Peroneal Tendonitis Foot - Peroneal Tendon Sore, Tendon Pain Treatment Seattle (2022)

Tendonitis is a common foot problem as our feet take tremendous amounts of stress and rarely get to rest. Peroneal Tendonitis is one of the more common forms of tendonitis that we treat. With this problem your foot may hurt along the lateral (outside) portion. You may also feel sore on the outside of your ankle or have a painful leg.

If you think you may have peroneal tendonitismake an appointment right away to see us in our Seattle clinic. We are experts in treating peroneal tendon injuries fast and effectively.

Video: How to Treat Peroneal Tendonitis

Anatomy of the Peroneal Tendons

There are two peroneal tendons – a short one (peroneus brevis) and a long one (peroneus longus). The peroneal tendons start on the outside of the calf and runs behind the ankle bone on the outside of the ankle. The brevis tendon attaches into the base of the 5th metatarsal, while the longus turns to run along the bottom of the foot and attach into the base of the first metatarsal.

A tremendous amount of tension and stress is placed is on this tendon with every step as it helps to support the foot. The amount of stress on the tendon varies from person to person depending on the shape of their foot (flatfeet versus a very high arch).

Symptoms and Diagnosis of Peroneal Tendonitis

Symptoms of peroneal tendonitis include pain and swelling along the outside of the ankle and along the course of the tendon. There is often pain on the outside (lateral portion) of the foot. Pain is present with walking, exercise or just standing. This discomfort will usually increase over time. This pain initially is absent when at rest but may progress to the point where pain is present even when not active. In advanced cases the injury to the tendon that started as tendonitis may result in a full or partial tear of the tendon.

We can usually make this diagnosis very easily by history and examination. Sometimes we will perform an in-officediagnostic ultrasoundor order an MRI to determine the extent of damage to the tendon.

(Video) Peroneal Tendonitis: Causes, Diagnosis, and Treatment

Initial Treatment

Treatment can depend on how long the symptoms have been present and the amount of strength that is lost (if any) in the tendon. Initial treatment may include:

  • Anti-inflammatory medication
  • Orthotics with wedging to reduce tension on the peroneals.
  • Physical therapy
  • Taping
  • Rest

Orthotics for Peroneal Tendonitis

Orthotics for this problem are designed specifically to reduce tension on the injured peroneal tendon. This often requires an orthotic that is deeper than normal around the outside of the heel and incorporates special wedging directly under the heel to reduce tension on the peroneal tendons.

Additional wedges are often added under the orthotic heel and under the metatarsal heads to further decrease tension on the peroneal tendons.

The correct orthotic can not only help heal the tendon by reducing tension on it but can also help prevent recurrence of the problem.

Prefabricated Orthotics for Peroneal Tendonitis

Often a high quality prefabricated orthotic works well for peroneal tendonitis. Our recommended prefab orthoticsfor peroneal tendonitis is the FootChair Podiatrist Designed Orthotic. This is the only prefab orthotic to incorporate an adjustable arch that can help improve both comfort and function.

(Video) How to Treat Peroneal Tendonitis with Seattle Podiatrist Larry Huppin

Peroneal Tendonitis Foot - Peroneal Tendon Sore, Tendon Pain Treatment Seattle (2)

For smaller shoes including high heels, flats and soccer cleats, the recommended OTC arch support is theFootChair Slim Orthotic with adjustable arch support. It’s the only effective OTC arch support we have found to fit in women’s heels and flats. It has the same exceptional adjustable arch support as the full-size FootChair but with a much slimmer profile. In addition it flexes to adapt to most heel heights.

In our clinic we often add specific modifications to the prefab orthotics to decrease tension on the peroneals. If you see a podiatrist be sure to take your arch supports with you so they can be modified.

Custom Orthotics for Peroneal Tendonitis

If we are not able to adequately reduce the tension on the peroneal tendons with modified prefabricated orthotics, then we will next createcorrectly prescribed custom orthotics.cCustom orthotics can be designed to more effectively reduce tension on the peroneal tendons. In addition, they last longer and are often covered by insurance. Because they cost more, however, we usually begin treatment with modified prefabricated orthoses.

Reducing Inflammation

Once we reduce tension on the peroneal tendons, then we want to reduce any acute inflammation. This might involve icing, medications, rest or physical therapy.

Shockwave Therapy for Peroneal Tendonitis

If reduction of tension and inflammation does not provide rapid relief, the next step in treatment is to stimulate healing of the tissue. The treatment with the best evidence at stimulaitng healing of tendon is Shockwave Therapy.

(Video) Shockwave Therapy for Peroneal Tendonitis | Seattle Podiatrist

Extracorporeal shockwave therapy is a conservative treatment for disorders of many tendons and has been shown to be a safe and effective method to stimulate healing of tendon. It involves 4 – 5 sessions of shockwave therapy, each about 1 week apart. Treatments create only very mild discomfort in most patients.

In a 2018 study of about 400 subjects, for example, “Shockwave therapy significantly reduced the pain that accompanies tendinopathies and improves functionality and quality of life. It might be first choice because of its effectiveness and safety”(1).

Shockwave therapy works by stimulating healing of tendon in two ways:

  • Neo-vascularisation: Shockwave therapy helps create new blood vessels locally. The improved blood flow helps tendon heal.
  • Release of growth factors: Growth factors are proteins that stimulate tenocytes – the cells that repair tendon.

Most studies show shockwave works approximately 70% – 80% of the time to eliminate the pain of tendonitis. In a 2018 meta-analysis(analysis of multiple studies),“Extracorporeal shock wave therapy exerted a positive overall effect on pain and function for lower-limbtendinopathy. Shock wave types and dosage levels may have different contributions to treatment efficacy.”(2)

In a 2015 systemic review, The British Medical Bulletin stated that “Extracorporeal shock wave therapy (ESWT) is an effective and safe non-invasive treatment option for tendon and other pathologies of the musculoskeletal system.”(3)

As with all modalities, Shockwave Therapy has both advantages and disadvantages:

(Video) Peroneal Tendonitis Treatment 2021 [Peroneus Brevis & Longus Pain!]

Advantages of Shockwave for Peroneal Tendonitis:

  • Appears to work by stimulating healing of the tendon, rather than masking it as anti-inflammatory medications might.
  • Studies on most tendons show about 70 – 80% effectiveness at healing the tendon.
  • Safe – there are no side effects at all.

Disadvantages of Shockwave for Peroneal Tendonitis:

  • Because shockwave acts to stimulate a healing process, improvement tends to be slow. You should not expect rapid relief. Maximum clinical benefits are found at 12 – 20 weeks with an average of 16 weeks to maximum benefit.
  • Shockwave therapy is not covered by insurance. The cost is $460 for the recommended 3 – 4 sessions.
  • While there are multiple studies showing the benefits of shockwave for tendonopathies, there are currently no high-level studies specifically on shockwave for the peroneal tendons. Studies on other tendons including the patellar, Achilles, rotator cuff and supraspinatus have been very positive. It is expected that the physiologic effects would be the same on the peroneal tendons.

You can learn more about shockwave therapy here.

Video: How to Tape for Peroneal Tendonitis
Peroneal Tendonitis Foot - Peroneal Tendon Sore, Tendon Pain Treatment Seattle (3)

The taping technique demontrated in this video is very effective at reducing tension on the peroneal tendons and easy to apply yourself. We recommend using Rocktape or another kinesiology tape as these tapes are much more gentle on the skin than standard athletic tapes. You can get Rocktape here.

Treatment for Resistant Cases

This problem should be treated as early as possible in order to prevent damage to the tendon.Contact us at our Seattle clinic right away if you are having symptoms.

In more severe cases we may place you in a removable cast (walking boot) from two to four weeks to allow the tendon to completely rest without placing the day-to-day demands of walking on it. If these measures fail to produce acceptable results surgical intervention may be necessary to clean around the tendon and repair any defects in the tendon. Surgical repair is rarely necessary, particularly with proper orthotics to reduce tension on the tendons and shockwave to stimulate healing of the tendons.

Self-Treatment of Peroneal Tendonitis

If you have a mild case of peroneal pain and want to try home treatments first then try our 8-step peroneal tendonitis home treatment plan. If you are not seeing significnant improvement within 3 weeks, however, be sure to make an appointment to see us.

References:

(1) Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Vasileios Dedes, et al. Mater Sociomed. 2018 Jun; 30(2): 131–146

(Video) Acute Peroneal Tendinitis Evaluation with @OrthoEvalPal

(2) Efficacy of Extracorporeal Shock Wave Therapy for Lower-Limb Tendinopathy: A Meta-analysis of Randomized Controlled Trials. Liao CD, et. al. Am J Phys Med Rehabil. 2018 Sep

(3)Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. Christoph Schmitz, et. al. British Medical Bulletin, Volume 116, Issue 1, December 2015

FAQs

How do you get rid of peroneal pain? ›

The most common treatment is rest. Rest allows the body to repair any damage and heal itself. Antibiotics can also help heal certain types of perineum pain. Perineal massage is a type of physical therapy that can help with pelvic pain, but it should be postponed until any inflammation subsides.

How long does it take to get rid of peroneal tendonitis? ›

Treatment. Peroneal tendinitis generally takes 6-8 weeks to improve and early activity on a healing tendon can result in a set back in recovery. Non-compliance can double the recovery time and can be very frustrating for patients.

How do you relax the peroneal tendon? ›

This stretch can be performed by sitting on the ground with your feet straight out in front of you:
  1. Wrap a towel around your toes and gently pull back until you feel a stretch at the bottom of the foot and back of the lower leg.
  2. Hold this stretch for 30 seconds and repeat three times.

What makes peroneal tendonitis worse? ›

Frequently affecting runners or athletes who have upped their training, peroneal tendonitis usually develops slowly, gradually getting worse and worse. Repetitive overloading or stretching of the peroneal tendons can cause small tears in the tendons which leads to inflammation, irritation, weakening and degeneration.

Should you massage peroneal tendonitis? ›

Massage. Your therapist may use soft tissue massage techniques to improve peroneal tendon mobility on the lateral side of your ankle. Massage may help improve tissue flexibility and circulation, and it may be used prior to exercise and stretching to improve overall mobility.

Will a walking boot help with peroneal tendonitis? ›

Treatments. The vast majority of peroneal tendinosis cases will heal without surgery. This is because it is an overuse injury and can heal with rest. If there is significant pain, wearing a CAM walker boot for several weeks is a good idea.

Will an ankle brace help peroneal tendonitis? ›

An ankle brace for peroneal tendonitis can help support the ankle and protect it from further injury during healing. This can range from full immobilization with an ankle boot to a snug fitting brace, or even simply taping the ankle for added strength.

Is walking good for ankle tendonitis? ›

Appropriate shoe gear, walking rather than running when you start an exercise program, and movements that strengthen your ankles and improve range of motion can help prevent tendonitis.

Is ice or heat better for peroneal tendonitis? ›

Heat may be more helpful for chronic tendon pain, often called tendinopathy or tendinosis. Heat can increase blood flow, which may help promote healing of the tendon. Heat also relaxes muscles, which can relieve pain.

Can shoes cause peroneal tendonitis? ›

Most commonly, peroneal tendonitis is caused by sudden increases in training, and the use of badly designed footwear. People who also have hindfoot varus posture are more likely to experience peroneal tendonitis.

Do cortisone shots help peroneal tendonitis? ›

Conclusion: Our study demonstrates US-guided PTS corticosteroid injection was safe and relatively effective in patients with symptomatic peroneal tendon tears or tendinopathy, including those who had undergone prior surgery, and may be considered in a comprehensive protocol of nonoperative management.

Can a podiatrist treat peroneal tendonitis? ›

If you are suffering from any of these symptoms, you need a peroneal tendonitis diagnosis which can only be performed by a trained podiatrist.

Can peroneal tendonitis be permanent? ›

If not treated by a medical professional, peroneal tendonitis can lead to a tendon tear or permanent nerve damage. For this reason, it's best to have it treated immediately before the condition gets worse.

Do I need to see a doctor for peroneal tendonitis? ›

Be on the lookout for other symptoms including swelling, warmth when touched, and joint instability and weakness. If you suspect that you have developed peroneal tendonitis, you should schedule a visit with your foot doctor. Only your podiatrist can accurately diagnose the source of your foot or ankle pain.

How do you relieve tendon pain in the foot? ›

How is foot tendonitis treated?
  1. Rest: Stop physical activity to avoid further damaging the tendons in your foot.
  2. Ice: Put an ice pack or cold compress on your foot for up to 20 minutes at a time. ...
  3. Compression: Reduce swelling by applying a compression bandage or wrap around the injured tendon.
Oct 26, 2021

Do insoles help peroneal tendonitis? ›

Prevention. Wearing shoes or shoe insoles that properly support the structures of the foot while also providing correction for alignment issues such as overpronation can help to reduce the likelihood that you will develop peroneal tendonitis.

Does peroneal tendonitis hurt at rest? ›

Symptoms of peroneal tendinopathy include: Aching pain on the outside of the ankle, especially with activity. Pain that decreases with rest. Swelling or tenderness behind the ankle bone on the outside of the ankle.

How do you wrap a foot with peroneal tendonitis? ›

KT Tape: Peroneal Tendonitis - YouTube

Does peroneal tendonitis hurt to touch? ›

There shouldn't be much pain while standing or when you push gently on the injured area. However, if the outside of your foot is very tender to the touch, and if you have a lot of pain standing or even while non-weightbearing, you may instead Have A Fracture On Your Fifth Metatarsal.

How is chronic peroneal tendonitis treated? ›

Treatment for peroneal tendonitis includes a program of stretching, strengthening, mobilisation and manipulation, proprioceptive and balancing exercises, icing, ankle bracing or taping during contact sports If symptoms are severe, a cast or ROM boot immobilisation is prescribed for 10 days.

What does a peroneal tendon tear feel like? ›

Peroneal tendon injuries can be acute, meaning the injury occurred suddenly, or chronic, meaning that damage occurred over time. Symptoms of peroneal tendon injuries can include pain and swelling, weakness in the foot or ankle, warmth to the touch, and a popping sound at the time of injury.

How do you massage the peroneal nerve? ›

Place the fingers at the bottom of the ankle at the lateral malleolus. Then, simply apply moderate to deep pressure as you move slowly up toward the knee along the fibula. You can also try starting from the knee and moving down to the ankle as well. Repeat the motion as needed for one to five minutes.

Do compression socks help tendonitis? ›

Anatomically designed compression zones target the feet and calves, for the advanced pain management of plantar fasciitis, Achilles tendonitis, arch pain and heel spurs.

Can a chiropractor help peroneal tendonitis? ›

Tendonitis occurs because of inflammation and irritation of a tendon and often responds very well to chiropractic treatment. Chiropractic treatment is a natural way of reducing inflammation and relieving pain if you suffer from tendonitis (often spelled tendinitis).

How do you strengthen peroneal tendons? ›

Peroneal Tendonitis Stretches & Exercises – Ask Doctor Jo - YouTube

What happens if tendonitis goes untreated? ›

If tendonitis is left untreated, you could develop chronic tendonitis, a tendon rupture (a complete tear of the tendon), or tendonosis (which is degenerative). Chronic tendonitis can cause the tendon to degenerate and weaken over time.

Does Icy Hot help with tendonitis? ›

Over-the-counter medicines like naproxen sodium (Aleve), ibuprofen (Advil, Motrin) reduce swelling. Arthritis and sports creams such as Icy Hot and Aspercreme reduce inflammation as well. Physical therapy. Gentle stretching and strengthening exercises can help heal the pain.

Why is my tendonitis getting worse? ›

A tendon injury typically gets worse if the tendon isn't allowed to rest and heal. Too much movement may make your symptoms worse or bring the pain and stiffness back. The joint areas most often affected by tendinopathy are the shoulder, elbow, wrist, hip, knee, and ankle.

Does an MRI show peroneal tendonitis? ›

MRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability.

Where do you feel pain with peroneal tendonitis? ›

Peroneal tendonitis is a condition that causes pain on the outside of the foot and up the outside of your lower leg when walking or running. Peroneal tendonitis is rare and caused by overuse that impacts athletes such as runners and longer distance walkers.

Can flip flops cause peroneal tendonitis? ›

Therefore, those who wear flip-flops for prolonged periods of time may experience foot and ankle pain, peroneal tendinitis, plantar fasciitis, stress fractures, and blisters from stubbed toes or even more serious injuries.

Does walking make peroneal tendonitis worse? ›

You have pain on the outside of the ankle or heel in the area where the peroneal tendons run. This pain is usually made worse by activities like running and walking and eases with rest. If it is tender or sore when you press on the peroneal tendons.

Is peroneal tendonitis permanent? ›

If not treated by a medical professional, peroneal tendonitis can lead to a tendon tear or permanent nerve damage. For this reason, it's best to have it treated immediately before the condition gets worse.

Is a walking boot good for peroneal tendonitis? ›

Treatments. The vast majority of peroneal tendinosis cases will heal without surgery. This is because it is an overuse injury and can heal with rest. If there is significant pain, wearing a CAM walker boot for several weeks is a good idea.

Can shoes cause peroneal tendonitis? ›

Most commonly, peroneal tendonitis is caused by sudden increases in training, and the use of badly designed footwear. People who also have hindfoot varus posture are more likely to experience peroneal tendonitis.

Can a chiropractor help peroneal tendonitis? ›

Tendonitis occurs because of inflammation and irritation of a tendon and often responds very well to chiropractic treatment. Chiropractic treatment is a natural way of reducing inflammation and relieving pain if you suffer from tendonitis (often spelled tendinitis).

Videos

1. Peroneal tendon tears: diagnosis and treatment
(Ettore Vulcano, M.D.)
2. Peroneal Tendonitis - Home Stretches and Exercise Rehabilitation Plan
(Travis Tarrant)
3. Peroneal Tendinitis is a Common Running Injury
(Neuhaus Foot & Ankle)
4. Peroneal Tendon Injury
(BestFootDoc)
5. KT Tape: Peroneal Tendonitis
(KT Tape)
6. Peroneal Tendonitis - Benedict Khoo, Singapore Podiatrist
(East Coast Podiatry)

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