Understanding Peroneal Tendonitis: Causes, Symptoms, Treatment, and Prevention in Relation to Mobility and Athletic Performance

Peroneal tendonitis affects the tendons located on the outside of the ankle. The peroneal tendons help support the foot and allow it to function. When peroneal tendonitis occurs, the tendons become irritated and cause ankle pain, reducing a person’s ability to partake in physical activity. While participating in sports is a leading cause of peroneal tendonitis, even simple actions like walking or running can result in discomfort and disability.

Overuse is one of the primary causes of peroneal tendonitis. Repetitive activities such as running or jumping without adequate rest can cause the tendons to become irritated and inflamed. In addition to overuse, the causes of peroneal tendonitis include improper footwear, such as shoes that do not support the foot sufficiently. Worn out shoes, shoes with inadequate cushioning, and shoes that do not fit properly are examples of shoes that can contribute to peroneal tendonitis. Anatomical factors such as foot pronation or the supinatus foot, characterized by flat feet or high arches, can cause increased stress on the peroneal tendons (Philbin et al., 2009; Selmani et al., 2006).

Symptoms of peroneal tendonitis typically start gradually but worsen. Pain and swelling of the peroneal tendon and associated tissues occur on the outside of the ankle and foot, which worsens with activity or changes in position of the foot. Tenderness to touch, stiffness, swelling, pain and inability to walk (gait abnormalities) are other common symptoms which typically begin with activities that stress the ankle, such as walking or running. In some cases patients report a feeling or sound of popping or snapping with ankle movement.

Peroneal tendonitis can be a disabling condition, primarily affecting athletes, dancers, and individuals who are extremely active. For the athlete, a reduced ability to compete can mean a loss of fun and decreased fitness levels. Simple activities such as walking, climbing stairs, or standing and walking on hard surfaces for periods of time can become painful. Treatment is typically aggressive and highly successful, so athletes can quickly return to their activities. By recognizing the causes and signs and symptoms of peroneal tendonitis, individuals can seek medical care and begin treatment early to avoid losing time from activity due to mobility issues that affect daily life and create frustration.

Treating peroneal tendonitis usually begins with non-surgical methods to allow the tendon to heal. Giving the tendon a rest from aggravating activities such as running or jumping is a critical component of successful treatment. The assistance of a physical therapist can be very helpful in a rehabilitation program. A physical therapist can develop an exercise program that focuses on peroneal muscle stretching and strengthening. In addition to exercises and physical therapy, pain and swelling can be controlled with anti-inflammatory oral medications such as ibuprofen (Advil) or naproxen (Aleve). These medications allow patients to perform exercises and participate in rehabilitation when they would be unable to do so because of pain.

In some cases, surgery is required to treat subacute and acute transτονilar traction injuries of the rotator cuff. When conservative management fails, surgery may be necessary to repair or reconstruct torn tendons. The surgeon will determine the appropriate surgical approach for each case. (Dombek et al., 2003; Sharma & Parekh, 2021)

Preventing peroneal tendonitis is just as important as rehabbing from it. One of the first things you should do to prevent strain on the peroneal tendons is to make sure you are wearing the right type of footwear. Having shoes that support your ankle and foot properly is essential to avoiding tendonitis in the peroneal tendons. In addition to having the right shoes, incorporating strength training into your workout routine can be beneficial in preventing peroneal tendonitis. This will not only strengthen your peroneal muscles but also enhance support in your lower leg and foot. Adding conditioning exercises, such as balance training, can also enhance muscle coordination and improve foot mechanics (Heckman et al., 2009).

We also work with clients to improve their biomechanics in footwear as well as methods for footwear maintenance to prevent further stress on the peroneal tendons and associated muscles throughout the lower legs. By implementing these simple techniques and treatments, athletes and active individuals alike will achieve superior mobility and improved performance. Early and effective treatment for peroneal tendonitis ensures clients will be back to their usual activities in no time, with the added benefit of a minimized risk for re-injury.

Citations:

Philbin, T.M., Landis, G.S. and Smith, B., 2009. Peroneal tendon injuries. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 17(5), pp.306-317. https://journals.lww.com/jaaos/fulltext/2009/05000/peroneal_tendon_injuries.5.aspx

Selmani, E., Gjata, V. and Gjika, E., 2006. Current concepts review: peroneal tendon disorders. Foot & ankle international, 27(3), pp.221-228. https://journals.sagepub.com/doi/abs/10.1177/107110070602700314

Danna, N.R. and Brodsky, J.W., 2020. Diagnosis and operative treatment of peroneal tendon tears. Foot & Ankle Orthopaedics, 5(2), p.2473011420910407. https://journals.sagepub.com/doi/abs/10.1177/2473011420910407

Bagley, C. and Parker, L., 2023. Diagnosis and treatment of peroneal tendon disorders. Orthopaedics and Trauma, 37(1), pp.71-78. https://www.sciencedirect.com/science/article/pii/S1877132722001300

Pedowitz, D. and Beck, D., 2017. Presentation, diagnosis, and nonsurgical treatment options of the anterior tibial tendon, posterior tibial tendon, peroneals, and Achilles. Foot and Ankle Clinics, 22(4), pp.677-687. https://www.foot.theclinics.com/article/S1083-7515(17)30082-7/abstract

Roster, B., Michelier, P. and Giza, E., 2015. Peroneal tendon disorders. Clinics in sports medicine, 34(4), pp.625-641. https://www.sportsmed.theclinics.com/article/S0278-5919(15)00046-0/abstract

Davda, K., Malhotra, K., O’Donnell, P., Singh, D. and Cullen, N., 2017. Peroneal tendon disorders. EFORT open reviews, 2(6), pp.281-292. https://eor.bioscientifica.com/view/journals/eor/2/6/2058-5241.2.160047.xml

Heckman, D.S., Gluck, G.S. and Parekh, S.G., 2009. Tendon disorders of the foot and ankle, part 1: peroneal tendon disorders. The American Journal of Sports Medicine, 37(3), pp.614-625. https://journals.sagepub.com/doi/abs/10.1177/0363546508331206

Dombek, M.F., Lamm, B.M., Saltrick, K., Mendicino, R.W. and Catanzariti, A.R., 2003. Peroneal tendon tears: a retrospective review. The Journal of foot and ankle surgery, 42(5), pp.250-258. https://www.sciencedirect.com/science/article/pii/S1067251603003144

Sharma, A. and Parekh, S.G., 2021. Pathologies of the peroneals: a review. Foot & Ankle Specialist, 14(2), pp.170-177. https://journals.sagepub.com/doi/abs/10.1177/1938640020916278