Peroneal Tendon Injury

What is a peroneal tendon injury?

Tendons are strong bands of connective tissue that attach muscle to bone. A strain is a stretch or tear of a muscle or tendon. Tendonitis is when a tendon is inflamed. When there are micro-tears in a tendon from repeated injury it is called tendinosis. Tendinopathy is the term for both inflammation and micro-tears. The peroneal muscles are on the outer side of the lower leg and their tendons attach to the foot. These muscles and tendons help move your foot to the outside.

How does it occur?

The peroneal tendons may be strained or torn when the foot and ankle are rolled inward (inversion). They also may be injured when your foot is forced upward toward your shin. Peroneal tendinopathy results from overuse. Peroneal tendon strain and tendinopathy can result from running on sloped surfaces or running in shoes with excessive wear on the outside of the heel.

What are the symptoms?

Symptoms include pain on the outer side of your lower leg and ankle. You may hear a pop or a snap when the injury occurs. You may have swelling around your ankle.

How is it diagnosed?

Your healthcare provider will examine your ankle and lower leg. He or she will move your ankle and leg to test these tendons. X-rays may be taken to see if there is a break in your ankle or in one of the bones in your feet.

How is it treated?

To treat this condition:

• Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth on the area every 3 to 4 hours, for up to 20 minutes at a time.
• You could also do ice massage. To do this, first freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over the area for 5 to 10 minutes. Do this several times a day while you have pain.
• Raise your ankle on a pillow when you sit or lie down.
• Use an elastic bandage, stirrup splint (called an Aircast or Gelcast), or a lace-up ankle brace as directed by your healthcare provider.
• Take an anti-inflammatory such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
• Follow your provider’s instructions for doing exercises to help you recover. While you are recovering from your injury, you will need to change your sport or activity to one that will not make your condition worse. For example, you may need to bicycle or swim instead of run.

How long will the effects last?

The length of recovery depends on many factors such as your age, health, and if you have had a previous peroneal tendon injury. Recovery time also depends on the severity of the injury. A mild strain and tendinopathy may recover within a few weeks. A severe injury may take 6 weeks or longer to heal. You need to stop doing the activities that cause pain until your tendon has healed. If you continue doing activities that cause pain, your symptoms will return and it will take longer to recover.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your normal activities depends on how soon your ankle recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your activities when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured leg compared to the uninjured leg.
• You have full strength of the injured leg compared to the uninjured leg.
• You can walk straight ahead without pain or limping.

How can I prevent a peroneal tendon strain and tendinopathy?

• Keep your ankles and peroneal muscles strong.
• Wear high-top athletic shoes or a supportive ankle brace.
• Warm up properly before starting your sport or activity.
• When running, choose level surfaces and avoid rocks or holes.