Introduction
Peroneal tendon issues, especially around the outer ankle, are common among athletes and active individuals. These tendons, located behind the outer ankle bone (lateral malleolus), are vital for stabilizing the foot during movement. If you’re experiencing persistent ankle pain, understanding what’s happening and how to treat it can help you get back to your daily activities.
This guide will cover:
- How peroneal tendon problems develop
- How doctors diagnose the condition
- What treatment options are available
Case Example: Sarah’s Story
Sarah, a 32-year-old marathon runner, started noticing pain on the outer side of her ankle after a long training session. She initially ignored the discomfort, thinking it was just soreness from a minor ankle sprain. However, the pain worsened with every run, and she eventually noticed swelling around her ankle. After visiting her doctor, she was diagnosed with peroneal tendonitis—a condition that affects the tendons behind the lateral malleolus. With a combination of rest, physical therapy, and a structured rehabilitation program, Sarah was able to return to her training regimen pain-free.
Anatomy: What’s Involved?
The peroneal tendons are two strong cords that run along the outside of your lower leg, just behind the fibula (the smaller of the two bones in your lower leg). These tendons, called the peroneus longus and peroneus brevis, work like pulleys when you move your foot. They help you point your foot downward and outward, providing stability when walking, running, or jumping.
The tendons sit in a groove behind the lateral malleolus, held in place by a sheath and reinforced by a band of tissue called the retinaculum. The peroneus longus tendon runs further under the foot and supports the arch, while the peroneus brevis attaches to a bone on the outer side of the foot (the fifth metatarsal).
Causes: Why Does It Happen?
Peroneal tendon problems often develop due to overuse, ankle injuries, or underlying foot structure issues. Here are some common causes:
- Repetitive motion: Activities that involve frequent ankle movement, like running or jumping, can irritate the tendons.
- High arches: People with high arches place more strain on their peroneal tendons, which can lead to overuse injuries.
- Ankle sprains: A common cause of peroneal tendon problems is an ankle sprain. When the foot rolls inward (inversion sprain), the tendons can stretch or even tear.
- Degeneration: Over time, the tendons can wear down (tendonosis) and lose their normal structure, becoming more prone to tearing or splitting.
Symptoms: What Does It Feel Like?
Patients often describe pain on the outer side of the ankle, particularly behind the lateral malleolus. You may also notice swelling or a popping sensation if the tendon slips out of place (subluxation). The pain typically worsens with activity and improves with rest.
Diagnosis: How Is It Diagnosed?
Doctors usually start with a physical exam, asking you to move your foot in various directions while they check for tenderness, swelling, or instability. X-rays may be ordered to rule out fractures. In more complex cases, an MRI can provide detailed images of the tendons to detect tears or degenerative changes.
Treatment: What Can Be Done?
Nonsurgical Treatment
For most patients, conservative treatments can help manage symptoms and promote healing:
- Rest and immobilization: You may need to wear a walking boot or brace for a few weeks to protect the tendons.
- Physical therapy: A therapist will guide you through exercises to reduce pain, improve ankle strength, and regain motion.
- Medications: Over-the-counter anti-inflammatory medications like ibuprofen can help reduce pain and swelling. In rare cases, cortisone injections may be used, but this comes with a risk of weakening the tendon.
Surgical Treatment
If symptoms persist despite conservative care, surgery might be necessary. Some common procedures include:
- Tendon release: This involves removing inflamed tissue around the tendon to reduce pain.
- Debridement: If the tendon is degenerative (tendonosis), damaged tissue is removed to allow for better healing.
- Tendon repair: In cases of a split or tear, the tendon is sutured back together.
Rehabilitation: Getting Back to Normal
Whether you’re recovering from surgery or managing your condition with physical therapy, rehabilitation plays a key role in your recovery:
- Nonsurgical rehab: A physical therapist will design a program to help restore your ankle’s strength and stability, focusing on coordination and balance exercises.
- After surgery: You may need to wear a cast or boot for a few weeks. Physical therapy will follow to improve range of motion and gradually build strength.
Conclusion
Peroneal tendon problems can be painful and frustrating, especially for active individuals. But with proper treatment and rehabilitation, most people can fully recover. If you’re experiencing persistent ankle pain, don’t hesitate to seek medical advice and start your journey to recovery.