Peroneal Tendinitis – What is that pain on the side of my foot? Could be a peroneal tendinitis.

Do you have pain on the outside of your foot?  If you have pain that is on the outside of the foot but not quite as far up as the ankle, you may have a condition called peroneal tendinitis. 

What Is Tendinitis?

Tendinitis is the inflammation or irritation of the tendon.  A tendon is the part of the muscle belly that comes off in a cord-like structure that allows the muscle to attach to the bone.  This is different than ligaments, which is a similar structure but attaches bone to bone.  In the foot, there are numerous tendons as they attach, or insert, into the 28 bones located in the foot.  This pain is caused outside of the joint and is different than joint pain itself.

What Is Peroneal Tendinitis?

The peroneal tendon is one of the major muscles in the lower leg that has a tendon that inserts on the outside of the foot, past the base of the baby toe and on the midfoot outside of the foot. The muscle belly starts below the knee and on the outside of the knee, and it runs along the outside of the lower leg, behind the ankle bone, and ends at the outside of the foot. One peroneal tendon (peroneus brevis muscle tendon) attaches to the outer part of the midfoot by the base of the baby toe, while the other tendon (peroneus longus muscle tendon) attaches near the inside of the arch.   The peroneus brevis muscle is responsible for flexion of the foot and eversion (moving the foot away from the body) and the peroneus longus is responsible for plantarflexion (pushing the foot away from the body) and eversion of the ankle.  Symptoms of peroneal tendonitis include pain on the outside of the ankle and the foot when active.  The pain is aggravated by side to side movement such as pivoting or in running, but may also be aggravated simply by walking. 


What Causes It And How Did I Get This Condition?

There are two types of peroneal tendon injuries: it can either be acute or chronic.

 In an acute situation, this can occur after an injury or accident.  This injury is often sports related that occurs suddenly, most often in individuals who participate in sports with repetitive ankle motion and medial and lateral stability. Symptoms of an acute injury may manifest as pain, swelling, inablilty to walk or weight bear, or weakness or instability of the foot and ankle. The patient may have even heard a snap or felt a crack in the ankle that may alert the patient of a tear or injury to the tendon itself, not just inflammation.

 In a chronic situation, it can develop over a period of time.  Sometimes repetitive motion or overuse can cause this injury as well. Patients with lateral ankle (outside of the ankle) instability or repetitive ankle sprains may experience this tendinitis more often since this tendon tends to stabilize the ankle, and when there is less lateral stability, this over works the peroneal tendons.  Those with higher arched feet may also experience peroneal tendonitis as there is more tendency for stress on the outside of the foot and ankle upon weight bearing and in the gait cycle. In a chronic situation, symptoms may include pain on the outside of the foot and ankle that comes and goes, aching pain but still with the ability to walk and weight bear, swelling that comes and goes.


What Else Could It Be?

It is important to make an appointment with the foot and ankle specialist in order to rule out any other possibilities. Your doctor at Prairie Path Foot and Ankle will take radiographs to rule out any bony abnormalities such as a chip fracture, stress fracture or avulsion fracture. Radiograph x-rays will also give the doctor insight into the structure of your foot, either high arch, normal arch or low arch, which could be contributing to your symptoms.  If it is not a bony problem but a soft tissue problem, the tendinitis could come with a concurrent ankle sprain or strain. In chronic conditions, the tendon over time may degenerate and there may be microtears that can occur.

What Are My Treatment Options? How Is This Treated?

If you are diagnosed with peroneal tendinitis, there are several treatment options depending on the severity of the issue.  In an acute situation where the patient has pain weightbearing, then the foot and ankle specialist may place the patient in an unnas wrap (soft cast with compression) to decrease the swelling (edema) and a CAM (controlled ankle motion) boot for immobilization. 

If the doctor suspects a tear, then she may order advanced imaging such as an MRI to rule this out.  There may be evidence of subluxation of the tendon, or when the tendon slips out of its position at the end of the ankle.  For either of these situations, the doctor may discuss surgical options.

In a chronic or overuse situation, your doctor may recommend an ankle brace that also accomplishes compression and immobilization, but still allows the patient to wear gym shoes.  She may also encourage physical therapy and an icing regimen.  In some occasions, a steroid injection may be warranted and this delivers local anti-inflammatory medication to the affected area. Sometimes NSAIDs (non-steroidal anti inflammatories) are given as prescription medication to bring down the swelling and inflammation, however due to more and more side effects and patients preferring not to take oral medications in general or interaction with other medications, NSAID prescriptions are on the decline.  Prairie Path Foot and Ankle Clinic recommends the use of the MLS pain laser for pain relief, edema relief, and faster healing as a modality of treatment.

 MLS Laser treatment in action

How Do I Prevent It From Coming Back?

Once resolved, it is important to take steps to prevent recurrence. First, it is important to identify the cause in the first place.  If it was due to an acute injury, then physical therapy and cross training can help strengthen the area involved.  If it was due to a chronic issue, then again physical therapy and gait training are important.  Whether acute or chronic, it is important to address the biomechanical abnormalities in the foot and in gait that contributed to the injury.  The best way to do this is with custom orthotics.  After taking a mold of both feet (not just the affected or injured one!) our doctors will send the slipper cast fiberglass total contact images of both feet to the lab.  The doctors will write a prescription based on physical findings that will guide the lab to construct orthotics that are custom for each patient.  These orthotics fit into the patient’s shoes and help stabilize the foot in gait and during sports.  Orthotics are the way to change the biomechanics and prevent further injury in the future.

If you have sports related pain, or any foot and ankle condition, come in to our office and make an appointment.  We will get you out of pain quickly!