Peroneal tendinopathy is a condition that often causes pain around the outside of the ankle or foot which eases with rest and worsens with activity such as walking, running and jumping.
Treatment for Peroneal Tendinopathy in the early stages usually begins with exercises that you can do at home.
What are the peroneal tendons?
The Peroneals are muscles which both have tendons which travel down the outside of your lower leg, behind the bone on the outside of your ankle.
The main function of your peroneals is to provide stability to your ankle when walking and prevent you going over on it causing an ankle sprain.
If these muscles are weak or overused this can lead to your tendons having to work much harder.
What are the symptoms of peroneal tendinopathy?
- Pain and or swelling around the outside of the ankle – above, behind or below the outside ankle bone.
- Pain on the outside border or instep of your foot.
- Feeling unstable when walking and struggling with uneven surfaces.
- Poor single leg balance on the affected side. The affected side will be worse than the unaffected and you may feel like you are always falling to the outside.
- Gradual onset of symptoms with pain worsening during activity.
What causes peroneal tendinopathy?
It is thought to be caused by overuse which can lead to small injuries of the tendon fibres which can cause pain.
Repetitive stress and micro trauma causes the normal ability to heal to slow which can result in injuries occurring within the tendon at a rate faster that the body can heal them.
Other contributing factors:
- Older age.
- Being overweight.
- Diabetes has been linked to increased risk of developing Peroneal tendinopathy.
- Inflammatory conditions i.e. rheumatoid arthritis, psoriatic arthritis etc.
- Weakness and/or tightness in the muscles within your feet or leg.
- Wearing unsupportive footwear such as sandals.
- Spending long periods of time standing, walking or running, especially with a sudden increase in these activities.
- Poor exercising or training technique and lack of recovery between activities.
- Prolonged use of oral corticosteroids and a certain family of antibiotics (fluoroquinolones).
- Previous foot and ankle surgery/trauma.
- Smoking.
What can help with peroneal tendinopathy?
Helpful tips
The great news is that most people’s symptoms improve by following the recommended advice below, but it may take several months to get better.
If you have any of the contributing factors that can be changed it is important that you make the necessary changes to these. This will help your recovery.
Footwear
Changing to comfortable running style trainers/shoes or hiking boots with a slight heel will provide the best support for the Peroneals. Try to avoid wearing hard, flat or unsupportive footwear. It is important to note that shoes that have flexible soles generally offer the foot less support and can increase the stress in the soft tissues of your foot and ankle. If your footwear has shoelaces make sure they are tied properly.
Timescales/Prognosis
Most people with peroneal tendinopathy symptoms will improve within 3 months of following the recommended advice, however, symptoms can take up to 1 year to improve in some people.
It is also normal to have periods of increased pain or flare ups during your recovery.
Pacing and spacing
Pacing and spacing methods can help you manage your pain better.
Pacing is the term used for breaking down an activity or task. This can be done by taking regular breaks. Prioritising daily activities can also help. This can prevent “over stimulating” your pain system.
When completing challenging tasks or activities, it may be useful to set a “baseline”. This is the amount you can manage on a good or bad day without increasing your symptoms. Therefore, you can plan rests and set achievable goals.
Pain activity ladder
By following the pain activity ladder you can identify activities that you would consider severely painful, moderately painful and mildly irritating and act to change your habits.
The pain scale, most often used in healthcare, measures pain from 0-10 (zero being no pain and 10 representing the worst pain you could imagine).
If you can identify the level of pain you are experiencing, you will find out if you are in the green, amber or red zone. The best way to move down to the green zone is by pacing and spacing your activity.
When you are completing your rehabilitation exercises it is often best to work within the green (and sometimes amber zones depending on what you deem is an acceptable level of pain) both during the exercises and within 48 hours of completing your exercises. If you find yourself in the red zone you are likely pushing yourself too hard and may flare up the pain.
If after following the above advice, your symptoms have not improved within 6 to 12 weeks, a referral to a physiotherapist may be beneficial. Speak to your GP about a referral.