Peroneal Tendonitis - An Uncommon Tendonitis

Hey guys!

Let’s talk about a lesser known, but still equally dangerous type of tendonitis – peroneal tendonitis. According to the Cleveland Clinic, less than 1% of people experience this type of tendonitis.

While peroneal tendonitis is a rare issue, it is equally difficult to diagnose. As many as 50% of those suffering from peroneal tendonitis were initially misdiagnosed.

So, if it is difficult for a professional to diagnose, how are you to know you have it? Without a doubt, if you are experiencing the symptoms mentioned below, visit your foot and ankle surgeon as soon as possible to start proper treatment.

What is peroneal tendonitis?

Tendonitis is an irritation or inflammation of a tendon. Tendons that are continuously stressed in the inflamed state, risk tearing or fully rupturing.

Peroneal tendonitis is an inflammation of tendons running along the outside of the ankle bone and down the side of your foot. These tendons attach the bones of your foot to your leg. Most of your foot and ankle stability come from the peroneal tendons.

Friction occurs when you overuse or overload the tendons. The tendons rub on the bones, causing swelling. Afterwards, the symptoms are very similar to many other foot and ankle ailments, making it difficult to diagnose.

The initial symptom you will experience is swelling with reduced range of motion. Your ankle will also hurt, especially with physical activity. The pain will follow along the outside of your foot along the tendon.

What are the causes and risk factors of peroneal tendonitis?

We typically find peroneal tendonitis in those who take part in sports with increased ankle movements. Think:

- Soccer

- Basketball

- Running

- Dancing (Ballet)

Not only do specific sports cause peroneal tendonitis, but so does an increase in training and improper form. Stressing the tendon with a new workout routine or an increase of strain will significantly challenge the tendon. Furthermore, poor footwear will lead to an improper weight distribution and risk your tendons.

Additionally, there are some risk factors that make you more likely to develop peroneal tendonitis. Chronic diseases such as arthritis, gout, obesity, and diabetes lead to high incidences of tendonitis. Age also plays a role. Most people suffering from peroneal tendonitis are over the age of 40. Other factors are:

- Lack of stretching before activities

- Previous tendon injuries

- Previous ankle and foot injuries that weaken the muscles

- High arches

- Naturally tight tendons

- Smoking

How do I treat my peroneal tendonitis at home?

The best way to treat your peroneal tendonitis is to avoid it entirely. Make sure you stretch properly before performing any activities. You will also want to start and increase workouts gradually. Invest in a good pair of supportive athletic shoes for when you exercise. Finally, listen to your body. If you feel any pain or discomfort, refrain from the activity causing it. Rest is always the best medicine.

To reduce inflammation, try an NSAID. Following the standard, RICE (rest, ice, compression, elevation) will also reduce swelling.

When do I see a doctor for my peroneal tendonitis?

If the pain is significant or you are experiencing pain any time you perform physical activity, you need to visit your local foot and ankle surgeon. 

As previously stated, peroneal is difficult to diagnose because of its general symptoms. Attempts at treating it on your own may lead to a more serious situation. Untreated peroneal tendonitis may eventually begin to tear. Both a partial and full tear will cause severe pain and ankle weakness.

How is peroneal tendonitis diagnosed?

Your doctor will perform a series of imaging, including x-rays, MRI, and even a CT scan. These images will help her diagnose the cause of your pain.

The imaging will help rule out fractures while the MRI will help rule out sprains.

Your doctor will perform a physical exam where she will feel along your foot for swelling and nodules on the tendons. Additionally, your range of motion will be assessed.

How will my doctor treat my peroneal tendonitis?

Initially, your doctor will probably recommend rest, ice, a gradual return to physical activity.

In the case your tendonitis is more progressed, conservative approaches will be recommended. A removable brace or walking boot may be suggested to support and immobilize both the foot and ankle. Often, suffers feel relief from steroid injections.

Physical therapy is wonderful suggestion if your peroneal tendonitis is caused by poor form or muscle weakness. A physical therapist will help you regain your flexibility and your strength.

However, there are situations in which the conservative approaches do not help. In this instance, surgery is an option. Moreover, if you have reached a partial or full tear of the tendon, surgery will probably be necessary. 

Proper recovery from surgery will be of the utmost importance. Your tendon will be weak, and a gradual buildup of activity is crucial.

When treated properly, peroneal tendonitis is an ailment you can return from with a full range of motion. While it may initially feel like some swelling and discomfort, it will quickly become a bigger issue. Proper foot wear will help alleviate some of your pain and may help you avoid injury entirely. Visit your foot and ankle surgeon if you experience significant pain along the outside of your foot.  

Hope this helps!

XOXOXO

Dr. Eva