What is Peroneal (Ankle) Tendonitis
Peroneal Tendonitis is the Most Common Ankle Tendonitis, with a Pain Pattern Along the External Side of the Ankle.
There are a number of tendons (fibrous tissue that connects muscle to bone) in the foot which helps control movement while you're walking or running. The peroneus longus and the peroneus brevis tendons are very important and wrap around the outside of your ankle. From this position they balance the ankle and the back of the foot and prevent your foot from turning inwards repetitively, causing lateral (inversion) ankle sprains.
Normally, these tendons pass behind the bone (fibula) on the outside of the ankle. For some people, injury can cause the natural holding structure to fail and allow these tendons to slip over the bone. This injury is usually called a peroneal tendon dislocation. When they slip into this position the peroneal tendons become slightly weaker than the muscles and tendons on the inside of the ankle and are more prone to injury as your ankle turns, rolls or becomes sprained.
Peroneal tendonitis is common for people starting a new exercise routine, increasing their activities or repetitive use of the ankle (like for marathon runners). Overuse or injury (direct trauma, a fall , an accident or rolling over on your ankle) causes weakness and loss of range of motion in the ankle. When this happens the tendons become irritated and inflamed. Injury to your peroneal tendons is kind of like taffy that has been overstretched until it becomes thin and eventually frays.
The tendon tries to protect itself from this constant irritation by trying to repair the damaged tissue. During the healing process your body will automatically fill in tears in your tendons with dense, brittle tissue called "scar tissue". The human body will use scar tissue as a temporary healing solution and will try to build the scar tissue as fast as possible to heal tears in your peroneal tendons. Scar tissue can form fast to strengthen the damaged tendon, but working fast doesn't mean that the job's done right. When scar tissue forms it doesn't come together as neatly as regular (healthy) tendon tissue would. Scar tissue fibers will lay down over top of your tear in a cluttered, messy and jumbled up way.
Imagine throwing a bunch of drinking straws in the air... When those straws hit the ground they will land in a random, unorganized way. It even seems silly to think that those straws could land perfectly straight and all in the same direction.
This is how scar tissue works. The scar tissue that forms in your peroneal tendon will be unorganized and won't line up properly with the healthy tissue surrounding the tear. This scar tissue will also attach to everything in and around your ankle including the surrounding healthy tissue as well. This can result in a long-term fusing together of your tendon that stiffens your entire ankle, reducing your mobility.
What are the Symptoms of Peroneal Tendonitis
Peroneal tendon injuries may happen suddenly through an acute incident / accident / trauma or develop over a period of time from over-use or re-injury (a chronic condition).
If you have peroneal tendonitis you may feel:
- Pain when you press on the inside of your ankle on the peroneal tendons
- Pain occurring from time to time on the outside of the ankle
- Pain that becomes worse with activity and lessens with rest
- Weakness when you try to rotate your ankle outward (eversion) or to the inside (inversion)
- Swelling, inflammation, warmth, or heat to the touch around the outside of your ankle.
- Instability of the foot and/or ankle
- An increase in the height of the arch at the bottom of your foot
It's important to recognize pain in these areas compared to pain over the fibula (your ankle bone) which might indicate a different problem like a stress reaction of the bone or fracture. Pain on the fibula occurs directly over the bone which is easily felt with your fingers. Peroneal tendon injuries are sometimes misdiagnosed and may worsen without proper treatment, prompt opinion by a foot and ankle doctor is advised.
How Do I Diagnose Peroneal Tendonitis
The diagnosis of peroneal tendonitis is usually made by examination of the ankle. A physical check by your doctor will help to determine where the tendons are inflamed, ruptured, or degenerated. The doctor will move your ankle into different positions during a physical examination. The peroneal tendons are checked by holding your foot up and out against the doctor's downward pressure. Stretching the foot up and in can also be used to test whether the tendons hurt. The doctor will also be looking for instability of your ankle joint, swelling, warmth and weakness on the outer side of your ankle.
X-rays may be ordered to make sure there is no fracture or other problem with your fibula or the other bones in your ankle. Your doctor may order a magnetic resonance imaging (MRI) scan of your ankle. These images can show if there is abnormal swelling or scar tissue in the tendons. MRI scans can also show lengthwise tears in the tendons.
What Causes Peroneal Tendonitis
Peroneal tendonitis is the degeneration of the tendon tissue in the ankle. What causes our tendon to start to fall apart?
- Poor footwear encouraging your foot to roll outward stretching the tendons.
- Improper training to an exercise program you have just started
- Repetitive ankle motions in sports, such as running and jumping
- A blow to the outside of the ankle or an ankle sprain
- A high arch puts extra tension on the peroneal tendons
- Incorrect alignment of heel and foot bones causing (hindfoot varus posture)
- A build up of scar tissue on the tendon, the weakened area of the tendon may tear or lead to rupture
Peroneal Tendon Dislocation (subluxation) / Tearing or dislocation can happen in 1 or both of these tendons. This leads to pain, swelling, sensitivity and a sense of instability behind the outside of the ankle. They can also pop out of the supporting ligaments that hold them in place (a dislocation). After this happens you might repeatedly dislocate the tendons in your ankle and this tissue will tear even more without proper treatment. If you suffer from torn (ruptured) or dislocated peroneal tendons you might need stitches or even a tendon replacement to fix the problem.
Nonsurgical Treatment for Peroneal Tendonitis
If you have a lot of pain you may need to have a walking boot or cast for 2 to 4 weeks. If there is no pain or tenderness with walking a stirrup ankle brace, arch support, or lateral heel wedge can help to take tension off of your injured tendons.
In most cases, your Doctor will start with nonsurgical treatments options. Some of the options your doctor may recommend include drugs or medications like NSAIDs (non-steroidal anti-inflammatory drugs) to manage pain and inflammation. Alternative medications like cortisone injections are NOT advised for any type of tendon condition. This is because there is increased risk of rupture of the tendon following a cortisone injection.
"Medical evidence shows that cortisone shots can damage the surrounding tissue, fray the tendon, and even trigger a rupture. Most side effects are temporary, but skin weakening (atrophy) and lightening of the skin (depigmentation) can be permanent." (reference: American Academy of Orthopaedic Surgeons)
Treating Peroneal Tendonitis - What You Can Do!
The good news is that most peroneal tendinitis injuries will heal with conservative treatments and surgery is often not needed! But what's better for peroneal tendonitis - heat or cold?
Cold Compression Therapy - Ankle Freezie Wrap®
RICE (Rest, Ice, Compression, Elevation) has been recommended for years by doctors, trainers, and other medical professionals to treat the pain and swelling, chronic pain from injury and after any re-injury. Overuse injuries need rest and time for the tissue to heal.
Although RICE can help to treat these symptoms, ice and freezer gel packs reach temperatures so low they can cause cryoburn, an ice burn on your skin. The problem is, up until now there hasn't been any other option to treat painful conditions and injuries, so ice and blue gel packs (full of anti-freeze and chemicals) have been the only choice up until now.
Fortunately you no longer have to settle for these ice cold methods that are uncomfortably cold against your skin, provide short term relief, cause ice burns, numb your skin and underlying tissue beyond feeling so you don't even notice the ice burn until it's too late and pool around your injury putting the cold everywhere except for where you need it most.
The Ankle Freezie Wrap® allows you to treat your ankle in an effective and convenient way. Our Freezie Wrap® will wrap around your ankle keeping the cold right over your peroneal tendons for the entire length of your treatment. Our food-grade, non-toxic gel packs can be chilled in the fridge or freezer to tailor the amount of cold that you need for your injury. It doesn't matter how you cool it down, because our gel packs are chock full of gel that's designed to cool down into millions of tiny snowflakes. This method of cooling means our gel packs aren't icy-cold and stay flexible even right out of the freezer! The cushioned gel will wrap around your ankle and it won't budge for the entire treatment period. You'll no longer have to deal with annoying pooling around your ankle or have to hold a hard block of ice on your injury!
Cold Compression Therapy with an Ankle Freezie Wrap® works by stopping and slowing nerve and cell function in the area and reducing swelling that can block blood vessels.
This is important because once blood vessels are blocked or damaged, they can no longer carry oxygenated blood through the tissue and tissue cells begin to break-down. Without cold compression therapy cellular break-down and tissue damage continues as the cells don't get the oxygen they need to survive. By limiting the amount of damage done to your tendon, you also limit the amount of healing that needs to occur. This is a very important step to heal tendon injuries faster and with less pain! This is why you need to treat your peroneal tendonitis right after it's hurt, when you notice pain / swelling / inflammation, or directly after a re-injury. Applying an Ankle Freezie Wrap® right away will stop the damage immediately and unblock your blood vessels to let your body's natural blood flow in to start healing the tissue.
Blood Flow Stimulation Therapy™ - Ankle Inferno Wrap®
After the inflammation in your ankle has been reduced, providing extra blood flow and strengthening the tissue in your peroneal tendons and the surrounding area is recommended.
Using Blood Flow Stimulation Therapy™ (BFST®), will help with your recovery and heal your tendon more completely. BFST® increases the amount of blood that flows naturally to your soft tissue to nourish your tendons, improving elasticity and speeding the healing process. This increased Blood Flow Stimulation Therapy to your peroneal tendon(s) is greatly needed.
The only way to get BFST® is through use of an Ankle Inferno Wrap®. The Inferno Wrap® is the only treatment method that improves blood flow and circulation on a deep tissue level. Other methods of warming / heating tissue (hot water bottles, hot baths, etc) will only ever increase blood flow on a surface / skin level. These methods need a LOT of time to even reach your peroneal tendons on a deep tissue level. And even if you were to use them this long your skin would heat up to an uncomfortable level and may even burn you.
The best source of heat treatment is from a product where you don't even feel that much heat. When you don't feel the heat, it means the therapy is working in your deep soft tissue which is really where you need it. It's kind of like how your heart works in your body. You can't "feel" your heart pumping blood all around your body to your arms and legs. You can't even hear your own heartbeat without listening very closely. This is exactly how deep tissue BFST® works too! You're not supposed to "feel" a lot of heat because the heat isn't treating your skin, it's treating your peroneal tendon increasing the blood flow right in your tendon tissue.
The Ankle Inferno Wrap® is the only product available anywhere that offers BFST® AND a thin, flexible Energy Web® (heating element) that conforms around your ankle. This Energy Web® also provides consistent, uniform heat all around your ankle to increase blood flow in the entire joint.
Our Ankle Inferno Wrap® is made from medical-grade material - this should be as important to you as it is to us! Other products that are sold in stores are considered "consumer goods" meaning the material only needs to be as good as a sweater that you wear. Clothing articles like this don't need to meet high standards of production or materials and may include materials that irritate your skin.
Since our wraps are medical-grade products registered with the FDA, they are of a higher quality and need to meet way more standards for manufacturing (ISO 10993 - bio-compatibility testing). This makes our wraps the safest product for heating treatment. Our manufacturer has spent years perfecting the wrap design to make sure you get the treatment you deserve!
How to Treat Scar Tissue in the Peroneal Tendons
As we mentioned before, the body's natural way to repair tendon tears is to grow massive amounts of scar tissue. This is tough, dense, brittle tissue that isn't nearly as flexible as healthy tendon tissue. It's only meant as a band-aid solution to bring the edges of your tear together and prevent further damage to your tissue. Unfortunately scar tissue will grow in any direction and won't grow straight / flat like normal healthy tissue. This unorganized growth of scar tissue is ultimately what causes stiffening in your ankle, nerve entrapment, restriction of movement, less elasticity, poor circulation, and reduced flexibility of ankle tissue.
Scar tissue may plague you for weeks, months and maybe even years depending on your level of activity and the amount of conservative treatments you have done during your rehabilitation. Scar tissue is a major problem, especially when it comes to re-injury of your ankle. When dealing with scar tissue it's always important to:
- listen well to your physician and if conservative treatments are recommended, remember to stick to your (daily) treatment plan using these therapies
- frequent use of the Ankle Freezie Wrap® will help reduce the swelling very quickly. Much of the pain you feel will be from the swelling, and you will be surprised how fast the pain drops off once the swelling is down.
- the Ankle Inferno Wrap® is a safe, electromagnetic energy device that will help reduce scar tissue and increase blood flow to the area (thereby accelerating the body's own healing process).
- when applied before stretching, the Ankle Inferno Wrap® will help flush the area with fresh blood. This will help improve your range of motion and prevent re-injury.
It may seem hard to believe, but our Ankle/Achilles Freezie Wrap® and Ankle/Achilles Inferno Wrap® home therapy products will assist you in recovering from your injury by maximizing blood flow where it's needed most, reduce swelling and inflammation induced pain.
Continue the healing process with resting your ankle. Limit the activities that may aggravate / irritate your ankle tendons, leading to re-injury. We spend hours on our feet so make sure to give your body proper care and attention when performing simple daily routines, enjoying recreational activities, exercising regularly, or participating in athletics. Why risk having to limit or give up your favorite weekend activity, your exercise routine, or even your job due because of peroneal tendonitis?
Gentle stretching is important to help align scar tissue along the normal lines of stress and strength in the healing tendon is enhanced. Scar tissue is fibrous and brittle, without the correct alignment you're left with a weak ankle. You'll have pain and tightness in your ankle for even the smallest daily activities, an this will greatly increase your chance of re-injury.
Prevention and Promotion of Lifelong Health
If you want to avoid re-injury, manage pain and increase circulation for lifelong health benefits, an Ankle/Achilles Freezie Wrap® and Ankle/Achilles Inferno Wrap® will provide exceptional results. Why spend time in pain, off from work and missing out on your active lifestyle when you can be proactive about your injury and the health of your body? Talk to your doctor about incorporating a regular routine of using a Freezie Wrap® and Inferno Wrap® with your conservative treatment protocol.
Learn More About SUPERIOR Peroneal Tendonitis Treatments
Learn more about how the Ankle/AchillesFreezie Wrap® is designed to be the most effective cold compression wrap on the market today.
Learn more about how the Ankle/Achilles Inferno Wrap® helps with the healing process.