Lateral Foot Pain - Understanding Peroneal Tendinopathy: Causes, Symptoms, and Treatment Options

At South Dublin Podiatry, we treat a wide range of foot and ankle conditions to help our patients regain their mobility and comfort. One common issue we encounter is peroneal tendinopathy, a condition that affects the peroneal tendons in the foot and ankle. If you're experiencing pain on the outside of your ankle or foot, it’s possible you may be dealing with this condition. In this blog post, we’ll explain what peroneal tendinopathy is, its causes, symptoms, and how it can be treated.

What is Peroneal Tendinopathy?

Peroneal tendinopathy is an overuse injury that involves the peroneal tendons, which are located on the outer side of the ankle and foot. These tendons help stabilize the foot and prevent excessive inward rolling, providing balance during activities such as walking, running, and jumping. The condition occurs when these tendons become inflamed, irritated, or degenerated, leading to pain and discomfort.

The peroneal tendons are made up of two tendons:

1. Peroneus longus tendon: which runs along the outside of the lower leg and wraps under the foot, attaching to the first metatarsal and medial cuneiform bones. 

2. Peroneus brevis tendon: which attaches to the base of the fifth metatarsal bone on the outside of the foot.

Common Causes of Peroneal Tendinopathy

Peroneal tendinopathy often develops due to overuse or repetitive stress on the peroneal tendons. The condition is seen in a variety of patients and commonly seen in athletes, particularly runners, dancers, and those involved in sports that require frequent cutting or direction changes, like basketball and soccer.

Here are some common causes and risk factors:

• Overuse: Repetitive movement, particularly in high-impact sports, can strain the peroneal tendons over time.

• Improper Footwear: Wearing shoes that do not provide adequate support, especially during exercise, can contribute to tendon stress.

• Ankle Instability: A history of ankle sprains or instability can lead to improper tendon movement, increasing the risk of tendinopathy.

• Sudden Increase in Activity: A rapid increase in exercise intensity or duration without proper conditioning can lead to tendon overuse.

Symptoms of Peroneal Tendinopathy

The most common symptom of peroneal tendinopathy is pain along the outer part of the ankle and foot. You may also notice:

• Swelling and tenderness along the peroneal tendons, or at the base of the 5th metatarsal.

• Pain that worsens with physical activity such as walking or during running, jumping, or lateral movements.

• Stiffness or weakness in the ankle.

• A feeling of instability in the ankle, particularly when walking on uneven surfaces.

If left untreated, peroneal tendinopathy can become chronic, leading to long-term discomfort and difficulty in daily activities. Early diagnosis and treatment are crucial to preventing complications.

Diagnosis

At South Dublin Podiatry, the diagnosis of peroneal tendinopathy begins with a thorough physical examination. Our podiatrist will assess your foot and ankle for signs of tenderness, swelling, and instability. In some cases, imaging studies like X-rays may be ordered to rule out other conditions, such as fractures or tendon tears, and to assess the extent of the tendon damage.

Treatment Options for Peroneal Tendinopathy

The treatment for peroneal tendinopathy depends on the severity of the condition, but most cases can be managed with conservative, non-surgical methods. Here are the primary treatment options:

1. Rest and Activity Modification: Taking a break from activities that exacerbate your symptoms is essential for healing. Reducing or eliminating high-impact activities like running can help prevent further damage.

2. Ice Therapy: Applying ice to the affected area can reduce and relieve pain. Be sure to use ice in 20-minute intervals, several times a day.

3. Orthotics and Supportive Footwear: Custom orthotics can provide better arch support and improve foot mechanics, reducing the strain on the peroneal tendons. Wearing shoes with good support is also crucial.

4. Physical Therapy: Strengthening and stretching exercises can help restore function to the tendons and improve ankle stability. A physical therapist can guide you through a personalized rehabilitation program.

5. Dry Needling: This procedure uses a fine needle to target myofascial trigger points, irritable spots palpable in gait bands of muscle. 

6. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen can help manage pain and reduce inflammation in the short term.

7. Bracing or Taping: An ankle brace or taping technique can provide extra support and prevent further strain on the tendons while they recover. 

Prevention Tips

To prevent peroneal tendinopathy or reduce the risk of recurrence, consider these preventive measures:

• Gradually increase the intensity of your workouts to avoid overloading the tendons.

• Wear proper, supportive footwear for your activities.

• Strengthen your ankle and foot muscles through regular exercises, which can help improve stability.

• Warm up before physical activity and incorporate stretching exercises into your routine.

Conclusion

Peroneal tendinopathy can be a painful and frustrating condition, but with the right treatment and care, you can recover and return to your regular activities. If you're experiencing ankle or foot pain or suspect you may have peroneal tendinopathy, don’t hesitate to schedule a consultation with our podiatry team. We’ll work with you to develop a personalised treatment plan to get you back on your feet as quickly and safely as possible.

Have read of our blog on Bio Mechanical Assessments for further information...

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