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.

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.

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.

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.

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.

Sprained ankle

Broken ankle

Arthritis

• Ankle Sprain

• Peroneal Tendon Subluxation

• Peroneal Tendon Rupture

• CT Band Syndrome

• Sinus Tarsi Syndrome

This article was written by Jeffrey A. Oster, DPM and last updated 6/12/07. No additional information is available for this topic.