Peroneal tendinopathy is an injury to the tendons of the foot and/or ankle. It often affects athletes like long-distance runners, basketball players, and dancers. People who have had ankle sprains, or those who have weak ankles, may also develop this condition. It commonly causes aching along the outside surface of the ankle that gets worse with activity, yet improves with rest. Physical therapists help people with peroneal tendinopathy reduce strain on the ankle and foot and strengthen their muscles.
Peroneal tendinopathy is a tendon injury that causes pain on the outside of the ankle. Tendons are connective tissues in the body that attach muscles to bones. The muscles and tendons involved in peroneal tendinopathy move the foot in an outward direction and help point the foot and ankle downward. These muscles and tendons (called peroneal muscle-tendon complex) work together to balance the foot and ankle and keep them stable.
The condition often develops over time as a result of overuse. The peroneal muscle-tendon complex can be overworked. If your foot doesn’t hit the ground in a good position when walking or running, it creates more stress on the tendon. For example, if your foot hits the ground more on the outside, the muscles and tendons must work harder to keep the foot and ankle stable. With overuse, tendons can become enlarged, thickened, and possibly swollen. Peroneal tendinopathy also can develop following an untreated ankle sprain.
Symptoms of peroneal tendinopathy include:
Your physical therapist will conduct a thorough evaluation, including taking your health history. The goals of the initial exam are to determine how bad the injury is and its cause. Peroneal tendinopathy may be the result of a single injury or repeated stress on the tendons. Your physical therapist will ask questions about your condition that may include:
After the interview, your physical therapist will complete a physical examination based on the information you provided. Your physical therapist may:
Your physical therapist may also refer you to an orthopedic doctor or podiatrist for diagnostic imaging (i.e., X-ray, MRI). An X-ray can identify any abnormal bones such as fractures or deformities that may cause pain. An MRI can identify issues with the tendon, muscles, and cartilage.
After your diagnosis, your physical therapist will work with you to develop a personalized treatment program to begin your recovery.
It is essential to get proper treatment for peroneal tendinopathy as soon as it occurs. Any muscle-tendon connection with ongoing symptoms and loss of function can become more serious. With early diagnosis, physical therapy can successfully treat peroneal tendinopathy.
Physical therapists are movement experts who provide treatments to improve quality of life. Treatment programs can include exercise, hands-on care, and patient education. Your physical therapist will design a targeted treatment program to speed your recovery. Your physical therapist’s evaluation will determine the program they create for you. They will also consider your goals for a safe return to sport or daily activities.
Your personal treatment program may include:
Patient education. Your physical therapist will teach you how to gradually increase and maintain your training regimen. This guidance will help reduce any chance of future injury.
Symptom management. Your physical therapist will help you identify and avoid symptoms related to painful movements of the peroneal muscle-tendon complex. Ice, ice massage, or moist heat may be used for pain management. You may also receive treatments like iontophoresis (medication delivered through an electrically-charged patch) and ultrasound.
Use of proper footwear and orthotics. Your physical therapist will recommend proper footwear for the activities you enjoy to ensure your ankles and feet get the support needed. It also may be necessary to get fitted for a custom foot orthotic (corrective inserts for your shoes) to reduce stress on your tendons.
Manual therapy. Your physical therapist may use hands-on techniques (manual therapy) to gently mobilize the joints in your foot, ankle, and lower leg. Soft-tissue mobilizations may be performed to loosen tightness, increase circulation, and relieve pain and swelling.
Range-of-motion exercises. You will learn exercises to help the ankle, foot, and toes move properly. These exercises will help improve the way you walk or run. Stretching exercises will help ease any tightness in the calf muscles and the tissues at the bottom of the foot.
Strengthening exercises. Walking or running on uneven surfaces (grass, sand, gravel, or trails) requires a lot of strength to avoid added stress on the ankle. Your physical therapist may teach you resistance exercises with bands, weights, or medicine balls. These exercises will strengthen your ankle, foot, and lower leg muscles. Your exercise program will be based on your specific condition, needs, and goals.
Functional training. As your symptoms, strength, and motion improve, your physical therapist will help you return to your previous level of activity. You may learn sport-specific exercises to improve your movements. Your physical therapist also will design a personal home-exercise program for you to continue to perform after your physical therapy sessions have ended. Following your home program will help you maintain and continue to build your ankle and foot strength.
Peroneal tendinopathy may be prevented by: