Today I’m going to talk about peroneal tendonitis. The peroneal tendons are a group of two tendons that essentially run along the course behind the outside of your ankle. They begin as two different muscles in the back of the leg, more along the outer side of the leg, in your calf. Then the tendons that are basically attaching this muscle to the bones on your feet then begin to run around the outer side of the ankle. If you look at this foot model, you can see this is where the big toe is and this is the little toe. On the side of the foot where the little toe sits, these tendons, and there is two of them, basically run underneath the ankle joint itself and then begin to split.
One tendon, the longer tendon called the peroneus longus, basically starts to split off and curve underneath the bottom of the foot near a bone called the cuboid bone. The short tendon called the peroneus brevis, basically continues onward until finally it attaches to something called the styloid process, or basically the base of a bone called the fifth metatarsal. If you look at your foot in the outside of the foot, in the middle of the foot, this is sort of the bump that you can feel when the foot flares outward a little a bit.
These tendons are very important in that they serve several different function. In particular, the function of the peroneus brevis is important, because it tends to act as a foil in order to stabilize the action of a much stronger muscle on the other side of the foot called the posterior tibial tendon. Essentially what this tendon does is it helps the foot to roll outward and upward, almost like a flattening motion. Your foot naturally does this when you stand and walk and bear weight as you go through your walking cycle, but certain points during the walking cycle, the foot has to actually has to actively do this for you in order to continue to complete the normal walking cycle. So, this tendon is very important.
What causes Peroneal Tendonitis?
Both these tendons can become irritated as a result of a lot of different types of problems that can occur during the course of normal walking. These problems are basically due to things like walking on uneven ground which causes your foot to kind of flex and roll inward a lot, and also any injury that forces your ankle to roll inward will often also injure this tendon as well. Due to the numerous different issues that can create irritation to this tendon, tendonitis or inflammation of the tendon is not uncommon. Once the tendon becomes strained, or stressed, or injured enough, it will become inflamed.
It is also not uncommon during this tendonitis process for small tears to actually occur within the substance of the tendon itself. As this tendonitis continues and progresses and your activity continues to progress without getting any help for it, it can become quite severe and also eventually it can become quite debilitating.
How do you treat Peroneal Tendonitis?
It’s very simple to treat this condition. Once you catch it and you realize you have it and get treatment, early interactive treatment to reduce the inflammation is usually very successful. That includes icing, that includes stabilizing the actual foot and ankle itself with a brace to reduce the rolling motion of the foot in order to keep this tendon more stable. It also includes anti-inflammatory medications to help decrease the inflammation overall.
That allows the tendon time to start to heal. If that’s not enough and the tendonitis is a bit more advanced, then physical therapy needs to be performed in order to try to more actively stimulate healing and to strengthen the muscle with which the tendon is attached to. If those measures aren’t successful and the tendonitis is pretty severe, you have one other option before having to consider surgery. That’s basically immobilizing the foot either in a cast or a walking boot to basically stop all motion together. If that doesn’t lead to healing, then surgery is the next option.
Surgery is generally successful in treating this condition. Often times surgeons will go in and repair any tears to the tendon structure itself. The tendon can be sort of strengthened and thickened by using artificial grafts to help the tendon become stronger and thicker, and to reduce the likelihood that the substance will become torn and irritated again by the normal course of walking. Alternately, there is other technologies that can be used to try to stimulate internal healing within the tendon itself, something called radio ablation, is a newer technique that’s being used for tendon repair in order to stimulate greater blood flow into the tendon to let the injured areas heal on their own.
All of these measures are fairly successful, and the post-operative course, while somewhat restricted initially, generally tends to quickly lead to activity and letting people get back to doing the things they like to do.