The symptoms of peroneal tendonitis are similar to other foot and ankle problems and it can be difficult to diagnose. Your healthcare provider will review your symptoms and perform a physical exam. They may also recommend imaging tests, such as X-rays, ultrasound or MRI.
People with high arches and/or abnormal gait are more prone to overloading the peroneal tendons. Medications and activity modification can help reduce the symptoms.
Diagnosis
The peroneal tendons are two tendons that run down the outside of your lower leg and ankle. They connect the peroneal muscles in your calf to the outer ankle bone (fibula). These tendons help control the position of your foot during walking and allow you to move your foot out to the side (eversion). The tendons become irritated with repetitive overload and develop an inflammatory response. This causes pain and swelling.
The diagnosis is made with a physical exam. The doctor will ask you about your symptoms and examine the ankle and foot for signs of tendonitis. X-rays or an MRI scan may be ordered to get a better view of the tendons and check for tearing or other damage.
Successful nonsurgical treatment of this condition often relieves tendon pain and swelling within a few weeks. Your doctor may recommend RICE (rest, ice, compression and elevation), or NSAID medications to reduce pain and inflammation. Your provider might also suggest an ankle brace or cast to stabilize your ankle and take pressure off the tendons. In rare cases, surgery might be necessary for severe cases of peroneal tendonitis that do not respond to conservative treatments. In surgery, the tendons are cleaned up (debridement or synovectomy) and any significant tearing is repaired. The gap in the tendons is then either filled with a tendon from another part of your body (allograft) or replaced with a new graft that is stitched to the intact tendons.
Treatment
Inflammation in the peroneal tendons develops over time with overuse or sudden activities and can result in pain along the outside of your foot and ankle. You may notice swelling or a lump that moves with the tendon as it moves when you walk or move your ankle in different positions. You may also experience a snapping sensation when you are participating in certain activities that place a lot of stress on the tendons.
Physicians will review your medical history and perform a physical exam of your foot and ankle. Your physician will press on the areas that are painful or irritated and move your ankle in different directions to see where the pain is coming from. Your doctor may also recommend diagnostic imaging tests like X-rays, ultrasound or MRI to help make a diagnosis and rule out fractures, breaks, abnormalities or scar tissue swelling.
At home, you can use RICE (rest, ice, compression and elevation) to reduce pain and swelling. Nonsteroidal anti-inflammatory drugs (like ibuprofen) can also help with inflammation and pain. A brace or cast may be used to immobilize your ankle and allow the tendons to rest. Physical therapy can strengthen your ankle and improve the flexibility of your foot. If the tendons are not improving, your physician may recommend surgery to clean up or repair a tear.
Surgery
Many people with peroneal tendonitis can heal with rest, anti-inflammatory medications and physical therapy. However, sometimes surgery is required to repair a tear or to correct the position of the tendons and reduce the risk of future injury. Patients who benefit most from peroneal tendon surgery are those who have recurrent or chronic problems with the tendons, including pain and swelling that does not improve with conservative treatment. These patients may also have a high-arched foot (cavus foot) that puts increased loads on the peroneal tendons.
During a physical exam, a Resurgens physician will press on the back and outside of your ankle to feel for areas of tenderness or pain. The doctor will also ask you to move your ankle in certain ways to see if there is any instability or weakness. They may order X-rays, an MRI or ultrasound to confirm the diagnosis and evaluate the condition of your tendons.
Peroneal tendons run side by side behind the prominent bone on the outside of your ankle. The two tendons (peroneus brevis and peroneus longus) help you control your foot’s movement as you walk, jump or play sports. A common problem is when the tendons slip out of their groove, a condition called peroneal tendon subluxation or dislocation. This can be caused by a sudden twist or maneuver of the ankle, or it can occur over time from repeated activities that require dynamic changes in direction.
Recovery
In mild cases, the pain and swelling can improve within 2-4 weeks with consistent conservative care. It can take a year or more to completely recover from severe peroneal tendonitis. It is important to follow our recommendation to avoid activities that aggravate your pain (like walking on uneven surfaces) and to gradually reintroduce exercise or activity.
You may need a supportive brace to help stabilize the ankle and rest the peroneal tendons while you heal. Taking non-steroidal anti-inflammatory medication to reduce inflammation and pain can also be helpful. Your Resurgens physician may recommend physical therapy for a thorough evaluation of your foot and ankle including history, movement assessment, pain palpation and strength/balance testing. A physical therapist can teach you how to properly perform strengthening exercises and modify your activity level. They can also provide orthotic prescriptions with a recessed area under the first metatarsal head to reduce excessive pressure on the peroneal tendons.
Surgical treatment can be recommended to relieve the irritation by creating a groove in the back of the fibula bone for the tendons or to remove a section of the tendons. Surgery can be performed arthroscopically or with open surgery. It is usually necessary to have a physical therapy program afterwards to help return you to your desired activity level. It takes time to build up the muscles in your ankle and foot to be strong enough to support the weight of your leg.