■ ■ ■ Description

Peroneal tendinitis is characterized by inflammation and pain of the peroneal tendons (at back of the outer ankle). More often these are partial tears of one or both of the tendons. These structures are the tendon attachments of the muscles of the outer leg to the (1) outer foot and (2) bottom of the inner foot. These structures are important in standing on your toes, in the pushing-off phase of running or jumping, and when turning your foot outward. This injury is uncommon. There may be a grade 1 or 2 strain of the tendon. A grade 1 strain is a mild strain. There is a slight pull without obvious tearing (it is microscopic tendon tearing). There is no loss of strength, and the tendon is the correct length. A grade 2 strain is a moderate strain. There is tearing of tendon fibers within the substance of the tendon, although it may occur where the tendon meets the muscle or bone. The length of the tendon or the whole muscle-tendon-bone unit is increased, and strength is decreased. A grade 3 strain is a complete rupture of the tendon.

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■ ■ ■ Common Signs and Symptoms

• Pain, tenderness, swelling, warmth, or redness over the back of the outer ankle at the peroneal tendons, the outer part of the mid-foot, or the bottom of the arch

• Pain with ankle motion (especially when pushing off or pushing down with the front of the foot) or when standing on the ball of the foot or pushing the foot outward

• Crepitation (a crackling sound) when the tendon is moved or touched

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■ ■ ■ Causes

• Peroneal tendinitis is caused by mechanical wear of the tendon in its groove behind the outer ankle, resulting in a degenerative process or overuse of the lower leg muscles. However, it may also occur from strain as a result of a sudden increase in the amount or intensity of activity, a direct injury, or an injury to the lower leg, foot, or ankle. It may also occur after return to activity with incomplete rehabilitation following previous injury to other leg or ankle structures.

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■ ■ ■ Risk Increases With

• Sports that require sudden repetitive pushing off of the foot (jumping and quick starts) or kicking and running sports (especially running down hills and long distances)

• Poor physical conditioning (strength and flexibility)

• Previous injury to the foot, ankle, or leg

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Allow time for adequate rest and recovery between practices and competition.

• Maintain appropriate conditioning:

  • Ankle and leg flexibility

  • Muscle strength and endurance

• Complete rehabilitation after previous injury.

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■ ■ ■ Expected Outcome

This condition is usually curable within 6 weeks if treated appropriately with conservative treatment and resting of the affected area.

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■ ■ ■ Possible Complications

• Prolonged healing time if not appropriately treated or if not given adequate time to heal

• Recurrence of symptoms if activity is resumed too soon, with overuse, or when using poor technique

• Untreated, tendinitis may result in tendon rupture, requiring surgery

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■ ■ ■ General Treatment Considerations

Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. A cast or walking boot may be recommended to 10 to 14 days to allow the inflammation to settle down by immobilizing the tendon. For less severe cases or before returning to activity, a wedge placed on the outer part of the heel or arch support may be prescribed to reduce stress to the tendon. Surgery to remove the inflamed tendon lining or degenerated tendon tissue (with direct repair or repair to the other peroneal

tendon) is occasionally necessary.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers may be prescribed as necessary by your physician. Do not take prescription pain medication for longer than 4 to 7 days. Use only as directed and only as much as you need.

• Cortisone injections are almost never indicated. These injections may weaken tendons, so it is better to give the condition more time to heal than to use them.

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■ ■ ■ Heat and Cold 

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 to 4 weeks despite treatment

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)

STRENGTH • Dorsiflexors

1. Attach one end of elastic band to fixed object or leg of table/desk. Loop the opposite end around your foot as shown.

2. Slowly pull the foot toward you. Hold this position for seconds. Slowly return to starting position.

3. Repeat exercise times, times per day.