So I have been asked several times, WHAT IS PERONAEL TENDONITIS??? Well here you go......

Peroneal Tendonitis

 

 

 

The peroneal tendons run on the outside of the ankle just behind the bone called the fibula. Tendons connect muscle to bone and allow them to exert their force across the joints that separate bones. Ligaments, on the other hand, connect bone to bone. Tendinitis is perhaps not the most appropriate term. This word implies that there is inflammation in the tendon. The reality is that there is tendinosis, which means that there is enlargement and thickening with swelling of the tendon. This usually occurs in the setting of overuse, meaning a patient or athlete doing a repetitive activity which irritates inflames the tendon over long periods of time.​

 

There are two peroneal tendons that run along the back of the fibula (Figures 1 and 2). The first is called the peroneus brevis.  The term "brevis" implies short.  It is called this because it has a shorter

muscle and starts lower in the leg.  It then runs down around the back of the bone called the fibula on the outside of the leg and inserts (i.e. connects) to the fifth metatarsal.  This is in the side of the foot.  The peroneus longus takes its name because it has a longer course. It starts higher on the leg and runs all the way underneath the foot to insert or connect on the first metatarsal on the other side. Both tendons, however, share the major job of everting or turning the ankle to the outside. The tendons are held in a groove behind the back of the fibula and have a roof made of ligamentous-type tissue over the top of them called a “retinaculum.”

People having peroneal tendinosis typically have either tried a new exercise or have markedly increased their activities. Characteristic activities include marathon running or others which require repetitive use of the ankle. Patients will usually present with pain right around the back of the ankle. There is usually no history of a specific injury.

DIAGNOSIS

The diagnosis of peroneal tendinosis can be made in large part by history (i.e. the story a patient tells).  As noted above, patients will have an overuse activity, rapid increase in recent activity, or other training errors and will have pain in the back and outside of the ankle.  There is pain on exam to palpation right on the peroneal tendons.  t is important to distinguish this from pain over the fibula which might indicate a different problem (i.e. stress reaction of the bone). Pain on the fibula occurs directly over the bone which is easily palpated.  Pain in the peroneals occurs slightly further behind. There is also pain with inversion or carrying the ankle to the outside. Patients may also have weakness in trying to bring the ankle to the outside (i.e. in eversion). It is important to look for the varus posturing of the heel which, as noted above, means that the heel is turned inwards. This can predispose a patient to the problem. The workup can also include using radiology. X-rays will typically be normal. Ultrasound is a very effective and relatively inexpensive way to assess the tendons and can show an abnormal appearance or tear which sometimes occurs.  An MRI is also equally important and can also show a tear.

 

TREATMENT

The vast majority of peroneal tendinosis will heal without surgery.  This is because it is an overuse injury and can heal with rest.  If there is significant pain, a CAM Walker boot for several weeks is a good idea. If there really is no tenderness with walking, an ankle brace might be the next best step.  Patients should very much limit how much they are walking or on their feet until the pain abates. This usually takes several weeks.  Resumption of training can then occur, but must occur very slowly and be based on pain.  For those patients who have hindfoot varus, as noted above, an orthotic that tilts the ankle to the opposite side may well help to offload the tendons.  It is important to talk to your doctor about changing your training.  This includes using new shoes for running or also cross-training, which means alternating activities each day.  Physical therapy is also very important.  This, as with ankle sprains, can be done to strengthen the tendons.

SO WITH ALL THAT BEING SAID, this is what happened to me during my last race.  I have now rested my foot for almost 7 days by not running or jumping on it.  I have also excluded any plyometric type exercises.  I take Mobic (strong anti-inflammatory) to keep help the tendon and I ice occasionally.  I have also replaced my shoes because they were DONE!