What Is Tendonitis?
Your body is made up of many parts. Tendons are just one group of essential elements that allow your bones to move. Tendons are strong tissues that hold muscles to bones. They are usually thin and corded, flexible but not elastic and they are all over your body. Often tendons may be confused with ligaments which are similar in makeup and nature; however, they serve very different functions. Ligaments hold bones, joints or pieces of cartilage together, and have nothing to do with muscles. Ligaments, too, are more flexible and elastic than tendons.
Tendonitis is the inflammation of a tendon caused by infection or rheumatic disease. The most common cause of the swelling is overuse. It causes the tendon to wear out, bruise and the affliction may cause it to be partially or entirely crippled for a time. Tendonitis causes extreme pain, the onset of which may be sudden, or it may become increasingly worse. Some people describe the pain as starting off as an uncomfortable ache, but over time and continued use, the pain increases in intensity until that particular body part is rendered almost entirely useless.
Where Does Peroneal Tendonitis Occur?
The peroneal tendons are found in the feet. Two peroneal tendons run down from the back of the leg and behind the ankle’s outer bone. The outer ankle bone is the knobby bone that juts out on either side of your ankle. The tendons continue to run behind it. One runs along the outside of your foot and connects to the midfoot around the base of your pinky or little toe. The other tendon is under the foot where it connects to the mid arch.
The primary function of the tendons, peroneal included, is to stabilize your ankle and thus your foot. It stops the ankle from rolling and the foot from flopping around. It is also responsible for allowing the foot to turn outwards and is essential in providing backup arch support.
When either of the tendons become inflamed, it can rub against the bone of the foot causing shooting pain both under and alongside the foot up to the ankle, and sometimes up the entire back of the calf.
What Causes It?
People who engage in repetitive motion of the ankle and foot are most likely to develop peroneal tendonitis. Runners are at an increased risk for the injury, as are soccer players, basketball players and hockey players. However, peroneal tendonitis can occur through normal wear and tear over the years. You don't have to be an athlete for this painful condition to afflict you. Other factors can contribute to the onset of peroneal tendonitis including:
One of the primary contributing factors in peroneal tendonitis onset is not wearing the proper shoes. It isn't possible to wear athletic shoes all the time unless your job allows it. However, having insufficient and inadequate support in your footwear will, over time, cause problems for your entire foot and ankle. This is especially important when engaging in repetitive-motion physical activity, including walking, running and the like. Having a shoe that can provide support for your ankle and foot will make these activities more enjoyable and less likely to cause injury.
Increased Use and Overuse
If you are doing a couch to 5K program, or even just trying to get a few more steps in a day, sudden, repetitive use and overuse of the feet can result in peroneal tendinitis. Whether you are trying a new exercise regime or just want to become more active, starting slowly and working your way up will have a profound effect on your feet.
When trying anything new, it is important that you know how to perform the activity correctly. If you are engaging in yoga, weightlifting or even running, mastering the mechanics behind the moves can help keep your peroneal tendon from sustaining injury.
Everyone knows carrying around extra weight is bad for you. Think about how much extra pressure that weight is putting on your feet, even for everyday activities such as walking. Every extra pound adds an increase in pressure to the peroneal tendons, so lowering that extra pressure can help ease the chances of injury.
Along with these situational causes, some physiological elements make peroneal tendonitis more likely to occur.
- Higher arches
- Imbalance of muscles in the lower body
- Joint disease or inflammation
- Lack of coordination between lower body elements
What Are the Signs and Symptoms?
Whether your peroneal tendonitis is something that came on quickly (acute) or developed slowly over a period of time (chronic), there are specific signs and symptoms you may experience:
- Pain when turning the foot
- Pain and swelling at the back side of the ankle
- Pain and swelling along the outer edge (outstep) of the foot
- Sudden instability of the ankle resulting in more instances of rolling
- The area is hot to the touch
Typically, the pain is worse when weight bearing and disappears when resting.
If you have these symptoms, you should see your doctor for further diagnosis. Your doctor will be able to tell you if what you're feeling is indeed due to an inflammation of the tendons in question or if it is something else like your calf bone (fibula) that is causing the discomfort. A fibular injury can almost always result in the same signs and symptoms as a tendon injury like this. Therefore, getting the proper diagnosis will result in faster treatment and recovery time. The doctor will most likely perform at least an X-ray to see if there is a visible problem. An MRI may be ordered, as that gives a much more detailed picture of the muscles and tendons of the foot than an X-ray does.
It is also quite common for a person with an injury to the peroneal tendon to also have a sprained ankle. A sprained ankle can be caused by ankle instability and rolling that may occur when the tendons are no longer able to adequately support the ankle.
What Treatment Options Are Available?
The most common and effective treatment for a peroneal injury is rest. This recommendation doesn’t mean you have to lay around all day for weeks, although depending on the severity your time on the go may be strictly limited. Typically, resting the afflicted foot means you can't engage in the same level and frequency of weight-bearing activities for a reasonable length of time. Sometimes a brace or boot is prescribed to offer support of the ankle and, in the case of a boot, complete immobilization. These assistive devices help keep even the mildest of weight-bearing activities from inflicting further damage to the area.
Depending on the severity of the tendonitis, you may also have to undergo a round of physical therapy after a certain period has passed. Over the counter medications such as non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to help control swelling and pain. If the pain is not alleviated this way, then a short-term prescription may be deemed necessary.
There are circumstances in which the doctor may recommend at least one if not a series of cortisone injections. Cortisone is a potent anti-inflammatory medication that proves useful in the reduction of swelling and pain associated with tendinitis. It is injected directly into the tendon, and while this can be effective, it can also lead to serious long-term consequences such as rupture of the tendon. It is not often used in the treatment of a peroneal strain unless the injury is extreme in nature.
Surgery is rarely performed; however, in rare cases, the swelling and pain cannot be reduced any other way. Surgery consists of removal of the inflamed tissue that surrounds the peroneal tendon. This encroaching tissue puts pressure on the tendon causing pain. When the tendon is enflamed it expands and pushes back against the tissue which causes swelling combined with discomfort. During surgery when the tissue is removed, it gives more space to the area and relieves the pressure and associated pain.
What Is the Prognosis?
Tendinitis can sideline you for a while, but the good news is you can make a complete recovery with little to no lingering issues. However, for this to occur, you need to follow the treatment plan as prescribed and recommended by your doctor. As stated above, this includes rest, and while that isn't always ideal, it is the best way to achieve full recovery of the damaged foot. If you don't get the adequate rest and insist on continuing physical activities, you may wind up suffering a tendon rupture or tear, which will sideline you further. Athletes, as well as ordinary folks, can have a successful and full recovery if they follow the doctor's orders.
Peroneal tendinitis is not something you want to let go too long without medical intervention. While there is an excellent chance of a full recovery, if you let the issue go untreated, it can get worse. In the meantime, avoiding repetitive activity, wearing the proper footwear and engaging in activities that are appropriate for your physical health condition can help reduce the chances of developing this painful ailment.