What is Peroneal Tendonitis?
Peroneal tendonitis is a condition that affects the peroneal tendons located behind the bone on the ankle. The term tendonitis refers to the inflammation of the tendons.
The peroneal tendons consist of two tendons: the peroneus longs and the peroneus brevis. These peroneal tendons stabilize and control the movement of the foot during walking. These tendons also are responsible for the eversion of the foot or the movement of the foot out to the side.
Peroneal tendonitis, which involves the irritation to the tendons, results from the repetitive overload on the tendons that causes them to be traumatized, leading to pain. The overloading of the tendons may be caused by both acute and chronic factors. Acute overload results from immediate stress on the area, while chronic development refers to the occurrence of tendonitis overtime.
The presence of injury to the peroneal tendons stimulates the inflammatory response. This leads to the production of chemical mediators that causes pain, swelling, redness, and heat in the area.
The inflammatory response also allows increased blood flow to the area to promote healing. The mechanism involved in peroneal tendonitis is similar to the damage in a rope. Frequent overload on the rope causes it to wear and break.
Excessive and repetitive tension also causes the peroneal tendons to tear, leading to inflammation. The presence of peroneal tendonitis causes the individual to limp; however, patients may still be able to walk but may experience difficulty in moving the foot into different positions.
Peroneal tendonitis may affect one or both of the peroneal tendons. Tendonitis in all areas of the body tends to heal slowly due to the limited blood supply in these structures. The limited supply causes decreased blood flow and migration of cells responsible for tissue repair in the area of injury.
Symptoms of Peroneal Tendonitis
The presence of inflammatory response gives rise to the symptoms of peroneal tendonitis. These symptoms include:
- Pain along the tendon
- Pain as a result of the production of prostaglandins – The pain, which is localized at the back of the foot in the ankle area and radiates to the side of the foot in line with the 5th tarsal bone, may also be felt throughout the day and can be aggravated by walking or exercising. Pain is most severe at night and in the morning.
- Swelling along the tendon area
- Swollen tissues around the tendon due to inflammatory response
- Stiffness in the foot and difficulty to stretch the foot due to reduced flexibility of the peroneal tendons
- Redness and burning sensation in the ankle area
- Hyperemia due to increased blood flow to the area
- Burning sensation -The chemical mediators of inflammation also stimulate the pain receptors.
Causes of Peroneal Tendonitis
The specific cause of peroneal tendonitis is the overloading of the peroneal tendons which causes stress and tension in the area, leading to tear and injury in the peroneal tendons. Specific risk factors include the following:
- Running on uneven floors or surfaces
- Playing basketball
- Playing racket sports
These activities usually cause excessive and repetitive stretching and tension on the peroneal tendon, leading to tendonitis. Older people have a higher risk for peroneal tendonitis due to a loss of elasticity in the tendons. Having high arches also gives undue tension on the area.
Diagnosis of Peroneal Tendonitis
Diagnosis of peroneal tendonitis includes:
In the case of peroneal tendonitis, a physical examination will reveal the injury as well as swelling and tenderness on the area.
MRI and X-rays are also done to determine the specific injury to the tendons. MRIs specifically detect tears in the peroneal tendons.
Imaging studies to detect presence of tears in the peroneal tendons
Image source: wheelssonline.com
Treatment of Peroneal Tendonitis
Treatment for peroneal tendonitis involves conservative approaches and surgery, depending on the severity of the condition. Treatments include:
- Rest – During the acute course of the condition, rest is very essential to prevent further injury and allow the foot to heal. High-impact activities and sports should be avoided.
- Exercises and Stretches – Special exercises are employed to manage peroneal tendonitis. Exercises, specifically stretches, improve the flexibility of the peroneal tendons. Exercise involves a range of motion exercises such as dorsiflexion, plantar flexion, inversion, and eversion of the foot.
Exercises and stretches
- Physical therapy – Physical therapy is a form of rehabilitative therapy to restore the previous function of the foot. Physical therapists may perform foot massage, exercises, and immobilization. Physical therapy is essential in retore the optimum function of the peroneal tendons.
- Bracing – Foot braces are also used to immobilize the foot and assist foot movement. Braces support the affected foot in order for the patient to assume functional mobility. Ankle bracing is a specific bracing technique that limits inversion of the foot.
- Taping – Taping techniques are also used to immobilize the foot and prevent certain foot movements that will potentially aggravate the condition. Taping involves the application of compression on the ankle towards the lower leg.
- Orthotics – Orthotics is a special foot device. A heel lift is a device applied to the shoe to prevent a flat foot; the lower the foot, the more stiff the tendon can become.
- Shoe modification – Flat shoes and slippers should be replaced with slightly elevated shoes. Furthermore, footwear with adequate arch support should be chosen. Proper fitting shoes also help prevent compression on the peroneal tendons.
Arch support for flat feet
- Medications – Anti-inflammatory medications are given to reduce inflammation and pain in the foot. Steroids may also be injected in the area for patients who do not respond to typical analgesics.
- Activity modification – High-impact activities should be limited during the course of the condition. Simple aerobics may be done. Weight lifting, running on uneven surfaces, and hiking should be avoided because these activities cause overloading of the peroneal tendons.
- Icing – Cold packs or ice may be placed over the area during the acute phase to relieve swelling and pain.
Patients with severe tear in the peroneal tendons may require surgery such as the following:
- Repair of peroneal retinaculum – This involves the repair of the retinaculum which normally supports the peroneal tendons. This area is usually susceptible to tears.
- Peroneal tubercle resection – The peroneal tubercle is a structure that separates the two tendons. When tendonitis occurs, this structure tends to enlarge, requiring resection.
- Ankle ligament stabilization – The ankles may also be affected due to peroneal tendonitis. Surgeons usually stabilize this ligament through surgery.
Surgery to treat peroneal tendonitis