Peroneal Tendinopathy

Peroneal tendinopathy is the most common cause of pain on the outside of the ankle resulting from overuse. There are two peroneal tendons that cross the lateral ankle joint to insert to the outside of the foot and under the foot at the base of the first toe. Damage of the tendons may the result of acute injury (ankle sprain) or by overuse.

Pain on the outside of the ankle that is aggravated by activity and relieved with rest. Local tenderness directly over the tendons is common with clinical assessment. Resisting the outward movement of the ankle can often reproduce a patient’s symptoms.

Tendon injury may be the result of overuse i.e. over training, or acute injury. Tendinopathy is a broad term that covers painful conditions that cause damage in and around tendons. Latest research suggests this occurs without the presence of inflammation; however inflammation of surrounding structures may occur.

Common causes of overuse in the peroneals may include:

• excessive foot eversion (outward roll)
• excessive foot pronation (inward roll causing the tendons to press together)
• running on a cambered surface
• soft footwear
• tight calves
• sports involving high activation of the peroneals i.e. jumping and side to side movements (e.g. basketball, netball and volley ball)

Initial treatment should involve rest from aggravating activities, soft tissue therapies and massage. Pain medication and bracing of the ankle may also be required in the short term.

Your podiatrist will assess your current running shoes to ensure appropriate support. Lateral wedges can be prescribed to reduce tension through the tendons. Progression to foot orthotics may be needed for long-term support and lateral stability. Ankle exercises will also be prescribed to strengthen the tendons.

For chronic pain tendon pain for longer than three months Shockwave Therapy may be recommended to promote healing of the tendon. Shockwave therapy is new to our Port Melbourne location Bodycare Podiatry.