Understanding Peroneal Tendon Injuries: Causes, Symptoms, and Treatment Options
Introduction & Anatomy
At Northern Montana Foot and Ankle Specialists, we treat all ailments of the foot and ankle. Commonly we have patients who complain of pain on the outside of the ankle. There are several soft tissue structures such as tendons or ligaments that cross the ankle, making an accurate diagnosis essential to ensure proper treatment. Two of these structures that are commonly implicated in ankle pain are the peroneal tendons as pictured below. There are two peroneal tendons, peroneus brevis and peroneus longus. The peroneal tendons originate as muscle bellies in the lateral compartment (outside) of the leg and become tendinous as they pass posterior to the lateral malleolus (the prominent bone on the outside of the ankle). One peroneal tendon attaches to the midfoot. The other peroneal tendon crosses deep and under the foot to the inner arch or instep. The main function of these muscles is to stabilize the ankle joint.
Causes
Peroneal tendon injuries can occur suddenly or develop over a long period of time. These types of injuries most commonly occur in active individuals that undergo repetitive ankle motion but can also occur in anyone. People who have high arches tend to be at higher risk for developing these types of injuries, due to increased stress placed along the lateral (outside) column of the foot. Common injuries involving the peroneal tendons include tendonitis, acute and degenerative tears, subluxations, and ruptures.
Tendonitis is a common term used to describe inflammation of a tendon. Peroneal tendonitis can involve one or both tendons. This can occur from overuse or secondary to trauma including an ankle sprain. Acute and degenerative tears are also caused by repetitive use or trauma. If not treated correctly in time these tears can lead to weakness, instability of the ankle, continued pain, and even rupture of the tendon.
The tendons course along the posterior aspect of the fibula within a groove called the fibular groove. When the peroneal tendons no longer course within their normal position this is called subluxation. Tissue (retinaculum) helps keep these tendons within this groove. A feeling of snapping of the tendon around the ankle is commonly felt with subluxation. Chronically “subluxed” peroneal tendons can lead to an increased risk of rupture. Commonly these injuries occur with a lateral ankle sprain that can involve injury to ligaments as well as tendons. Because of this it is important to have your foot and ankle doctor perform a thorough physical exam to pinpoint where your pain is at. In addition, an x-ray or other advanced imaging studies may be needed to fully evaluate the injury.
Treatment
Treatment can vary and is dependent on the type of peroneal injury you have sustained.
Non-surgical treatment options include:
Immobilization -
Cast, boot, or splint immobilization may be used to protect your foot and ankle as well as allow time for your injury to heal
Physical therapy -
Therapy is often prescribed by your doctor for these injuries and can help reduce swelling and pain. As symptoms improve exercises can be added to help strengthen the lateral ankle and improve range of motion.
Rest, Ice, Compression, Elevation -
Resting your injured ankle, icing, applying light compression, and keeping your foot elevated can help with swelling, inflammation and pain. Discuss with your doctor how often you should be doing these.
Medications -
Your podiatrist may recommend certain medications such as NSAIDs (non-steroidal anti-inflammatories) to help reduce pain and swelling.
Bracing -
Your doctor may recommend bracing depending on the severity of your injury.
When non-surgical treatment options fail, sometimes surgery may be needed to repair the tendons involved. Your podiatrist will help determine the appropriate procedure for your condition.
If you suspect you may have a peroneal tendon injury or notice changes in your foot health please consider making an appointment with one of our qualified podiatrists at Northern Montana Foot and Ankle Specialists. Call (406) 257-8686
