Stress and overuse of the feet can lead to a number of painful conditions that sometimes require treatment. Pain in the peroneal tendon can be problematic and if left untreated can turn into Peroneal Tendonitis, more commonly known as ankle tendonitis.
It sounds cliché, but there’s no denying that our feet constantly take a pounding. For all the work they put in, our feet and ankles also tend to get the least amount of rest and recovery time. After all, it’s the feet that hit floor first every single day.
That’s why it’s necessary to spend time caring for our feet as we age and seek treatment at the first signs of foot pain.
What is Peroneal Tendonitis?
The soft tissue in our bodies that connects bones to muscles is known as tendons. With excessive friction, overuse, injury or repetitive movements, these tendons can become inflamed and cause pain that ranges from mild to severe.
Each foot has two peroneal tendons that are attached to the area that runs down the lower leg (peroneus longus and peroneus brevis). These two tendons provide support for the weight the ankle bears, with one attached to the outer part of the foot at the base of the little toe. The other one wraps underneath the foot and attaches to the inside arch of the foot.
Ankle Tendonitis, or Peroneal Tendonitis, occurs when the peroneal tendons in the ankle become inflamed or injured. Over time, this can develop into a condition known as tendinosis. Here, repeated friction, injury, or overuse cause a thickening or enlargement of the tendon that can lead to chronic pain issues.
Peroneal tendonitis is very common among athletes, especially those involved in sports that require running, sprinting with quick stops, starts, and pivoting movements.
In some cases, it’s easy to ignore the early warning signs of ankle tendonitis because pain in the peroneal tendons can lessen as a person warms up their body.
Unfortunately, this can cause further injury, pain and instability in the ankle.
Peroneal Tendonitis Symptoms
Regardless of how a person develops ankle tendonitis, whether it’s from a peroneal tendonitis tear that happens suddenly, or from excessive friction over a longer course of time, the result is the same. It can be a painful condition that seriously inhibits a person’s mobility and ability to perform at high levels.
Some of the most common ankle tendonitis symptoms include:
- Soreness that runs along the outside portion of the foot and ankle, and might even lead to pain in the leg
- Discomfort or pain in the back of the ankle
- Pain in the foot while simply standing, walking, or even when there is no weight on the foot at all
- Pain while exercising
- An ankle that feels weak or unstable during normal activity levels
- Inflammation, swelling, and even warmth along the outer portion of the foot and the back of the ankle
Understanding what leads to a peroneal tendon injury is important for everyone, but especially for athletes or vocational workers who can’t afford any injury-related downtime.
Causes of Peroneal Tendonitis
An ankle tendon tear or sprain can lead to weakened tendons and, eventually causes Peroneal Tendonitis. Without treatment, the likelihood of further injury also increases.
Anyone can develop ankle tendonitis if they’re not careful, but athletes in sports that require repetitive ankle movements must be particularly proactive.
While overuse, overtraining, and repetitive movements can lead to peroneal tendonitis, there are a number of other issues that can cause the condition.
Typical Causes of Peroneal Tendonitis include some of the following:
- Poor training techniques
- Lack of warm-up time, or a sudden increase of weight-bearing activities on the ankle rather than a gradual rise
- Bad fitting or unsupportive footwear during strenuous activity
- Improper running or jumping techniques
- High foot arches
- Under-developed muscles or strength in the lower limbs
Fortunately, there is a range of treatments that are effective for deal with the pain and symptoms of peroneal tendonitis.
Peroneal Tendonitis Treatment
As with other soft-tissue and tendonitis injuries, the first approach for ankle tendonitis treatment is to severely limit or stop any activity that causes pain.
Receiving a diagnosis for peroneal tendonitis requires a physical examination from a physician, along with a discussion about the symptoms and recent or long-term physical activities and habits.
It is likely that a sports physician will perform an ultrasound to examine the soft-tissue, in combination with an MRI and x-rays to rule any other issues, such as a fractured ankle or foot bones.
Based on the severity of a person’s symptoms, injury, and inflammation, there are a variety of treatment options.
Ankle Tendonitis Treatment usually includes some of the following:
1. RICE Method
The RICE Method is a four-pronged initial treatment approach for many injuries and involves Rest, Ice, Compression, and Elevation of the affected area. RICE can help reduce pain and inflammation, particularly in the earlier stages of the condition.
2. Non-Prescription Pain Medications
Over-the-counter Non-steroidal anti-inflammatory medications, such as ibuprofen (Advil) or naproxen (Aleve) can help to reduce pain and swelling of the ankle and tendons.
3. Ankle Brace for Peroneal Tendonitis
An ankle brace for peroneal tendonitis can help support the ankle and protect it from further injury during healing. This can range from full immobilization with an ankle boot to a snug fitting brace, or even simply taping the ankle for added strength.
4. Physical Therapy
Physical Therapy is particularly important as means for strengthening the ankle with peroneal tendonitis exercises and massage or heat therapy. Physical therapy also includes learning proper performance techniques for whatever physical activity is leading to tendonitis in the ankle.
5. Shockwave Therapy for Ankle Tendonitis
Extracorporeal Shockwave Therapy (ESWT), also known as EPAT Therapy, is a noninvasive, painless procedure that induces faster healing by increasing blood flow, while promoting new blood vessel growth and creating proteins that improve tendon repair.
A STORZ Shockwave Device delivers high-pressure impulse waves deep into the ankle’s soft-tissue.
Delivered over several short sessions, Shockwave therapy can be done while a person is still active since there is no anesthesia required.
Because Shockwave Therapy can reduce injury-related downtime, athletes or workers can return to normal activities more quickly than with other traditional therapies or by waiting for the injury to heal on its own.
Orthotics that are either custom made to the foot or prefabricated can help decrease the stress placed on the peroneal tendons. As a result, this can also lower the risk of continued injury.
7. Cortisone Injections
Cortisone injections, which are a powerful steroidal anti-inflammatory medication, may be recommended in some cases. While this slightly invasive and somewhat painful procedure will reduce swelling and pain, it can also weaken the peroneal tendons and actually result in a full rupture or tear of the soft-tissue at some point in the future.
Peroneal tendonitis surgery is generally a last resort treatment reserved for when all other, less invasive, approaches have failed. Surgeons can either remove or attempt to repair damaged tendons, but as with any surgical procedure, there are inherent risks that should always be considered ahead of time.
Ankle tendonitis symptoms caused by peroneal tendonitis from repetitive movements or overuse can lead to pain in the ankle, foot, or leg when running, walking, standing, and even when resting.
Talk to a doctor at the earliest sign of pain in the ankle or foot and consider some of these treatment methods for reducing pain and speeding up recovery and healing.