What is Peroneal Tendinopathy?
The peroneal tendons run side by side behind the outer ankle bone. One of the tendons attaches to the outer part of the midfoot and the other tendon runs under the foot and attaches to the inside of the arch. These two tendons work together to stabilise the foot and ankle and to prevent ankle sprains.
The types of feet that tend to develop this condition are higher arched feet and/or feet which have a tendency to ‘roll out’ which we sometimes refer to as lateral ankle instability or supination instability.
Supination instability (rolling out) may be a result of foot structure, shoes that have excessively worn, over-supportive running shoes or could even be a result of wearing shoe inserts that ‘over correct’ the foot. The greater the instability the more likely this will cause the peroneal tendons to become ‘overused’
- May occur acutely (short period of time) or chronic (develop over a long period of time)
- Pain, swelling and stiffness along the outside of the ankle and foot sometimes radiating back up into the outside of the lower leg
- Morning stiffness
- Pain after rest during movement
Like most tendon injuries, initial treatment involves resting the tendon followed by exercises to improve function and load tolerance.
This particular type of tendon injury repsonds well to orthotic therapy. Providing they are designed correctly, they can help with pain management, optimise recovery and return to sport.
The treatment plan may also include:
- Activity modifications to desensitise and deload tendons
- Footwear modifications to lessen ankle joint instability and reduce load on tendons
- In-shoe modifications such as padding or wedging to support the outside of the foot
- Exercise prescription to increase capacity and load tolerance
- Shockwave therapy
- Laser Therapy
Shockwave therapy can be helpful in terms of managing pain but can feel quite unpleasant during treatment.
Laser therapy is also very effective adjunct treatment option and is painless. It specifically helps with pain management and has anti-inflammatory and tissue healing benefits.