Peroneal Tendonitis and Tenosynovitis
The two major tendons that run along the outside of your ankle are called the peroneal or peroneus tendons. They are known individually as the peroneus longus tendon and the peroneus brevis tendon. The peroneal tendons are important tendons because they prevent the foot from rolling and causing a lateral (inversion) ankle sprain. The superior peroneal retinaculum and inferior peroneal retinaculum ligaments run over top of the 2 peroneus tendons holding them close to the calcaneus (heel bone).
Peroneal Tendonitis, Tears, and Tenosynovitis
Tearing may occur in one 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 which is called a dislocation. Once this occurs, continuous or recurrent dislocation and tearing may occur without immediate attention and repair. Stitching and at the worst, tendon replacement may be required for patients suffering from torn or dislocated peroneal tendon(s).
Peroneal tendonitis (also spelled tendinitis) is the inflammation and irritation of one or both of the peroneal tendons. Like all forms of tendonitis, peroneal tendonitis is a condition that may flare up and subside over a period of time.
Peroneal tendinitis is usually caused by repetitive use of the tendons, but can also be caused by trauma such as a rolled or sprained ankle. Little tears in the peroneus longus tendon and the peroneus brevis tendon irritate the tendon fibers resulting in pain and inflammation.
Peroneal tenosynovitis is swelling and inflammation of the peroneal tendons' sheaths (or coverings) which prevents the tendons from gliding smoothly within the sheaths causing pain. It can be experienced at the same time of peroneal tendonitis, and has similar symptoms. It often results in trouble moving the ankle and will feel sore to the touch. In rare cases, tenosynovitis can be caused by infection, so it is always recommended to check with your doctor to rule this out as a cause.
Tearing of the peroneus longus tendon and/or the peroneus brevis tendon can occur. This leads to pain, swelling, sensitivity and a sense of instability in the ankle. The tendon(s) can also pop out of the supporting ligaments that hold them in place (superior peroneal retinaculum and inferior peroneal retinaculum ligaments) which is known as dislocation.
Peroneal Tendon - Location & Function
There are a number of tendons (fibrous tissue that connect muscle to bone) in the foot which help to control movement while you are walking or running. Two ankle tendons commonly injured are the peroneus longus and the peroneus brevis, and together, these are known as the peroneal tendons.
These 2 long tendons have acquired this name because they harness most, if not all, the strength pertaining to the outside of the leg/ankle. The peroneal tendons are important tendons because they prevent the foot from rolling and causing a lateral (inversion) ankle sprain. The superior peroneal retinaculum and inferior peroneal retinaculum ligaments run over top of the 2 peroneus tendons holding them close to the calcaneus (heel bone). If these 2 tendons were cut, you would have no ability to prevent your foot from turning inward when you walk, effectively causing constant ankle rolling. If these tendons are overstrained and too long, you will find the same thing happening - you will be frequently having ankle inversion sprains.
Peroneal tendons are long, attaching to outer leg muscles then running behind and underneath 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. In such cases, this 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. Due to this (you probably guessed it), you are more likely to roll your ankle inward and sprain it on a frequent basis.
The "Peroneal Tendon" is actually a name give to two tendons: the Peroneus Longus and the Peroneus Brevis. Together, they are harness all the strength pertaining to the outside of the ankle (this is known as "lateral ankle strength")
Who is at Risk?
- People who play sports or do activates that involve repetitive ankle movements.
- People who participate in activities such as running on uneven surfaces, racket sports, basketball, hiking, or skiing.
- People with high arches in their foot.
- People in aging populations, because our tendons lose elasticity and become brittle.
Treatment - What You Can Do!
Allowing your peroneus longus tendon and the peroneus brevis tendon to rest is always recommended following a tear or dislocation. Avoid all activities that may have caused the injury or irritation and begin cold compression treatments as soon as possible. The peroneal tendons are difficult to rest completely as they are essential tendons for walking and daily activities. During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort in your ankle until the pain and inflammation settle.
The trick with healing a peroneal injury is getting it to heal with minimal scar tissue formation and with as much realignment of the tendon fibres as possible - something ultrasound therapy is great at! Even with optimum healing, there is always less elasticity in previously injured peroneal tendons. This will cause the tendons to hurt during daily activities and exercise. However, if you heal your peroneal tendons efficiently and quickly, your chance of re-injury later on is much lower than average.
Fortunately, there are healing tools that can help treat your peroneal tendons and speed up the healing process so you can get back to a life without pain and risk of further injury. Therapeutic ultrasound will treat scar tissue and reduce inflammation while Blood Flow Stimulation Therapy (BFST®) promotes blood flow to heal your tendons faster and more completely than any other methods available.
What You Need to Successfully Treat Your Peroneal Tendinitis or Tendinosis Injury:
- A Professional Cold Compression Ankle/Top-Foot ColdCure Wrap® to reduce inflammation of the soft tissue injury (as soon as possible).
- A Deep Tissue Therapeutic Ankle/Top-Foot BFST Wrap® to increase Blood-flow to the injured tendons (
Blood Flow Stimulation Therapy™ Therapy).
These 2 tools are what you need for rapid healing. These are the tools that top professional athletes use to treat their injuries every day. And just like these athletes, you can treat yourself at home. In fact, if you want to heal properly you have to treat yourself because you need to treat your injury every single day.
At the AidMyPlantar Online Store you will find the tools necessary to relieve the pain of foot tendon and ligament inflammation and dramatically speed the healing. A sesamoid tendon injury is a race against time. The faster and stronger you heal your tendinitis, the less chance there is for re-injury. As well, leaving sesamoiditis untreated could easily leads to the development of over-compensation injuries that can become surprisingly debilitating, leading to increased downtime and immobility.
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If you have a Peroneal Tendon Injury, it's important to heal it quickly and completely. If you don't, it may plague you on and off again for years and cause more debilitating injuries due to over-compensation.
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 and/or swelling along the tendon and possibly up the leg along the fibularis longus muscle during or after activity.
- 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 hot to the touch around the outside of your ankle.
- Instability of the foot and/or ankle
- An increase in arch height 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.
Be Careful About Cortisone
Steroid injections can provide temporary relief from the pain of tendon related injuries and are very popular. However, these injections should generally be avoided if possible as they weaken the tendon and may lead to a rupture. If you do opt for an injection, doctors usually recommend that you do not participate in strenuous activities for several weeks to reduce the risk of a rupture.
"In other words, in some way, the cortisone shots impede full recovery, and compared with those adopting a wait-and-see policy, those getting the shots 'are worse off'. Those people receiving multiple injections may be at particularly high risk for continuing damage. (reference: Reynolds, G. (1288). Phys Ed: Do Cortisone Shots Actually Make Things Worse?. Well. Retrieved 17 November 2016, from website)
Doctors won't give you a cortisone shot if it's at all possible that you have a fracture (acute or chronic) in your sesamoid bone(s). If cortisone is used with even the slightest stress fracturing, the cortisone will make the injury worse by stopping the bone's natural healing process. Over time if left untreated, your fracture will get worse and surgery will be more likely needed.
"Complications of cortisone shots can include:
"Risks - Cortisone Shots - Mayo Clinic". 2016. Mayoclinic.Org. Accessed November 17 2016. website
- Joint Infection
- Nerve Damage
- Thinning of skin & soft tissue around injection site
- Temporary Flare of Pain & Inflammation in the Joint
- Tendon Weakening or Rupture
- Thinning of Nearby Bone
- Death of Nearby Bone
- Temporary Increase in Blood Sugar"
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?
Get Swelling & Pain Down with the
Ankle/Top-Foot ColdCure 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/Top-Foot ColdCure 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/Top-Foot ColdCure 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/Top-Foot ColdCure 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.
Accelerate Tendon Healing with the
Ankle / Top-Foot BFST 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 Blood Flow Stimulation Therapy™ is through use of an Ankle / Top-Foot BFST Wrap®. The BFST 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 / Top-Foot BFST 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 / Top-Foot BFST 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!
Scar Tissue - A Big Problem with Peroneal Tendinosis & Tenosynovitis
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/Top-Foot ColdCure 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 / Top-Foot BFST 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 / Top-Foot BFST 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 BFST 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 Peroneal Tendon re-injury, manage pain and strengthen the ability of your body to heal itself, an Ankle/Top-Foot ColdCure Wrap® and an Ankle/Top-Foot BFST Wrap® will provide exceptional results.
Why spend time in pain, off from work and missing out on an active lifestyle when you don't have to?
Learn More About SUPERIOR Peroneal Tendonitis Treatments
Learn more about how the Ankle/Top-Foot ColdCure Wrap® is designed to be the most effective cold compression wrap on the market today.
Learn more about how the Ankle/Top-Foot BFST Wrap® helps with the healing process.
With these FDA Registered home therapies you will notice incredible improvement in your peroneus longus and the peroneus brevis tendons. You will reduce your pain and strengthen your tendons to get yourself back on your feet again. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!