Peroneal Tendon Injuries

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The peroneal muscle and tendons run down the outside of the lower leg and into the foot. The Peroneus brevis tendon attaches to a bone on the outside and middle of the foot. The Peroneus longus tendon runs under the foot and attaches near the inside of the arch. Together, they serve to help stabilize the foot and ankle of the human body. As a result, Peroneus brevis tendon injury can often be misdiagnosed as a lateral (outside) sprain of the ankle ligaments. The injury is often from improper or rapid increases in training, or overuse in sports or activities that involve repetitive ankle motion, such as dancers, runners, and soccer players. Athletes with poor lifting shoes, higher arches, or inward-turned heels may be at higher risk for developing Peroneus brevis tendon injuries due to the increased stress placed on the peroneal tendons. The different types of peroneal tendon injuries include:

  • Tendonitis – Tendonitis (or tendinitis) is an inflammation or irritation of a tendon. Tendons are pieces of connective tissue between muscles and bones. Tendonitis can be either acute (occurring suddenly and typically short-term) or chronic (developing over time and typically long-term) in nature.
  • Subluxation – A subluxation is a partial dislocation of a joint. It is often the result of acute injury or repetitive motion injury but can also be caused by medical conditions that undermine the integrity of ligaments.
  • Tendinosis – Tendinosis occurs when tendons degenerate, meaning that they begin to break down. Tendons may have small tears or disorganized collagen fibers instead of straight collagen fibers. This condition is most common in the elbow, shoulder, knee, hip, and legs.

Causes & Symptoms

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Generally, Peroneus brevis tendon injuries may be acute or chronic – they often occur in people who participate in sports that involve repetitive ankle motion. Additionally, people with higher arches are at a greater risk for developing Peroneus brevis tendon injuries. Basic types of peroneal tendon injuries are tendonitis, tears, and subluxation:

 

Tendonitis

This is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon or trauma (such as an ankle sprain). Symptoms of peroneal tendonitis include pain, swelling, and warmth to the touch.

Acute tears

Acute tears are caused by repetitive activity or trauma. Immediate symptoms of acute tears include, pain, swelling, and weakness or instability of the foot and ankle. As time goes on, these tears can lead to a change in the shape of the foot in which the arch may become much higher.

Degenerative tears (Tendinosis)

Tendinosis is usually due to overuse and occurs over long periods of time, often years. In degenerative tears, the tendon is like toffee that has been overstretched until it becomes thin and eventually frays. Having high arches also puts you at greater risk of developing a degenerative tear. The symptoms of degenerative tears may include; sporadic pain on the outside of the ankle, weakness or instability in the ankle, and an increase in the height of the arch.

Subluxation

This means one or both tendons have slipped out of their normal position. In some cases, subluxation is due to a condition in which a person is born with a variation in the shape of the bone or muscle. In other cases, subluxation occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (also known as retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation may include a snapping feeling of the tendon around the ankle bone, sporadic pain behind the outside of the ankle bone, and ankle instability or weakness. Early treatment of a subluxation is critical since a tendon that continues to move out of position is more likely to tear or even rupture. Therefore, it is recommended to seek medical attention if you feel a snapping sensation.

 

Symptoms of a Peroneus brevis tendon injury can vary, however, usually presents as pain and swelling along the lateral aspect of the ankle. There may also be a feeling of ankle weakness or instability, especially when pushing off of the toes. In cases of subluxation, a snapping sensation along the outside of the ankles will be felt while walking.

Who gets Peroneus Tendon Injuries

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Certain risk factors that are accompanied by peroneus brevis tendon injuries include the following below:

  • Non-supportive footwear – People who participate in sporting activities while wearing non-supportive footwear (such as shoes that are too tight, poorly fitted shoes, and / or shoes that have been worn for an extended period of time) are most likely prone to experiencing peroneal tendon injuries. These injuries include subluxation and tendinitis.
  • Overtraining – Increasing the intensity of sports activities that involve excessive running and jumping may lead you to develop symptoms of peroneal tendon injuries, such as falling on a hard surface, constantly landing from jumping, and performing repetitive ankle movements.
  • Sports – Several sports that may increase peroneus brevis tendon injuries include basketball, baseball, skiing, soccer, and boxing. Overall, any sports activity that requires repetitive ankle movement can increase your chance of experiencing a peroneal tendon injury.
  • Tight calves – Many athletes will notice a sudden tightness sensation located in their calves due to the excessive use of their legs while participating in sports.
  • Occupational activities – Most people tend to experience peroneus brevis tendon injuries when they are working in areas that require you to walk for an extended period of time, such as carpenters, machine operators, construction, and farmers.
  • Having high arches in the feet – Some patients are born with high arches in their feet, thus leading to an increased risk of developing tendinitis, subluxation, and tendinosis (degenerative tears).

How Do They Affect You? How Serious Are They?

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It is recommended to seek immediate attention from a medical professional if you have experienced a tear in your peroneal muscle, as it is important to have the ankle assessed by a surgeon as soon as possible to ensure that the correct treatment is started. If you choose to leave your peroneal muscle untreated after an injury, it can cause more serious problems, including a complete tendon rupture, which is much more difficult to treat.

Recommended Treatment & Rehabilitation

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During a diagnosis of peroneus brevis tendon injuries, your doctor will begin by discussing your medical history. This will often lead to topics of overuse, increased activity, or some other cause linked to a peroneal tendon injury. It is very important to determine that the pain is in the peroneal tendons and not the fibula, as this could indicate a different problem. In addition to this particular diagnosis, a Magnetic Resonance Imaging (MRI) scan, X-ray, or ultrasound might also be used to rule out any breaks, identify abnormal swelling or scar tissue, and further help with your peroneal tendon recovery.

After a diagnosis has been done, a physiotherapist will work with you to help boost the recovery for your peroneal muscle. It is essential to get proper treatment for peroneus brevis tendon injuries as soon as it occurs (this includes subluxation, tendinosis, and tendinitis). Any muscle-tendon connection with ongoing symptoms and loss of function can become more serious. With early physiotherapy, treatment regarding this condition can be successful.

Your physiotherapist will begin designing certain treatment plans, such as the following:

  • Patient education – Your physiotherapist will teach you how to gradually increase and maintain your training regimen. This guidance will help reduce any chance of future peroneal tendon injury.
  • Symptom management – Your physiotherapist will help you identify and avoid symptoms related to painful movements of the peroneal muscle-tendon complex. Ice, cold massage, or moist heat may be used for pain management. You may also receive treatments like iontophoresis (medication delivered through an electricity-charged patch) and ultrasound.
  • Manual therapy – Your physiotherapist may use hands-on techniques (manual therapy) to gently mobilize the joints in your foot, ankle, and lower leg. Soft-tissue mobilizations may be performed to loosen tightness, increase circulation, and relieve pain and swelling.
  • Use proper footwear and orthotics – Your physiotherapist will recommend proper footwear for the activities you enjoy to ensure your ankles and feet get the support needed. It may also be necessary to get fitted for a custom foot orthotic (corrective shoe inserts) to help reduce stress on your tendons.
  • Range-of-motion exercises – You will likely learn exercises to help the ankle, foot, and toes move properly. These exercises will help improve the way you walk or run. Stretching exercises will help ease any tightness in the calf muscles and the tissues at the bottom of your foot.
  • Strengthening exercises – Walking or running on uneven surfaces (grass, sand, gravel, or trails) requires a lot of strength to avoid added stress on the ankle. Therefore, your physiotherapist may teach you resistance exercises with bands, weights, or medicine balls. These exercises will help strengthen your ankle, foot, and lower leg muscles.
  • Functional training – As your symptoms, strength, and motion improve, your physiotherapist will help you return to your previous level of activity. You may learn sport-specific exercises to improve your movements. Your physiotherapist will also design a personal home-exercise program for you to continue to perform after your physiotherapy sessions have ended. Following your home program accordingly will help you maintain and continue to build your ankle and foot strength.

The following below are a few stretches that will help improve symptoms associated with peroneus brevis tendon injuries:

 

Standing calf stretch

First, stand facing the wall or door and place the palms against it, slightly higher than the shoulders. Next, step back into a split stance, keeping both feet flat on the ground with the toes pointing forward. Slowly lean forward and bend the front knee to feel a stretch in the lower part of the back leg. Hold this position for up to 30 seconds, then repeat this method 2-3 times a day.

Heel raises

Stand behind the chair, countertop, or table and hold onto it for added support. Rise onto the toes and hold the position for 5-10 seconds. Letting go of the support, lower the heels down slowly. If necessary, when lowering down, keep holding the support for balance. Repeat this exercise 5-10 times a day.

Towel stretch

Sit on the ground with the feet straight out in front. Take the towel and wrap it around the toes on one foot. Then, gently pull back until a stretch runs from the bottom of the foot up to the back of the lower leg. Hold this stretch for 30-60 seconds, then repeat 2-3 times a day.

Ankle flexion

Begin by sitting upright on the floor and placing a resistance band around the ball of one foot while extending that leg out in front. Point the toes on the extended leg away from the body, then slowly flex the ankle by pulling the toes toward the shin. Repeat this movement up to 10 times a day.

Alternative & Homeopathic Treatment

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There are a variety of ways to help treat symptoms linked to peroneal tendon injuries homeopathically, without the need for additional surgery or prescriptions. Some of these treatments are:

  • Ice application – Applying an ice pack, or frozen bag of vegetables, wrapped in a towel, for at least half an hour, can help reduce further swelling and inflammation located in your peroneal tendons.
  • Heat application – Applying a heat pack will increase blood circulation.
  • Compression – Compression alone helps to prevent the buildup of other fluids in your peroneal muscle and limits swelling.
  • Turmeric – One such herb that helps reduce inflammation comes from turmeric. Other herbs to help ease the pain of peroneus brevis tendon injuries would be white willow, ginger, and bromelain.
  • Rest – Resting for approximately 7-8 hours nightly is the most recommended time when your body is rebuilding and repairing your peroneal muscle due to the injury.