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Details:
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Peroneal tendonitis is a condition that occurs due to acute or chronic
overloading of the peroneal tendons. Peroneal tendonitis results when a
load is applied to the tendon that is greater than what it can sustain. As
a result, the peroneal tendon becomes injured and inflamed. The
suffix 'itis' always refers to a condition that is inflamed; ie bronchitis,
arthritis, etc. Therefore, tendonitis is simply an injury resulting in
inflammation in and around a tendon.
Tendons are notoriously slow to heal, and the peroneals are no
exception. The reason for this is simply that the blood supply to the
tendon is small and extremely fragile. As a result, tendons are
poorly supplied with blood and are unable to respond well in the case of an
injury. When a tendon is injured, there's an acute demand for more blood
flow. This demand is called inflammation. Inflammation is the body's
tool that is used to bring additional oxygen and healing cells into a specific
area.
Why does tendonitis hurt? While inflamed, the tendon is actively working
to repair itself. There's an acute influx of blood, oxygen and cells that
results in swelling. The arrival of all these cells is a new and
unusual activity in and around the tendon causing pain. Pain is simply
natures way of saying 'I'm not ready to carry this load. Please give me a
rest'. Although pain is not desirable, pain is our best guide to the nature and
degree of injury and will help guide choices used in healing the injury.
Treatment Of Peroneal Tendonitis
As mentioned, tendons are notoriously slow to heal. Treatment for
peroneal tendonitis can take weeks to months to see significant progress. Most
important in the treatment of this condition is the need to decrease the load applied to the peroneal tendon with
each step. This can be done by wearing
a heel lift and
avoiding walking in bare feet. Also avoid low heeled shoes such a loafers,
slippers, etc. A lateral sole wedge is also helpful. A lateral sole
wedge is simply a wedge placed under the lateral or outside of the shoe. Lateral sole wedges inhibit the foot from rolling out. They
can be placed on orthotics or glued to the outside of the shoe.
Ice, rest
and anti-inflammatory medications are also helpful.
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Nomenclature:
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Brevis - meaning brief or short. Used to define the shorter of the two peroneal tendons.
Crepitus - a crackling sensation with motion.
Longus - the longer of the two peroneal tendons
Plantarflexion - the motion of the foot away from the shin. The combined peroneal
tendons plantarflex the foot at the ankle during each cycle of gait.
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Anatomy:
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 The peroneal tendons originate high in the lateral aspect of the leg
attaching to both the tibia and fibula. They descend the later compartment
of the leg rounding the posterior aspect of the lateral malleolus (outside ankle
bone) to continue down to the lateral side of the foot. The peroneus
brevis inserts into the base of the fifth metatarsal. The peroneus longus
curves under the midfoot to the bottom of the arch. Both the brevis and
longus are innervated by the superficial peroneal nerve.
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Biomechanics:
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The peroneal muscles tendons have two functions;
- Their primary function is to stabilize the foot as the body passes over
the foot. The peroneal tendons will help to stabilize the foot on uneven,
rough surfaces. As the foot rolls from side to side, the peroneal tendons
help to inhibit a lateral ankle sprain by preventing the foot from rolling
to the outside (lateral side) of the foot
- The secondary function of the peroneal is to assist the calf with
plantarflexion.
The peroneal muscles and tendons will be active in the gait cycle beginning
in mid stance (to stabilize the foot) through toe off (to help the calf with
plantarflexion). The antagonist of the peroneus brevis is the tibialis
posterior. The antagonist of the peroneus longus is the tibialis anterior.
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Symptoms:
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Peroneal tendonitis is usually specific to the peroneus brevis
tendon. Pain is most commonly found at the insertion of the tendon at the
base of the 5th metatarsal. Pain is usually insidious in onset. Pain
normally begins with the start of an activity that tends to warm up and subside
as the activity progresses. Peroneal tendonitis does not normally cause
swelling or redness.
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Differential Diagnosis:
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Sprained ankle
Broken ankle
Arthritis
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Products Recommended for Peroneal Tendonitis:
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See Also:
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References:
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This article was written by Jeffrey A. Oster, DPM and last updated 6/12/07. No additional information is available for this topic.
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