Peroneal Tendinitis

with Rehab

ExitCare ImageTendonitis is inflammation of a tendon. Inflammation of the tendons on the back of the outer ankle (peroneal tendons) is known as peroneal tendonitis. The peroneal tendons are responsible for connecting the muscles that allow you to stand on your "tippy toes" to the bones of the ankle. For this reason, peroneal tendonitis often causes pain when trying to complete such motions. Peroneal tendonitis often involves a tear (strain) of the peroneal tendons. Strains are classified into three categories. Grade 1 strains cause pain, but the tendon is not lengthened. Grade 2 strains include a lengthened ligament, due to the ligament being stretched or partially ruptured. With grade 2 strains there is still function, although function may be decreased. Grade 3 strains involve a complete tear of the tendon or muscle, and function is usually impaired.

SYMPTOMS

  • Pain, tenderness, swelling, warmth, or redness over the back of the outer side of the ankle, the outer part of the mid-foot, or the bottom of the arch.

  • Pain that gets worse with ankle motion (especially when pushing off or pushing down with the front of the foot), or when standing on the ball of the foot or pushing the foot outward.

  • Crackling sound (crepitation) when the tendon is moved or touched.

CAUSES

Peroneal tendinitis occurs when injury to the peroneal tendons causes the body to respond with inflammation. Common causes of injury include:

  • An overuse injury, in which the groove behind the outer ankle (where the tendon is located) causes wear on the tendon.

  • A sudden stress placed on the tendon, such as from an increase in the intensity, frequency, or duration of training.

  • Direct hit (trauma) to the tendon.

  • Return to activity too soon after a previous ankle injury.

RISK INCREASES WITH:

  • Sports that require sudden, repetitive pushing off of the foot, such as jumping or quick starts.

  • Kicking and running sports, especially running down hills or long distances.

  • Poor strength and flexibility.

  • Previous injury to the foot, ankle, or leg.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Complete rehabilitation after previous injury.

PROGNOSIS

If treated properly, peroneal tendonitis usually heals within 6 weeks.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated or if not given enough time to heal.

  • Recurring symptoms, if activity is resumed too soon, with overuse, or when using poor technique.

  • If untreated, tendinitis may result in tendon rupture, requiring surgery.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. Sometimes, the foot and ankle will be restrained for 10 to 14 days to promote healing. Your caregiver may advise that you place a heel lift in your shoes to reduce the stress placed on the tendon. If non-surgical treatment is unsuccessful, surgery to remove the inflamed tendon lining (sheath) may be advised.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 to 4 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Peroneal Tendinitis

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Ankle Eversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the top of your foot and your fingers across the bottom of your foot.

  • Gently push your foot downward with a slight rotation, so your littlest toes rise slightly toward the ceiling.

  • You should feel a gentle stretch on the inside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Inversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the bottom of your foot and your fingers across the top of your foot.

  • Gently pull your foot so the smallest toe comes toward you and your thumb pushes the inside of the ball of your foot away from you.

  • You should feel a gentle stretch on the outside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Plantar Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Use your opposite hand to pull the top of your foot and toes toward you.

  • You should feel a gentle stretch on the top of your foot and ankle. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times per day.

ExitCare Image STRETCH – Gastroc, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, keeping the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the calf. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Soleus, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, keeping the other knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your heel on the floor, bend your back knee, and slightly shift your weight over the back leg so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Gastrocsoleus, Standing

Note: This exercise can place a lot of stress on your foot and ankle. Please complete this exercise only if specifically instructed by your caregiver.

  • Place the ball of your right / left foot on a step, keeping your other foot firmly on the same step.

  • Hold on to the wall or a rail for balance.

  • Slowly lift your other foot, allowing your body weight to press your heel down over the edge of the step.

  • You should feel a stretch in your right / left calf.

  • Hold this position for __________ seconds.

  • Repeat this exercise with a slight bend in your knee.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Peroneal Tendinitis

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided by your caregiver.

ExitCare Image STRENGTH - Dorsiflexors

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you, using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Towel Curls

  • Sit in a chair, on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel only by curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, add weight to the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Eversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band across your opposite foot, away from the pole, slowly, pull your little toe out and up. Make sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band, as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.