Diagnosis: Peroneal Tendinopathy
What is Peroneal Tendinopathy?
Peroneal tendinopathy or peroneal tendonitis is an irritation of the peroneal tendons that run along the outside of the ankle1.
Symptoms of Peroneal Tendinopathy
Many people with peroneal tendinopathy complain of pain on the outside of the ankle, foot or lower leg after activities that place large amounts of stress on these tendons such as: excessive walking or running (especially on hard, uneven surfaces) 2. Other symptoms that may be experienced with peroneal tendinopathy include:
- Pain with turning the foot in or out1
- Feeling of instability around the ankle when standing1
- Gradual increase in pain over the outside of the ankle1
- Pain on touching the outside of the ankle2
How is OA Peroneal Tendinopathy Diagnosed?
It is important to distinguish peroneal tendinopathy to other conditions that may cause pain on the outside of the ankle such as a sprain of the ligaments on the outside of the ankle, or a stress fracture of the fibula. The physiotherapist is able to diagnose peroneal tendinopathy largely by the history of the symptoms given3. Therefore, it is crucial that a good history is taken. Most people with this condition state a sudden increase in the amount of physical activity (especially running activities). On examination, the physiotherapist will feel around the outside of the ankle. Pain due to peroneal tendinopathy is usually felt just behind the bump of the ankle. There is also pain felt on rolling the ankle inwards and outwards3. The physiotherapist may also look at the positioning of the foot on standing and walking to make sure there are no abnormalities that may contribute to the development of this condition. In some cases, an ultrasound may be used to examine the structure of the tendons3.
What Causes Peroneal Tendinopathy?
There are two tendons that run just behind the ankle, collectively known as the peroneal tendons. These tendons attach to two muscles of the lower legs3. These muscles are responsible for turning the foot out, which is an important phase in running and walking2. As mentioned above excessive running and walking as well as sudden increase in physical activity are the main causes of peroneal tendinopathy as they place excessive stress on these tendons3. Activities that involve jumping or sudden changes in direction such as tennis and basketball can result in this condition as well1. In some individuals abnormal foot postures such as an abnormally tuned in foot, which causes the tendons to work harder3.
How is Peroneal Tendinopathy treated?
Most cases of peroneal tendinopathy resolve without the need for surgery. This is because it is an overuse injury that eases with rest. In some cases if the pain is severe the use of a CAM boot or a brace can be used to reduce the symptoms3. It is recommended that activities that flare up pain be limited for a few weeks or till the physiotherapist says it is safe to continue. The physiotherapist may also prescribe an exercise program consisting of a series of calf and ankle stretches and strengthening exercises to help strengthen the tendon and help regain full pain free range of motion3. Also, in some cases where the cause of the condition is due to foot posture or running posture, the physiotherapist can help correct these errors using taping, braces and biomechanical training3.