It is not all about go hard or go home. You have to be careful when electing to do exercises as it can impact in terms of injuries occurring. Overuse injuries is a common one I see, it is advised that proper build up to activities are done to reduce the risk of an injury.

What is Peroneal Tendinosis?

The peroneal tendons run on the outside of the ankle just behind the bone called the fibula. Tendons, connect muscle to bone, and allow them to exert their force across the joints that separate bones. Ligaments, on the other hand, connect bone to bone. Tendinitis implies that there is inflammation in the tendon. Tendinosis means there is enlargement and thickening with swelling of the tendon. This usually occurs in the setting of overuse, meaning a patient or athlete does a repetitive activity that irritates the tendon over long periods of time.​

Symptoms

Characteristic activities include marathon running or others which require repetitive use of the ankle. Patients will usually present with pain right around the back of the ankle. There tends to be no history of a specific injury.

Causes

​Improper training, or rapid increases in training, and poor shoe wear, can lead to peroneal tendinosis. Also, patients who have a hindfoot varus posture (the heel is slightly turned inwards),  may be more susceptible. This is because in those patients, the peroneal tendons are required to work harder. Their main job is to evert or turn the ankle to the outside, which fights against the varus position. The harder the tendons work, the more likely they are to develop tendinosis.

How is Peroneal Tendinosis Diagnosed?

Diagnosis can be made through:

• The patient’s history
• Evidence of an overuse activity
• Evidence of rapid increase in recent activity
• Examining/palpating the tendons, which results in pain
• The patient experiencing pain on the fibula directly over the bone
• Pain being experienced in the peroneals slightly further behind
• Inversion or carrying the ankle to the outside
• Weakness in trying to bring the ankle to the outside (i.e. in eversion).
• X-rays
• Ultrasound – a very effective and relatively inexpensive way to assess the tendons and can show an abnormal appearance or tear which sometimes occurs.
• An MRI – equally important, and can also show a tear.

 

What are the Treatment Options?

The vast majority of peroneal tendinosis cases will heal without surgery. Since it is an overuse injury, it can heal with rest.  If there is significant pain, a CAM Walker boot for several weeks is a good idea. If there really is no tenderness with walking, an ankle brace might be the next best step. Patients should very much limit how much they are walking, or on their feet, until the pain abates. This usually takes several weeks. Resumption of training can then occur, but very slowly and be based on pain level.

 

 

For those patients with hindfoot varus,  an orthotic that tilts the ankle to the opposite side may help to offload the tendons. It is important to talk to your doctor or podiatrist about changing your training. This includes using new shoes for running or also cross-training, which means alternating activities each day. Physical therapy is also very important. This, as with ankle sprains, can be done to strengthen the tendons. Surgical treatment is indicated if the pain does not get better with rest. Conservative treatment should last even up to a year before considering surgery.

How long is the recovery?

Patients usually recover fully but this can take considerable time. You must be patient and allow the tendon to heal before resuming activity. If you need surgery, your recovery time may be substantial. You may be instructed not to put your foot down with weight for about six weeks. Your orthopaedic surgeon likely will order physical therapy as well.

​The outcome is usually good. However, sometimes it takes time for people to get back to their activity. When a tear develops, and there is chronic thickening of the tendon, the outcomes are not as good.

Potential Complications

​​If the tendinosis is not addressed, tearing of the tendon can occur. Also, weakness of the tendons can lead to an ankle sprain. In the case of surgery, infection can develop. Nerve damage can occur, if the sural nerve, which runs along the side of the foot and provides sensation to the foot, is cut or stretched. Instability itself can lead to many sprains, which can damage the cartilage on the inside of the ankle.

Your feet mirror your general health . . . cherish them!