Peroneal Tendonitis
Peroneal Tendonitis is an inflammation of the peroneus longus muscle tendon. This is normally from an overload or overuse of the tendon with activities such as running. Slight variation in biomechanics like high arches and inverting the foot can put this tendon under more strain. The plantar flexion action of the muscle (pointing of the toes) and where the tendon crosses beneath the lateral malleolus can create small amounts of friction.
Origon, Insertion & Action
The Arrow: Indicates where the peroneus longus tendon crosses below the lateral malleolus (arrow head).
Running with Peroneal Tendonitis
Have you started running, or recently increased the number of kilometres you are running and now have pain on the outside of your ankle? The pain can be felt just below the bone that sticks out on the side of your ankle. And is worse when you point the toes or touch on the area.
It could well be peroneal tendonitis. (Or peroneal tendonopathy)
These muscles include both the peroneus brevis and peroneus longus tendons. (peroneus longus pictured above).
To best control the pain and inflammation with this muscle,I have some tips and exercises to try below:
Peroneal Tendonitis Treatment
- Make sure you have the right footwear and good heel support. Ensure you are not over inverting the foot, requiring excessive contraction of the peroneals (everters) throughout mid-stance during the running gait.
- Trial some taping of the peroneal muscles to deload the tendons and the cross over of each tendon at the back of the ankle.
- Icing: This actually works in this instance and is very helpful when just using a piece of ice to micro-massage over the affected area for ~20minutes.
Eccentric strengthening exercise. This is probably the most important and my favourite. I will be making a video on this exercise shortly, so look out for it. The technique and quality of this movement is crucial, so make sure you do this one correctly. The peroneals are plantar flexors and everters of the foot. So start the exercise with the foot pointed outward to the side position and also with the toes and foot pointed down as much as you can. Resistance then needs to be applied by way of a resistance band. This is wrapped around the outside of the foot and then is slowly pulled inward. Allow the foot to slowly come back, letting the resistance win. This movement needs to take place ~20 seconds. Repeat only 3-4 times and of course, PAIN FREE! If it sounds complicated do not worry. The video is coming. - The Physiotherapists may also trial dry needling or ultrasound for this condition as both have been found to work very effectively.
Management of workload is obviously also very helpful and crucial in this instance when still running with the condition and is best to speak with a physio about how to manage this workload and how to gently modify it.
So I hope this introduction to peroneal tendonitis and the anatomy can help you to understand the pain on the outside of your ankle. Give the exercise and tips a go and if you would like to know any more information or would like me to help with the management please reach out.
Ben Mack
Physiotherapist
