The peroneal tendons run down the outside of your ankle and foot. They help you keep your foot stable on uneven ground. These tendons can become painful and swollen (tendonitis). Tears or subluxation can happen, too.
These injuries often occur in people who participate in sports that put repetitive strain on the ankle. People with high arched feet are more at risk, too.
Symptoms
The peroneal tendons are important in helping to keep your foot and ankle stable on uneven ground, especially as you walk or run. Often, injury to the peroneal tendons results in pain and swelling on the outside of your ankle (lateral ankle) or the bottom of your foot (peroneal arch). The severity of these injuries can vary. Most patients with mild overuse type injuries, which are more common, improve with non-invasive treatment. Patients with acute trauma or large split tears may need surgical intervention more quickly.
Your Resurgens physician can diagnose peroneal tendon injuries through a careful physical examination of the foot and ankle. They will look for swelling, feel how the tendons move when you turn your ankle in different directions and check the strength of the tendons. Your doctor will also order x-rays and an MRI to help determine how bad the injury is. X-rays will usually show that the tendons are enlarged and have become thicker, which is called tendinitis. An MRI will often find that the tendons have a split tear and that there is fluid around the tendons.
Acute injuries to the peroneal tendons can cause them to snap forward or dislocate over the fibula. This can cause pain, swelling and a clicking on the outside of your ankle. This can be caused by a direct blow to the tendons or repetitive stress over time, like from participating in dynamic sporting activities that require sudden changes of direction. Other risk factors include wearing poorly fitting shoes, having higher arches in the feet or legs and rapid increases in training or activity.
Diagnosis
Your healthcare provider will ask you about your symptoms and perform a physical exam. They will press on parts of your foot and ankle to check for tenderness or swelling. They may also ask you to move your foot in certain ways to see if the tendons have any weakness. People with peroneal tendinosis often have pain when they press directly over the fibula (the prominent bone on the outside of the ankle). They also have pain or weakness when they try to bring their foot inside towards the center of the body (inversion) or outwards (eversion). They may have a high arch in their foot, which increases the stresses put on the tendons.
Most people with a peroneal tendon tear improve with nonsurgical treatment. This can include resting your foot, reducing your level of activity and wearing a brace or boot to support your foot. It can also include physical therapy, which can help strengthen your foot and ankle.
Sometimes your provider will recommend surgery to treat a severe or complete tear. This can be because of a traumatic injury, such as an inversion ankle sprain (rolling your ankle inward), or because of chronic stress and pressure on the tendons from overuse. They might also recommend surgery if there is a physical irritant, such as a prominent bony prominence like the peroneal tubercle, that is pressing on the tendon.
Treatment
Many cases of peroneal tendonitis are successfully treated with non-surgical methods. This is because the tendons are overuse injuries that respond well to a period of rest and re-training. A healthcare provider who specializes in foot and ankle conditions will evaluate your symptoms, palpate the outside of your foot and ankle to determine how your peroneal tendons are functioning and then recommend treatment that is specific to your condition.
Conservative treatment includes RICE (rest, ice, compression and elevation) to decrease pain and swelling. Your healthcare provider may also recommend a brace or boot to immobilize your foot and help it heal. In addition, physical therapy exercises may be recommended to increase ankle range of motion and strengthen the ankle and peroneal tendons. Finally, activity modification, which includes limiting activities that aggravate your injury and gradually increasing intensity of activities over time, can be very helpful.
In some cases, the peroneal tendons can become torn due to a traumatic injury, such as rolling your ankle inward (inversion injury). When this occurs, your healthcare provider may recommend surgery to prevent the tendons from snapping forward over the lateral malleolus, a condition known as subluxation. Surgery can involve removing damaged tendons and sometimes replacing them with a donor tendon from another area of the body. In other instances, the peroneal tendons are transferred to another muscle in the foot, called peroneus brevis transfer or a personal stop procedure.
Recovery
The peroneal tendons act as support for your ankle and foot when you walk on uneven ground. They also help protect your ankle ligaments from injury. When you injure one of the tendons, it can cause pain on the outside of your ankle and feel unstable when you walk. You can have a peroneal tendon tear due to a sudden injury (like a fall or a sharp roll of your ankle) or it may develop gradually with repeated stress on the tendons.
If you have mild to moderate peroneal tendon tears, conservative treatments can often relieve your symptoms. Rest, ice and elevation will help reduce swelling and pain. Non-steroidal anti-inflammatory drugs, such as ibuprofen, can help relieve pain. A brace can protect the injured tendons and help stabilize your ankle. If you have a full-thickness peroneal tendon tear, your healthcare provider might suggest surgery to clean out the tear or make the groove in the back of the fibula deeper to give the tendons more space.
To speed up your recovery, it’s important to avoid activities that increase the stress on your tendons until your ankle heals. Your healthcare provider will let you know when it’s safe to start your normal activity again. During the recovery process, it’s normal to have ups and downs in your pain level.