporting recovery. These may reduce pain to some extent. It is important to note that these exercises should be done under the supervision of a physical therapist under the guidance of your Orthopaedic surgeon.
• Physical therapy: A physical therapist can design a personalized program including various modalities like ultrasound, massage, and exercises to accelerate healing and prevent the problem from coming back.
• Medications: Your doctor may suggest management using a regenerative approach for managing peroneal tendinopathy and sometimes add-on over-the-counter pain relievers to help manage pain. It is strongly advisable that these medications must be prescribed by your Orthopaedic surgeon.
• Bracing or Taping: Providing extra support to the peroneal tendon can help prevent further injury during healing or performing activities.
• Injections: In advanced cases, your doctor may decide to inject corticosteroids or PRP (platelet-rich plasma) within the peroneal tendon.
• Surgery: In some cases, when usual treatments fail, the doctor may suggest or perform surgery on the peroneal tendon. [2]

Prevention is Key

While it's not always possible to prevent peroneal tendinopathy, certain measures can reduce the pain & discomfort:

• Maintaining a healthy weight: Excess weight puts extra stress on your feet.
• Wearing supportive shoes: Choose shoes with good arch support and cushioning and lateral support.
• Gradually and regularly increasing activities: Gradually increasing the intensity and duration of physical activity and incorporating strength and flexibility exercises into your routine.
• Cross-training: Vary your activities to avoid overuse of the peroneal tendons.
• Addressing any underlying foot or ankle problems promptly.

References

• 1. National Institutes of Health (NIH). Peroneal Tendon Injuries.
• 2. Mayo Clinic. Peroneal Tendon Tear: Mayo Clinic.
• 3. Centers for Disease Control and Prevention (CDC). Sprained Ankle: CDC.