Peroneal Tendonitis: Treatment and Recovery Time

Where is the Peroneal Tendon?

The peroneal tendon is the fibrous tissue that joints the muscle and bone of your ankle. The peroneal tendons are situated in the lateral compartment of the leg and include the peroneus longus and peroneus brevis muscles. The function of the peroneal tendons is to allow the movement of the foot downwards away from the lower leg, providing stability when walking.1

What is Peroneal Tendonitis?

Peroneal tendonitis is the inflammation of the peroneal tendons that often causes pain in the outside of the ankle or foot. The pain eases when resting and worsens by walking, running or jumping. Peroneal tendonitis presents different symptoms being the most common:2

  • Pain and/or swelling around the outside of the ankle and/or foot.
  • Feeling unstable when walking and struggling on uneven surfaces.
  • Poor single- leg balance.
  • Pain worsening during activity. 

The main causes of peroneal tendonitis are overuse which can cause micro-injuries in the tendon and traumatic injuries such as sprains. However, there are risk factors that can contribute to developing peroneal tendonitis:2

  • Previous injuries or surgeries in your ankle.
  • Poor exercising or training technique and overuse. 
  • Previous conditions such as rheumatoid arthritis, diabetes or rheumatoid psoriasis. 
  • Being overweight, older age, smoking.

Left untreated, peroneal tendonitis can lead to a tendon rupture which happens when your tendon partially or completely tears. Damaged or weakened tendons can also lead to subluxation, meaning a dislocation of your ankle.3

The diagnosis of peroneal tendonitis can be difficult as it shares symptoms with other common foot injuries and conditions. In fact, a recent study reveals that 60% of the cases are misdiagnosed.3 To exclude other pathologies, your doctor might request x-rays, MRI, CT scans or ultrasound to narrow the diagnosis. 

Peroneal tendonitis is often treated conservatively, to help relieve tendon pain and inflammation within three to four weeks. Common treatments include:3 

  • Bracing. Using an ankle brace to support your ankle when mobilising. 
  • Immobilisation. Similar to braces, a cast or boot might be used to immobilise your ankle for a few weeks so your tendons can heal.
  • Medication. Painkillers and anti-inflammatory medication might be useful to relieve the symptoms of peroneal tendonitis. 
  • Injections. Steroid injections directly in the joint to numb your ankle might be an option when bracing, immobilisation and medication don’t work.
  • Physical therapy. Home exercises to help stretch and flexibility in the ankle. Other therapies can include heat, ice and ultrasound.
  • RICE method. This remedy can be done in the comfort of your home. You can perform RICE (raise, ice, compression and elevation) by applying ice and/or compression to your ankle for 20 minutes every 2 hours, and elevate your ankle above the level of your heart to reduce inflammation. 

In cases where the conservative treatment doesn’t help, you might need surgery. Surgery for peroneal tendonitis consists of cleaning the damaged outer layers of tissue from your peroneal tendons during a procedure called synovectomy.3

“Prevention is better than cure”. How can we prevent peroneal tendonitis? There are many ways to prevent it but you can try the following:3

  • Maintain healthy body weight. 
  • Stop smoking.
  • Never push through foot or ankle pain.
  • Allow for rest between workout and exercising. 
  • Stretch and warm up your ankle before any physical activity. 
  • Gradually work up to intense physical activity. 
  • Use ankle brace or foot orthotics if needed.

It is important that you do “pacing and scaling”. Pacing and scaling between tasks can help to manage the pain better. This can be done by taking regular breaks and prioritising activities throughout your day.2

Finally, the prognosis of peroneal tendonitis can be tricky as it depends on many factors such as previous injuries, type of treatment or degree of damage. Most people recover fully from this condition within 3 months if following the treatment and advice provided, however, symptoms can take up to a year to disappear in some cases.2

To sum up, peroneal tendonitis is a condition where one or both of your ankle tendons become painful and/or swollen. The reason why this happens is often overusing and traumatic injuries such as sprains. The most common symptoms are pain, swelling and discomfort when mobilising while they often ease at rest. The treatment for peroneal tendonitis is conservative in most cases, highlighting bracing and RICE method as the first line, followed by medication, injections and, in worse cases, surgery. Symptomatology generally improves by resting and pacing, and most people fully recover from peroneal tendonitis within 3 months of treatment.

Summary

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Eduardo Bondia-Marion

Masters of Public Health - MIPH, Liverpool School of Tropical Medicine

Eduardo is an Associate Lecturer in Nursing and graduate in International Public Health with strong experience in clinical roles between the hospital and community sectors.
He has more than 10 years experience as registered nurse and more recently as an associate lecturer at The Open University.

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