Peroneal Tendonitis
Peroneal Tendonitis
Peroneal Tendonitis
Plantar View
Side View of Ankle
3/4 View of Ankle
A Peroneal Tendon Injury typically happens as a result of a tear in the ligament bands that hold the tendons in place. When you exercise with this injury it typically leads to tendonitis since the tendons are no longer secured and can rub against the bone. First you damage the ligament but don't notice it, and after a while, peroneal tendonitis or a tendon tear sets in.
Exercise to strengthen the ankle only after you are well into the healing process.
If you exercise and it makes the pain worse, stop immediately to avoid additional injury to your Peroneal Tendons.
Peroneal Tendon Injuries usually happen when a person rolls or "twists" their ankle.
You will hear it called an overuse injury, but these tendons, and the ankle itself are designed for huge amounts of use.
So to say it is an overuse injury is a bit misleading.
Often a person rolls their ankle and tears one of the retinaculum, which are ligament bands that hold the tendon in place.
This allows the tendon to move and rub against the bone and other tissues in the ankle.
Tendonitis is the result of this rubbing.
Healing this injury needs a lot of rest or a surgical fix to the band so the tendons can once again become secure.
If you have pain below and or behind the ankle bone there is a good chance you have some damage to the bands.
However, if you have pain above the ankle, which is less common, you may have an injury to the tendon and not the bands.
If this is the case you can likely heal this without surgery with rest, and protecting it from reinjury.
The internet is full of misinformation about the Peroneal Tendons.
Some sites are just trying to sell things and don't really care if it will help your specific situation.
Other's offer good advice that does not fit for all stages of the healing process.
Exercise is important but timing is critical.
The biggest thing to know about exercise and Peroneal Tendons is to not start too soon.
The ligament bands and tendons need rest to heal at first.
If fact, if you have a bad injury, you might need a cast, and crutches might even be a good idea, for the first few weeks.
After you stop immobilization, your ankle tendons are getting plenty of "exercise" from normal movement during the early stages.
Adding more exercise too early in the healing process can just aggravate the condition.
There are two Peroneal Tendons. The Brevis and the Longus. They attach to the muscles in the lower leg and travel down the side of the leg, behind the ankle, and attach to the foot. Their job is to stabilize the foot and the ankle while moving about. They can tilt the foot and turn the foot.
The tendons also travel through a tendon sheath.
Which is like a pipe the tendons travel through to keep them from rubbing against other tissues.
That pipe is held in place by two bands of strong ligamental tissue called a retinaculum.
One of the most common injuries happens when a person rolls their ankle and causes a partial or complete tear to one of the bands.
This means the tendon will move out of their normal location enough to rub against bone or other tissues.
This rubbing will cause tendonitis.
If the injury is not healed you can end up with chronic problems in the ankle.
The whole system will become inflamed and start a cycle of continual small injuries.
The longer this goes on the more likely a more significant injury, such as a tendon rupture, is to occur.
You must carefully consider the timing of introducing exercise.
You don't want to make matters worse or interrupt the healing process.
If you hurt your ankle, you can be sure someone will tell you to exercise it. It could be a site online, a friend or a doctor. But it is up to you to understand your condition and advocate for yourself. People will tell you that your muscles around the tendons are weak and to get exercise to strengthen them. Or they will tell you the area needs blood flow to heal and to exercise to get that blood flow.
Blood flow does speed up healing of injured tendons.
Bringing more blood flow to the area allows the tendons to get more nutrients from surrounding tissues.
While you are healing though it's best to just rest the area.
You have to be careful how you get the blood flow.
A method that irritates the tendons like exercise or massage is not appropriate during the early part of the healing process.
No need to add additional exercise movement that will bring more irritation and swelling.
Focus on rest and cold compression to reduce the inflammation for now. Then once you are well into the healing process you can use exercise for increased blood flow. If you want to stimulate blood flow earlier on in the process you can use BFST. This allows you to stimulate blood flow without movement so you can do it much earlier in the healing process.
Most people heal without this extra step though. It just much takes longer. Athletes and people who want to heal as fast as possible will use BFST.
All those sites promoting exercises for Peroneal Tendon injuries or tendonitis never mention this key point.
If you exercise too soon you are just making the problem worse.
During the first few weeks after an injury, you might need to immobilize the area with a brace or your doctor may suggest an air cast or boot.
You might even need crutches for a few weeks.
After you stop using the rigid protection, it's a good idea to use tape to keep from reinjuring the ankle.
When you have to move around for work, keep the area taped up all day so it is protected from further injury.
The tape will limit the movement of the skin over the top of the injured tissue.
This limits the movement of the injured tissue below the skin as well.
Tape is like armor for your injured tendon.
The reason you see professional athletes taped up all the time is because it works.
Cold compression and tape are two very effective ways to reduce the inflammation and irritation in the tendon.
You need to wear the tape all day so use medical tape like King Brand Support Tape not athletic tape.
Athletic tape is not designed to be used all day and the glues often have toxic chemicals in them.
For more information on Proactive Treatments, you can click this link.
When it get's down to it, it's an injury that could happen to anybody.
Rolling the ankle is a very common thing.
It does not really matter now.
Now you have an injury and it is time to rest that injury.
It's not the time to strengthen the ankle.
At least not before the pain goes away on its own.
Even if you feel you do have weak lower leg muscles, the healing process would be the same.
Even if there is a muscle imbalance, that does not change the healing steps that you need to take.
You still need to rest the ankle and reduce the inflammation and protect the area from more injury.
Only after you have healed the injured tendon would it make sense to start looking at ways to strengthen the area.
Bottom line, to heal this condition you want to rest and reduce the swelling, protect the area from further injury, and if you want to speed up the healing use blood flow stimulation therapy like BFST.
These boards purposefully put your ankle in an unstable situation to engage the muscles and tendons in the lower leg.
If you have a torn or detached Peroneal Tendon this is a sure-fire way to make that injury worse.
Yes, stability boards do provide some training to the muscles and tendons in the leg but they are more for training your nervous system.
They train your ability to quickly adjust your whole body to unstable situations.
If you want to try a stability board, go for it, but save it for after you have fully healed your Peroneal Tendon.
For more information on Proactive Treatments, you can click this link.
The compression wrap has to be the worst advice for this condition.
Not only are some stores online promoting these wraps which will squeeze the already inflamed tendon but some are suggesting you exercise with them on.
This is a very bad idea.
It will add to the irritation of the injured Peroneal Tendons.
For the first few weeks you may need to immobilize the ankle with a boot or air cast, or just give it a break by using crutches.
This will let the tendons start to heal.
You definitely do not want to clamp down on the tendons with a tight wrap or compression sock.
This will increase the irritation every time you move.
Instead, after you are not using the cast, boot or crutches, use tape to protect the injured Peroneal Tendons.
Tape will do what wraps could never do.
It will help prevent further injury.
And it does not constrict the area or put too much pressure on the tendon.
Tape right where it hurts.
Make an "X" or a "+" right over the point of the most pain on the tendon.
Use one strip of tape running up and down on the tendon right over the painful spot.
Then use another strip running across the painful point in the opposite direction.
Stay taped up the whole time you have to move around.
Many tapes are not designed to use all day. They often have toxic chemicals in the glue that would be on your skin all day.
Use a high quality medical tape like KB Support Tape.
For more in-depth information about how an injury heals click here for our Healing Page.
This is a common idea with lots of injuries. You have an injury? Stretch it, they will say. The idea is often that it will loosen the muscles attached to the injured tendon and that will help somehow. This does not make sense though. Yes, stretching may make your muscles less tight. But this does not heal the inflammation or soothe the irritation in the Peroneal Tendon.
Stretching isn't bad.
In many cases it increases your muscles' range of motion and that's not a bad thing.
It just won't help your Peroneal Tendons.
This isn't a range of motion kind of problem.
Really, the area just needs enough time to heal and for the inflammation to subside.
If you enjoy stretching go ahead.
If your pain increases with any activity, including stretching, stop and come back to the activity after you have healed a bit more.
For more information on Proactive Treatments, you can click this link.
For a little while - not forever - it is really helpful to give your ankle a rest. In many cases, resting your ankle for a few weeks will give it time to heal to a point that your body gets ahead of the healing / reinjury cycle. It's important to realize that once the pain and any swelling go away, your underlying injury will not be healed completely, so take it easy. Go back to regular life gradually, once the pain and swelling are gone.
For more in-depth information about how an injury heals click here for our Healing Page.
