A tendon is band of connective tissue that attaches a muscle to a bone. There are two peroneal tendons in the foot that run alongside each other behind the outer ankle bone. The first peroneal tendon attaches to the outer part of the midfoot, and the second tendon extends beneath the foot and attaches near the inside of the arch. Peroneal tendons mainly function in stabilizing the foot and ankle, and protecting them from sprains.
Injuries of the peroneal tendon occur in two forms – acute and chronic. Acute injuries occur suddenly, while chronic injuries develop of over a period of time. People actively involved in sports that require repetitive ankle motion are at an increased risk of this injury. Injuries are also more likely in individuals with higher arches. Common forms of peroneal tendon injuries are tendonitis, tears and subluxation.
Tendonitis involves inflammation of one or both tendons. Activities that require repetitive use of the tendon, overuse of the tendon or trauma – as in an ankle sprain – are the most common causes of inflammation.
Tendonitis includes the following symptoms:
Repeated activity or trauma often results in acute tears. Patients may experience immediate symptoms such as:
As the injury progresses, these tears may alter the shape of the foot and result in higher arches.
Tendonosis (degenerative tears) normally result from overuse and develop over extended periods of time, often years. For degenerative tears, the tendon can be compared to taffy that has been overstretched until it becomes thin and eventually frays. Individuals with high arches are at an increased risk of developing degenerative tears. Symptoms may include:
Intermittent sporadic pain on the outside of the ankle.
Ankle weakness or instability.
An increase in the height of the arch.
Subluxation occurs when one or both tendons are dislocated from their normal position. Genetics may cause subluxation in which an individual is born with a bone or muscle deformity. Other cases of subluxation result from trauma, as in an ankle sprain. Chronic tendon subluxation may develop when patients damage or injure the tissues that stabilize the tendons. Symptoms may include:
A snapping sensation in the tendon that surrounds the ankle bone.
Sporadic intermittent pain behind the outside ankle bone.
Instability or weakness of the ankle.
Patients are strongly advised to seek immediate treatment because a tendon that continues to sublux, or move out of position is more likely to tear or rupture. Make an appointment with Dr. Radovic if you experience the characteristic snapping sensation.
Patients are advised to immediately seek treatment from Dr. Radovic, as peroneal tendon injuries may be misdiagnosed or worsen without proper evaluation. When diagnosing a peroneal tendon injury, Dr. Radovic will evaluate the foot and ankle and watch for pain, swelling, warmth, instability and weakness on the outer side of the ankle. In addition, Dr. Radovic will examine the signs of an ankle sprain and other related injuries that may have occurred in addition to the peroneal tendon injury. X-rays and other diagnostic imaging exams may be ordered to determine the extent of injury. Most importantly, patients should be properly evaluated because prolonged discomfort following a minor sprain may result in further complications.
Non-surgical treatments vary depending on the type of peroneal tendon injury, and include:
Wearing a cast or splint to immobilize the foot and ankle and allow the injury to heal.
Anti-inflammatory medications by oral route or injection may reduce pain and inflammation.
Physical therapy treatment includes ice, heat or ultrasound therapy to help relieve pain and swelling. Rehabilitation exercises may be added over time to retrain the muscles, and improve range of motion and balance.
Dr. Radovic may recommend the temporary use of an ankle brace when undergoing activities that require repetitive ankle motion. Bracing might also be used as a treatment when the extent of injury does not qualify for surgery.
In some instances, patients may require surgical repair of the tendon or tendons and the structures that support the foot. Dr. Radovic will choose the most suitable procedure based on the individual’s condition and lifestyle. Physical therapy is an important aspect of post-operative rehabilitation.