What is it?
Peroneal tendinopathy is characterized as any impairment to the structure and function of the tendons of the peroneal muscles (peroneus longus and peroneus brevis) that run down the outside of the lower leg. The most common symptoms include pain, discomfort, and/ or swelling to the outside portion of the ankle. There are a number of different pathologies that fall under the ‘tendinopathy’ umbrella, but the most common include peroneal tendinitis and peroneal tendinosis. The two conditions are similar in clinical presentations and are commonly mistaken for one another; differentiation however, is important.
One key difference is that tendinosis does not have the associated swelling that occurs with tendinitis. Tendinitis is classified as an inflammation, or swelling, of the tendon resulting from a micro-tear due to an acute overload, such as forceful trauma, that is too heavy and/or sudden (1).
Tendinosis is differentiated in that the tendon damage results from chronic overuse, such as repetitive strain over time, without allowing appropriate time for the tendon to recover (1). Both diagnoses are commonly associated with athletes or workers who are involved in repetitive strain type activities, like running or factory line work.
The primary focus of treating tendinitis is to control swelling, whereas initial treatment of tendinosis is focused on the elimination of the source of repetitive strain (1). With each of the pathologies, controlling biomechanics and protecting the tendon from excessive strain is the focus of long-term treatment. Many of the treatment options overlap, but one distinction between the two is the use of anti-inflammatory medications (1). Speak with your family physician to determine whether anti-inflammatories are appropriate for you.
What do people experience?
Symptoms are typically insolated to the lateral or outside portion of the ankle and may include:
- Sharp pain or a dull ache
- Muscular tightness
- Reduced ankle stability, range of motion, and strength
- Ankle sprains
- Stiffness upon waking in the morning
- Pain or stiffness when rising after extended periods of sitting
- Changes to the way you walk
Risk factors for discomfort include:
- Activities with lateral (side-to-side) movement or sudden direction changes
- Poor fitting or worn out footwear
- Unsupportive footwear, such as wearing sandals while being active; it is important to select appropriate footwear that will control and cushion the movements of your foot and lower limb
- Uneven terrain – avoid surfaces with uneven terrain like trails or loose gravel, as they may place a greater strain on the involved tissues
- High impact and high volume, or intensity of exercise
- Weight – depending on your mechanics, being overweight or obese may increase the strain on the muscles and tendons in your lower legs
Your mechanics may also be an issue. Depending on your alignment and mechanics, you may be predisposed to straining the muscles and tendons in the outsides of your lower limbs. Consult with your physiotherapist or pedorthist if you suspect this may be the case.
What are my options for treatment? Who else can help?
Your family physician typically serves as the first line of defense for treatment. He or she will be able to assist you with medications and life style alterations if appropriate, or to refer you to the right type of medical professional for further care.
- Physiotherapists and kinesiologists may be appropriate to assist with exercises, stretches, or lifestyle alterations.
- Pedorthists may be appropriate to control motions of the foot that may be impacting the load place on the peroneal muscles.
- Kinesiologists may assist with ergonomics (ensuring living environments and work stations are conductive to your posture and mechanics).
- Massage therapists may be able to assist with muscular stiffness or discomfort.
Staying active with pain
Staying active while you recover is important for overall health and well-being. Appropriate exercise selection, however, is important. As a general guideline, avoid any exercises or activities that induce or intensify your symptoms – that means both during and after the activity. With soft tissue injuries, like some tendinopathies, once the tissue is warmed up it will often feel fine while active. If this is the case, the discomfort will usually set in once you stop the activity, after a period of rest, or may come the next morning when you get out of bed. If any of these are the case, reduce the intensity or duration of the activity until you reach a point that does not induce your symptoms. In particular, avoid sports with sudden direction changes like soccer, basketball, volleyball, or racquet sports, and exercises with lateral (side-to-side) movements such as plyometrics, Zumba, kickboxing, etc. Choose mild intensity exercises or cross-training activities that will keep you active while encouraging a healthy recovery.
1- Bass E. Tendinopathy: Why the difference between tendinitis and tendinosis matters. International Journal of Therapeutic Massage and Bodywork. 2012; 5:1 14-17.