Stress and overuse of the foot can cause some painful conditions that sometimes require treatment. Peroneal tendon pain can be a problem, and if left untreated, it can develop into peroneal tendinitis, commonly known as ankle tendonitis.
It may sound cliché, but it's undeniable that our feet are constantly hit. Our feet and ankles also tend to get the least amount of rest and recovery time for all the work they do. After all, it's the feet that hit the ground first every day.
This is why it is necessary to take the time to care for our feet as we age and seek treatment at the first signs of foot pain.
What is peroneal tendinitis?
The soft tissues in our body that connect bones and muscles are called tendons. These tendons can become inflamed and cause mild to severe pain due to excessive friction, overuse, injury, or repetitive motion.
Each foot has two peroneal tendons, which attach to the area that runs down the lower leg (peroneus longus and peroneus brevis). These two tendons provide support for the weight carried by the ankle, and one attaches to the outside of the foot at the base of the little toe. The other wraps under the foot and attaches to the medial arch of the foot.
Ankle tendonitis or peroneal tendonitis occurs when the peroneal tendon in the ankle joint becomes inflamed or injured. Over time, this can develop into a condition called tendinopathy. Here, repeated friction, injury, or overuse can cause the tendon to thicken or enlarge, leading to chronic pain problems.
Peroneal tendinitis is common among athletes, especially those who perform sprinting movements that require running, quick stops, starts, and spins.
In some cases, it's easy to ignore the early warning signs of ankle tendonitis because the pain in the peroneal tendon lessens as the person warms up.
Unfortunately, this can lead to further ankle injury, pain, and instability.
Symptoms of Peroneal Tendonitis
No matter how a person develops ankle tendonitis, whether it's a sudden peroneal tendonitis tear, or excessive friction over a long period of time, the results are the same. This can be a distressing condition that severely inhibits a person's ability to move and perform at high levels.
What is peroneal tendinitis (ankle tendonitis)?
Some of the most common symptoms of ankle tendonitis include:
- soreness that runs along the outside of the foot and ankle, and may even lead to leg pain
- discomfort or pain in the back of the ankle
- Pain in the foot when standing, walking, or even when the foot is completely weightless
- pain during exercise
- Ankle that feels weak or unstable at normal activity levels
- Inflammation, swelling, or even heat on the outside of the foot and the back of the ankle
Knowing what causes a peroneal tendon injury is important for everyone, especially an athlete or professional worker who cannot afford any injury-related downtime.
Causes of Peroneal Tendonitis
A torn or sprained ankle tendon can weaken the tendon and eventually lead to peroneal tendinitis. Without treatment, the likelihood of further injury also increases.
Anyone can develop ankle tendonitis if they are not careful, but athletes who need to repeat ankle movements must be especially active.
While overuse, overtraining, and repetitive motion can lead to peroneal tendinitis, there are many other problems that can contribute to this condition.
Typical causes of peroneal tendinitis include some of the following:
- poor training skills
- Lack of warm-up time, or a sudden increase in ankle weight-bearing activity rather than a gradual rise
- Inappropriate or unsupportive footwear during strenuous activity
- Improper running or jumping technique
- high arch
- Underdeveloped lower extremity muscles or strength
Fortunately, there are a range of treatments that can effectively manage the pain and symptoms of peroneal tendinitis.
Peroneal Tendonitis Treatment
As with other soft tissue and tendonitis injuries, the first approach to ankle tendonitis treatment is to severely limit or stop any activity that causes pain.
Receiving a diagnosis of peroneal tendinitis requires a doctor to perform a physical examination, along with a discussion of symptoms and recent or long-term physical activity and habits.
A sports physician will most likely perform an ultrasound to examine the soft tissue, along with an MRI and X-rays, to rule out any other problems, such as a fractured ankle or foot bone.
There are a variety of treatment options depending on the severity of a person's symptoms, injury, and inflammation.
Ankle Tendonitis Treatment for Peroneal Tendonitis
Ankle tendonitis treatment typically includes some of the following:
1. Rice method
The RICE approach is a four-pronged initial treatment for a variety of injuries, including rest, ice, compression, and elevation. RICE can help reduce pain and inflammation, especially in the early stages of the disease.
2. Over-the-counter pain relievers
Over-the-counter NSAIDs, such as ibuprofen (Advil) or naproxen (Aleve), can help reduce pain and swelling in the ankle and tendon.
3. Ankle Brace for Peroneal Tendinitis
An ankle brace for peroneal tendinitis can help support the ankle and protect it from further injury as it heals. This can range from fully securing with an ankle boot to a comfortable brace, or even simply duct tape securing the ankle for added strength.
4. Physical Therapy
Physical therapy is especially important as a means of strengthening the ankle with peroneal tendinitis exercises and massage or heat therapy. Physical therapy also includes learning proper performance techniques for any physical activity that causes ankle tendonitis.
5. Shockwave Therapy for Ankle Tendinitis
Extracorporeal shock wave therapy (ESWT), also known as EPAT therapy, is a non-invasive, painless procedure that promotes faster healing by increasing blood flow, while promoting the growth of new blood vessels and producing proteins that improve tendon repair.
The STORZ shock wave device delivers high-voltage pulses deep into the soft tissues of the ankle.
Since anesthesia is not required, shockwave therapy can be administered in several short bursts while a person is still active.
Because shockwave therapy reduces injury-related downtime, an athlete or worker can return to normal activities faster than other traditional treatments, or wait for the injury to heal on its own.
Orthotics that are custom or prefabricated for the foot help reduce the pressure placed on the peroneal tendon. Therefore, this also reduces the risk of ongoing injury.
7. Cortisone Injection
In some cases, injections of cortisone, a powerful steroidal anti-inflammatory drug, may be recommended. While this slightly invasive and somewhat painful procedure reduces swelling and pain, it also weakens the peroneal tendon and can actually lead to a complete rupture or tear of the soft tissue at some point in the future.
Surgery for peroneal tendonitis is usually reserved for last resort treatment when all other less invasive approaches have failed. Surgeons can remove or attempt to repair damaged tendons, but as with any surgical procedure, there are inherent risks that should always be considered ahead of time.
Symptoms of ankle tendonitis caused by peroneal tendinitis from repetitive motion or overuse can cause pain in the ankle, foot, or leg when running, walking, standing, or even at rest.
Talk to your doctor at the earliest signs of ankle or foot pain and consider some of these treatments to reduce pain and speed recovery and healing.