Peroneal Tendon Injuries: Causes, Symptoms, Treatment, and Rehabilitation

What are Peroneal Tendons?

The peroneal tendons are two tendons that run along the outside of the lower leg and ankle. The peroneus longus tendonruns from the top of the fibula (the smaller bone in the lower leg) to the foot, and the peroneus brevis tendon runs from the fibula to the base of the fifth metatarsal. These tendons are essential for stabilizing the foot and ankle, particularly during activities such as walking, running, and jumping.

Causes of Peroneal Tendon Injuries

Peroneal tendon injuries can occur due to a variety of factors, including trauma, overuse, or structural abnormalities in the foot and ankle. Some common causes include:

• Overuse: Repeated activity, especially activities that involve running or lateral (side-to-side) movement, can cause wear and tear on the peroneal tendons, leading to tendonitis or tendon tears.

• Ankle Sprains: A common cause of peroneal tendon injuries is an ankle sprain, particularly when the foot rolls inward (inversion injury), placing excessive stress on the tendons.

• Improper Footwear: Wearing shoes that don’t provide adequate support or have poor cushioning can contribute to tendon strain and injury.

• Flat Feet or High Arches: Structural abnormalities such as flat feet or high arches can alter the mechanics of walking, increasing stress on the peroneal tendons and leading to injury.

• Sudden Increase in Activity: A rapid increase in activity level, such as an intense exercise program or sport, can put excessive strain on the tendons.

• Direct Trauma: A direct blow to the side of the ankle or lower leg can damage the peroneal tendons.

Symptoms of Peroneal Tendon Injuries

Symptoms of peroneal tendon injuries can vary based on the severity of the damage, but commonly include:

• Pain: A dull or sharp pain on the outside of the ankle and lower leg, especially during activity or after prolonged standing.

• Swelling: Swelling along the outside of the ankle or lower leg, particularly near the peroneal tendons.

• Weakness: Difficulty with pushing off the foot or standing on tiptoes due to weakness in the affected tendon.

• Instability: A feeling of instability or weakness in the ankle when walking, running, or performing activities that require quick movements.

• Clicking or Popping Sensation: A clicking or popping sound when moving the foot, which may indicate tendon damage or displacement.

Types of Peroneal Tendon Injuries

There are different types of injuries that can affect the peroneal tendons:

1. Peroneal Tendonitis

This is the inflammation of the peroneal tendons, often caused by overuse. Tendonitis can result in pain and swelling along the side of the ankle.

2. Peroneal Tendon Tears or Ruptures

A peroneal tendon tear occurs when one of the tendons is partially or completely torn. Tears can be caused by sudden, forceful movements or ongoing tendon wear.

3. Peroneal Tendon Subluxation or Dislocation

This occurs when the tendon slips out of its normal groove at the back of the fibula, leading to pain and instability. It often happens due to a traumatic injury, such as an ankle sprain.

Diagnosis of Peroneal Tendon Injuries

To diagnose a peroneal tendon injury, a healthcare provider will perform a physical examination, inquire about the patient's activity history, and may use imaging tests to confirm the diagnosis. Diagnostic methods include:

Clinical Examination:

• Physical Assessment: The doctor will check for tenderness, swelling, and movement restrictions around the ankle. They may also assess the stability of the peroneal tendons by applying specific pressure and testing range of motion.

• MRI or Ultrasound: These imaging tests help to identify tears, inflammation, or structural damage in the peroneal tendons.

Treatment for Peroneal Tendon Injuries

Treatment for peroneal tendon injuries can be conservative or surgical, depending on the severity of the injury.

Non-Surgical Treatment:

• Rest: Avoiding activities that cause pain or put stress on the tendons is essential for recovery. Rest helps reduce inflammation and prevent further damage.

• Ice Therapy: Applying ice to the affected area for 20-30 minutes at a time can help reduce swelling and pain.

• Compression and Elevation: Using an elastic bandage or ankle brace to compress the area can reduce swelling, while elevating the foot helps with fluid drainage.

• Physiotherapy: Physical therapy is crucial for rehabilitation, focusing on strengthening the peroneal tendons and improving flexibility. Physiotherapists will use techniques such as:

  • Eccentric strengthening exercises: These exercises help in the rehabilitation of tendon injuries by improving strength and function.

  • Stretching: Stretching exercises for the calf and ankle can improve flexibility and relieve tension on the tendons.

  • Taping or bracing: Taping techniques or ankle braces can support the peroneal tendons during the recovery process and reduce the risk of re-injury.

• Orthotics: Custom orthotics or arch supports may be prescribed to address any foot abnormalities (such as flat feet or high arches) and reduce strain on the tendons.

• Anti-inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be prescribed to reduce inflammation and alleviate pain.

Surgical Treatment:

Surgery is typically only recommended for severe tendon tears or cases that do not respond to conservative treatments. Surgical options may include:

• Tendon Repair: If a tendon is torn, surgery may be required to reattach or repair the damaged tendon.

• Tendon Debridement: In cases of chronic tendonitis or degeneration, surgery may be necessary to remove damaged tissue and promote healing.

• Peroneal Tendon Stabilization: If the tendon has dislocated or is at risk of dislocation, surgery may be performed to stabilize the tendon and prevent it from slipping out of its normal groove.

Rehabilitation at Palms Physiotherapy & Allied Health

Rehabilitation is an essential part of recovery from a peroneal tendon injury. Our expert physiotherapists will design a personalized rehabilitation program that may include:

• Pain Management: Cold therapy, massage, or electrotherapy can be used to manage pain and reduce inflammation.

• Strengthening Exercises: Focused on strengthening the peroneal tendons and surrounding muscles to improve ankle stability and function.

• Range of Motion and Stretching: Restoring full range of motion through targeted stretches can help in the healing process and prevent further injuries.

• Proprioception and Balance Training: Exercises to improve balance and proprioception (the sense of where the body is in space) will help prevent future injuries.

Our goal is to help you return to your normal activities and improve your strength, flexibility, and function.

Preventing Peroneal Tendon Injuries

To prevent peroneal tendon injuries, consider the following:

• Gradual Increase in Activity: Avoid sudden increases in physical activity, and gradually build up intensity to prevent overloading the tendons.

• Proper Footwear: Wear shoes that provide adequate support, especially if you have foot abnormalities such as flat feet or high arches.

• Stretching and Strengthening: Regularly stretch and strengthen the muscles around the ankle and lower leg to reduce strain on the tendons.

• Warm-Up and Cool-Down: Always warm up before exercise and cool down afterward to prevent injuries.

Peroneal tendon injuries can cause significant discomfort and hinder physical activity, but with proper treatment and rehabilitation, most individuals can make a full recovery. If you’re experiencing pain or symptoms of a peroneal tendon injury, contact Palms Physiotherapy & Allied Health to receive expert care and support for a successful recovery.