Peroneal Tendinopathy

Peroneal Tendinopathy

Peroneal tendinopathy is irritation of the tendons that pass behind your ankle (peroneal tendons). These tendons attach muscles in your foot to a bone on the side of your foot and underneath the arch of your foot. This condition can cause your peroneal tendons to get bigger and swell.

What are the causes?

This condition may be caused by:

  • Putting stress on your ankle over and over again (overuse injury).
  • A sudden injury that puts stress on your tendons, such as an ankle sprain.

What increases the risk?

This condition is more likely to develop in:

  • People who have high arches.
  • Athletes who play sports that involve putting stress on the ankle over and over again. These sports include:
    • Running.
    • Dancing.
    • Soccer.
    • Basketball.

What are the signs or symptoms?

Symptoms of this condition can start suddenly or develop gradually. Symptoms include:

  • Pain in the back of the ankle, on the side of the foot, or in the arch of the foot.
  • Pain that gets worse with activity and better with rest.
  • Swelling.
  • Warmth.
  • Weakness in your foot or ankle.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your symptoms.
  • Your medical history.
  • A physical exam.
  • Imaging tests, such as:
    • An X-ray or CT scan to check for bone injury.
    • MRI or ultrasound to check for muscle or tendon injury.

During your physical exam, your health care provider may move your foot and ankle and test the strength of your leg muscles.

How is this treated?

This condition may be treated by:

  • Keeping your body weight off your ankle for several days.
  • Returning gradually to full activity gradually.
  • Putting ice on your ankle to reduce swelling.
  • Taking an anti-inflammatory pain medicine (NSAID).
  • Having medicine injected into your tendon to reduce swelling.
  • Wearing a removable boot or brace for ankle support.
  • Doing range-of-motion exercises and strengthening exercises (physical therapy) when pain and swelling improve.

If the condition does not improve with treatment, or if a tendon or muscle is damaged, surgery may be needed.

Follow these instructions at home:

If you have a boot or brace:

  • Wear it as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen it if your toes tingle, become numb, or turn cold and blue.
  • Do not let it get wet if it is not waterproof.
  • Keep it clean.

Managing pain, stiffness, and swelling

  • If directed, apply ice to the injured area:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Raise (elevate) your ankle above the level of your heart when resting if you have swelling.

Activity

  • Do not use your ankle to support (bear) your full body weight until your health care provider says that you can.
  • Do not do activities that make pain or swelling worse.
  • Return to your normal activities as told by your health care provider.

General instructions

  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Wear supportive footwear that is appropriate for your athletic activity.
  • Avoid athletic activities that cause swelling or pain in your ankle or foot.
  • See your health care provider if you have pain or swelling that does not improve after a few days of rest.
  • Stop training if you develop pain or swelling.
  • If you start a new athletic activity, start gradually to build up your strength, endurance, and flexibility.

Contact a health care provider if:

  • Your symptoms get worse.
  • Your symptoms do not improve in 2–4 weeks.
  • You develop new, unexplained symptoms.

Peroneal Tendinopathy Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your ankle. These exercises also help to relieve pain and stiffness.

Exercise A: Gastroc and soleus, standing

  1. Stand on the edge of a step on the balls of your feet. The ball of your foot is on the walking surface, right under your toes.
  2. Hold onto the railing for balance.
  3. Slowly lift your left / right foot, allowing your body weight to press your left / right heel down over the edge of the step. You should feel a stretch in your left / right calf.
  4. Hold this position for __________ seconds.

Repeat __________ times with your left / right knee straight and __________ times with your left / right knee bent. Complete this stretch __________ times per day.

Strengthening exercises

These exercises improve the strength and endurance of your foot and ankle. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Dorsiflexors

  1. Secure a rubber exercise band or tube to an object, like a table leg, that will not move if it is pulled on.
  2. Secure the other end of the band around your left / right foot.
  3. Sit on the floor, facing the object with your left / right foot extended. The band or tube should be slightly tense when your foot is relaxed.
  4. Slowly flex your left / right ankle and toes to bring your foot toward you.
  5. Hold this position for __________ seconds.
  6. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise C: Evertors

  1. Sit on the floor with your legs straight out in front of you.
  2. Loop a rubber exercise or band or tube around the ball of your left / right foot. The ball of your foot is on the walking surface, right under your toes.
  3. Hold the ends of the band in your hands, or secure the band to a stable object.
  4. Slowly push your foot outward, away from your other leg.
  5. Hold this position for __________ seconds.
  6. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise D: Standing heel raise (plantar flexion)

  1. Stand with your feet shoulder-width apart with the balls of your feet on a step. The ball of your foot is on the walking surface, right under your toes.
  2. Keep your weight spread evenly over the width of your feet while you rise up on your toes. Use a wall or railing to steady yourself, but try not to use it for support.
  3. If this exercise is too easy, try these options:
    1. Shift your weight toward your left / right leg until you feel challenged.
    1. If told by your health care provider, stand on your left / right leg only.
  4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

Exercise E: Single leg stand

  1. Without shoes, stand near a railing or in a doorway. You may hold onto the railing or door frame as needed.
  2. Stand on your left / right foot. Keep your big toe down on the floor and try to keep your arch lifted.
    1. Do not roll to the outside of your foot.
    1. If this exercise is too easy, you can try it with your eyes closed or while standing on a pillow.
  3. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

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