Peroneal Tendinopathy
The Highlights
Peroneal tendinopathy is typically an overload injury to one or more of the peroneal tendons that around and behind the outside of the ankle.
In our clinic, we can diagnose this problem easily with physical examination and occasionally with the added use of diagnostic ultrasound.
Treatment is fundamentally about rebuilding strength and load-tolerance in the tendon through progressively more difficult exercises. All other treatment methods are to support this including taping, foot orthoses (specialist insoles), Extracorporeal Shockwave Therapy and even ultrasound-guided injection therapies.
What is it and what are the symptoms?
In essence, Peroneal Tendinopathy is the progressive decrease in health of either the Peroneus Brevis or Peroneus Longus tendons which lie in the posterior-lateral compartment of your leg before passing into the foot behind your lateral malleolus (the bony prominence on the outside of your ankle). It is a condition we see a lot in runners both road and trail-based as well as hikers but it can affect people of all levels of ability.
Peroneal tendinopathy can occur anywhere along the course of either tendon but common sore spots for both tendons are behind your lateral malleolus (the bony prominence on the outside of your ankle). There may also be pain at the attachment on to the base of the 5th metatarsal bone if the peroneus brevis tendon is involved and occasionally under the cuboid bone where the peroneus longus travel under the foot. It results in pain, difficultly walking (lifting the heel off the ground in particular) and may lead to a feeling of instability at the ankle.
Why does it happen?
Like other tendinopathies, the ultimate driver of peroneal tendinopathy is an ability for the tendon to keep up with the demands placed upon it, being unable to adapt and heal sufficiently. The locations where the tendon becomes damaged tend to be at it's points of maximum friction or at their enthesis (insertion points onto bone), suggesting this might be an important factor. The mechanical function of some people's feet and lower limbs can also place high loads on these tendon which we will seek to address in treatment.
What are the treatment options?
Diagnosis, as we preach in our discussion of all foot and ankle conditions, is key to getting to the right treatment. Fortunately, experienced Podiatrists (we like to think that's us!) can usually assess and diagnose this problem easily from simple clinical tests. On occasion we may also advise our in-house diagnostic ultrasound service allowing us to take a look inside at the overall tendon health and the adjacent structures they relate to.
Footwear (ideally with good upper support like walking boots) is very important in this condition as it tends to be with most tendons that cross the ankle. In runners, we will also tend to take an interest here in which shoes are involved as these can make a big difference.
The next steps of rehabilitation involve finding ways of reducing the load on the tendons so they have the opportunity to properly heal. This can include the use of taping in the short term. It can also include foot orthoses (specialist insoles) designed to influence foot mechanics in a positive way - on this point, almost all mass-marketed insoles that can be bought online or over the counter are designed in a way that does the exact opposite of what we need for peroneal tendinopathy; as such we strongly recommend people don't go down this route and instead see a Podiatrist who understands how to design a device that actually works for this issue. Our range of bespoke custom foot orthoses can be especially helpful in dealing with more advanced peroneal tendon issues, especially if there are also ankle instability issues.
As part of our mission to bring advanced Podiatry practices to the Scottish Borders we also offer options for more complex or longstanding versions of this condition including fully-bespoke Richie Brace therapy and ultrasound-guided injection therapies which can be a game-changer when other options haven't hit the spot.
