Peroneal tendonitis is a condition where you experience pain on the back of your lower leg due to injury or damage of one or two of the peroneal tendons. The two peroneal tendons (peroneus longus and the peroneus brevis), work in tandem to prevent the foot from excessively rolling inwards.
These tendons are also responsible for the plantar-flexing in your foot and stabilization of the foot and ankle during running.
Runners who have high foot arches are more likely to suffer Peroneal tendonitis due to the tendency of their feet to roll outwards. This results in excessive rubbing at the interface of the bone and tendon leading to swelling and inflammation of the tendon.
The pain gets intense with activity and may progress to a worse condition if not addressed on time.
As a runner, you don’t want to get sidelined from your running activity. In this guide, you’ll get to know more about peroneal tendonitis including the causes, symptoms, prevention and the available treatment.
Causes of Peroneal Tendonitis
Generally, peroneal tendonitis is an overuse condition which results in inflamed and painful tendons. There are factors that increase your chances of suffering from peroneal tendonitis. These include:
- A surge in weight-bearing activities like running and jumping.
- Repetitive rolling out of the ankle especially when running up slopes.
- Having high foot arches.
- A tight calf muscle intensifies the rubbing at the peroneal tendons causing it to swell.
- Improper workout or running footwear gives inadequate support to the foot.
- An ankle injury may also progress to peroneal tendonitis if not allowed to heal properly.
- Injury caused by improper training.
Symptoms of peroneal tendonitis include:
- Painful ankle especially on the outer part.
- Pain gets worse with activity and subsides during rest
- Swelling and inflammation behind the ankle.
- Area behind the ankle feels warm and tender to the touch
- Aching when the foot is turned in or out.
- The ankle feels weak and unstable during weight-bearing activity.
- Pain when the foot turns outward especially when running on a slope.
- The area outside the foot may experience some numbness.
Diagnosis for peroneal tendonitis basically begins with a review of your medical history with your physical therapist. The doctor may want to know something about your job, work out, hobbies etc. The purpose of this is to evaluate your risk factors such as overuse or weight-bearing activity.
Then your doctor will perform a physical examination, usually by flexing your foot to different positions to check for symptoms. Your doctor also applies a little pressure on specific areas of the ankle to confirm that the pain is on the peroneal tendons and not in the fibula.
Your doctor may also want to see your posture and gait to evaluate whether your shoes are supportive enough.
Special tests such as ultrasound, X-ray or MRI scan may be performed to locate the damaged tendons and any abnormality in the foot.
Treatments for Peroneal Tendonitis
Although peroneal tendonitis is not very common, it can progress to a serious condition if not treated in time. If not treated, the damaged tendons can deteriorate, making it difficult to treat with the usual physical therapy.
However, with early treatments, it is possible to recover from peroneal tendonitis using physical therapy. Your physical therapist may recommend the following treatment plan:
Pain Reduction: The earliest remedies for peroneal tendonitis is to avert pain by avoiding movements that cause pain. This will allow the damaged tendon to heal. Therapy for pain reduction may include cold therapy, moist heat treatment, ultrasound and iontophoresis.
Massaging can also help mobilize the soft tissue and the joints in the foot to ease the tightness and enhance blood circulation. This can ease the pain and reduce inflammation.
Motion Exercises: Proper range-of-motion movements will allow your foot and ankle to gradually bear load without sustaining further tendon damage. Plantar-flexion is necessary for averting the tightness usually experienced in the calf muscle when you have peroneal tendonitis.
Weight-Bearing Exercises: Your doctor will also identify the muscles that need strengthening to facilitate your return to running without experiencing pain. Strengthening exercises can be done using weights, bands or medicine balls.
Normalizing the Foot Function: Following the initial therapy, symptoms of peroneal tendonitis will start going away. So, your therapist will design a do-it-yourself program that will enable you return to your activity.
Such a program might entail sport exercises such as single-leg standing and trending on uneven terrain to stabilize your ankle and enhance foot strength
Proper Footwear: Proper running shoes are inevitable in preventing and treating peroneal tendonitis. Your foot and ankle requires support to avert the tendency of the foot to roll inwards. Corrective orthotics can also be recommended to enhance the supportiveness of your running shoes.
Medication: Non-steroidal Anti-inflammatory Drugs (NSAIDs) such as ibuprofen may be used to ease the pain and inflammation as well as help in healing.
Strong anti-inflammatory medications such as cortisone injections may be applied. However, this is rarely used due to the risk of tendon rupture.
Peroneal tendonitis is rarely treated using surgery. Surgical treatments are only used for repairing damaged tissues or releasing the tissue causing irritation.
How to Choose the Best Running Shoes for Peroneal Tendonitis
As a runner, you don’t have to abandon your activity because of peroneal tendonitis. All you need is the correct running shoe for preventing injuries or for enhancing quick recovery.
Here are some features to look for when choosing the best running shoes for peroneal tendonitis:
Sufficient support is necessary to keep your ankles and heels from injuries when running. Supportive running shoes utilize advanced cushioning such as FlyteFoam, molded sock liners and EVA to protect your underfoot from injuries. Thus, you can run even on hard surfaces without sustaining any injuries.
Good Shock Absorption
You need running shoes that are responsive and absorb shock when your foot hits the ground to minimise overworking the tendons. Look for properties such as air or gel cushioning in your running shoes. You can also consider shoes that have sock liners or provide room for additional orthotics
Most of the impact on your foot is transferred to your ankle during weight-bearing activities. That means tendons around the ankle are very likely to get damaged when your underfoot is not sufficiently cushioned.
To prevent these injuries, your running shoes should have ample cushioning in the midsole. Blown rubber is an excellent technology for providing cushioning in running shoes.
When you run in a lightweight shoe, you don’t use a lot of energy to lift your foot. So, your tendons will experience less stress. If run in a heavy shoe, your ankle and heel tends to be stressed. This can increase the likelihood of tendon injuries.
What’s more, a lightweight running shoe will be a hardy gear for your recovery process.
Best Running Shoes for Peroneal Tendonitis
- New Balance Men’s 990v4
- Asics Gel Kayano 25
- Saucony Triumph ISO 4
- Asics Gel Cumulus 20
- Nike Mens Zoom Vomero 13
Here are tips to help you prevent future injuries:
- Choosing proper running shoes to provide support to your foot.
- Stretching up your peroneal tendons and calf muscles.
- Gradually increasing your weight-bearing activities.
- Avoiding improper training.
- Treating your ankle injuries in time to prevent progression to peroneal tendonitis.
The underlying secret to recovering from peroneal tendonitis is to follow a proper rehabilitation program. You should not be in a rush to get back to activity.
The earlier your tendons are treated, the better. If left untreated, tendons can tear and take long to heal. Most importantly, get yourself the correct running shoes for peroneal tendonitis. These will help you in the recovery and prevent future injuries.