The outer edge of the leg consists of muscles called the peroneals. They attach the fibula bone (outside leg bone) to the outer edge and bottom of the foot. These muscles help move the foot up and out, also known as eversion. The tendon portions of these muscles insert to the outside of the foot at the fifth metatarsal base and at the bottom of the foot into several bones. The peroneal tendons can get fatigued due to excessive use from repetitions of prolonged high forces, which ultimately results in pain. The overuse of the tendons results in degeneration and inflammation of one or both of these tendons. Sometimes excessive running, walking, jumping, and doing sports, including a lot of side to side movements and moving on uneven surfaces or slopes can cause this condition. The overuse of these tendons, if unattended, can often lead to tears of one or both of these tendons. A split or longitudinal tear is the most common type of tear found with peroneal tendonitis. Split tears of these tendons can cause swelling, persistent pain and difficulty walking.
A diagnosis for Peroneal Tendonitis can easily be made by just physical examination. Pain or discomfort is usually experienced to the outer edge of the lower leg, ankle or foot along the course of the peroneal tendons. Ultrasound or MRI can also be used to diagnose the severity of the condition and also identify tears, ruptures or dislocations. Ultrasound is a quick and effective way to diagnose the condition by visualizing local areas of inflammation and identify tears in the tendons. This can be done in the office and on the same day as the appointment. A MRI can be ordered to further investigate the disorder which can help identify tears, ruptures, dislocation, subluxation and chronic tendonitis of these tendons. This can be especially useful in terms of surgical planning.
Peroneal Tendonitis Treatment:
Initial treatment for peroneal tendonitis usually involved rest, ice, use of nonsteroidal anti-inflammatories and immobilization. Physical therapy and stretching can also help decrease inflammation and strengthen the peroneal tendons. There are also several in office treatments that may provide acute and chronic pain relief for peroneal tendonitis. Cortisone injections may provide immediate relief and decrease inflammation. Extracorporeal Pulse Activation Technology, EPAT and Extracorporeal Shock Wave Therapy, ESWT can also be used to treat acute pain, chronic pain and heal the injuries. These technologies use pressure waves to increase metabolism and blood flow to the area of the condition, enhancing the healing of the injury. Depending on severity of the condition, surgery may also be warranted to repair the tendons.
Peroneal Tendonitis Prevention:
Like any other conditions which involve overuse injuries, peroneal tendonitis can be prevented by stretching and wearing proper footwear. This may include custom made orthotics, bracing and shoe modifications to help alleviate excessive forces or strain on the peroneal tendons.
Dr. Alvin Bannerjee practices in Washington DC (19th street) and is on staff at Medstar Georgetown and George Washington University hospitals. He attended Temple University School of Podiatric Medicine and did his residency at Medstar Washington Hospital Center and Georgetown University Hospital. He enjoys treating foot and ankle traumas and practicing sports medicine. In his spare time he enjoys running, biking and traveling.
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