Peroneal tendonitis is an inflammatory condition found along the course of
either the peroneus longus tendon, the peroneus brevis tendon or both tendons.
Peroneal tendonitis occurs
as a result of acute or chronic
overloading of one or both of the peroneal tendons. Peroneal tendonitis results when a
load is applied to the tendon that is greater than what it can sustain over
time. The location of pain associated with peroneal tendonitis is distal
to the lateral ankle and just proximal to the 5th metatarsal base as seen in the
image to the right.
Tendon injuries, including peroneal tendonitis, are notoriously slow to heal. The reason
that tendons are slow to heal is simply due to the fact that the blood supply to
a
tendon is limited and extremely fragile. As a result, tendons are poorly
supplied with blood and are unable to respond well in cases of injury. When a
tendon is injured, the initial response to the injury is that the tendon becomes
inflamed. Inflammation is the primary means by which the body sends
out a signal or call for help to manage the injury to the tendon.
Inflammation is a signal that requests increased chemical and cellular responses
to the injury. Inflammation is also the body's
tool that is used to bring additional blood flow and oxygen into a specific
area to promote healing.
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 limiting physical activity and promoting 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. Therefore, treatment of
peroneal tendonitis can take weeks to months before the problem is completely
resolved. Most
important in the treatment of peroneal tendonitis is the need to decrease the load applied to the peroneal tendons with
each step. There are two means by which this can be accomplished. First,
begin by wearing
a heel lift and
avoiding walking in bare feet. The lower the heel, the tighter the peroneal
tendons and subsequently the greater the load carried by the peroneal tendons. Also avoid low heeled shoes such a loafers,
slippers, etc.
Calf stretching or the use of a
night splint can also be of value.
Second,
a lateral sole wedge may also helpful. A lateral sole
wedge is a wedge placed under the lateral or outside aspect of the foot. A lateral sole wedge inhibits the foot from rolling out.
Limiting the outward roll of the foot decreases the load applied to the peroneal
tendons. There are a number of varieties of lateral sole wedges.
Lateral sole wedges
can be placed directly in the shoe or
applied to orthotics. Lateral sole wedges can also be placed on the
outside of the shoe by a shoe repair shop or O&P facility.
Medical treatment of peroneal tendonitis includes the use of
ice, rest and
anti-inflammatory
medications. If oral medications are ineffective, injectable cortisone
is often used. In severe cases, non-weight bearing casts may be necessary.
Walking casts may be used as long as the walking cast is modified with a
heel lift. Walking casts are traditionally very low in the heel.
If a walking cast is used to treat peroneal tendonitis without a heel lift, the
low position of the heel may actually contribute to the symptoms of peroneal
tendonitis.
