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Peroneal tendinitis occurs when there is inflammation along one or both of the tendon sheaths and/or tears along a portion of the tendon. This can result in ankle instability, pain, or elevation of the arch of the foot.
- Pain can be felt along the entire course of the tendons
- Tenderness along the involved tendon
- Heightening of the arch of the foot
- When there is an injury to the peroneal fascia, the tendons can subluxate. This felt as a popping or dislocation of the tendons along the outside of the ankle
Diagnosis is made by a comprehensive foot and ankle exam by Dr. Stewart along with x-rays of the foot. Imagining studies such as ultrasound and MRI are sometimes required to determine the extent of tendon injury.
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.
Early and aggressive conservative treatment is recommended to prevent further tendon injury. Dr. Stewart terms peroneal tendinitis a pro-active condition. Although we can never offer a 100% guarantee, the majority of Dr. Stewart’s patients improve with conservative (non-surgical care).
After I was diagnosed with peroneal tendinitis and receiving treatment that was ineffective, I began to think that foot and ankle pain was something I would just have to endure for the rest of my life. It was apparent to me that Dr. Stewart genuinely cared about my recovery and I was not just another number. Dr. Stewart reassured me that there were treatment options available that could improve my quality of life. – Amber Pruitt
Conservative treatment for Peroneal Tendinitis includes:
- Immobilization of the foot and/or ankle. Depending on the severity of the condition, this may require cast immobilization with crutches, a walking boot, a hinged ankle foot orthosis with supportive shoe gear, a multi-ligamentous ankle brace with supportive shoe gear, or custom foot orthotics with supportive shoe gear
- Modification of physical activity including avoidance of walking, jogging, running, and the elliptical for exercise; recommended exercises include circuit training, swimming, and bicycling
- Stretching and strengthening exercises with a Theraband
- Therapeutic laser
- Compression therapy generally with prescription compression stockings
- Physical therapy
- Weight loss and dieting
- Medications including anti-inflammatory medications (NSAIDs), Tylenol, oral steroids, and in some cases narcotic pain medication
- Ice along the tendons 2-3 times per day for 20 minutes at the area of maximum tenderness. Elevation is recommended while icing
- Avoidance of flip-flops, flats, and barefoot walking
- Supportive shoe gear including a motion control running shoe such as Brooks, Asics, New Balance, or Saucony; Keen and Merrell style shoes are also recommended
- Custom foot orthotics
- Steroid injections into foot and/and or ankle joints
If all conservative intervention fails, then surgical intervention maybe required. Dr. Stewart will determine which procedure is best for you.
Surgical treatment for Peroneal Tendinitis includes:
- Tendon debridement and repair
- Tendon transfer
- Repair of the peroneal fascia and peroneal groove on the fibula
- Cutting of the fibula bone and fixation with screws or plates