What is the Peroneal Tendon?
Tendon pain on the outer side of the ankle is called Peroneal Tendinopathy. The Peroneal tendon is a cord-like structure that attaches a muscle on the outside of your lower-leg to the outside of your foot.
When the Peroneal tendon lifts the outer edge of your foot and is very important for walking and balance.
What is Peroneal Tendinopathy?
Tendinopathy is a condition that involves pain and reduced strength in a tendon. This often occurs following a change in activity levels. It may result from doing more activity than previously, however it can also be a result of doing less than you would normally for example, after a period of illness or extended rest.
If you have a Peroneal Tendinopathy, you will likely experience pain on the outer aspect of your foot and/or just behind your outer ankle bone (lateral malleolus).
The result is that the irritated tendon means the activities you do now are too much for you to tolerate. Therefore, you get pain.
Common features
Most people will experience pain after rest and first thing in the morning.
When following the correct advice and rehabilitation programme full recovery can take between 3 and 12 months.
Should I be resting or moving?
You are safe and generally better off if you move. There is no evidence to suggest your tendon is at greater risk of damage with more activity.
If you keep still and significantly reduce your activity levels, your tendon may become more irritated, and your muscles will become weaker leading to further pain and reduced strength.
Activity Diary and Modifications
It is sometimes useful to make a note of the daily activities that can potentially aggravate your symptoms. Below are some of the main aggravators and some modifications you can make to help reduce the painful reaction.
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Aggravator
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Modification
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Walking on uneven ground
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Ensure you wear supportive footwear. Often an ankle/lace-up boot can give extra stability and reduce the strain on the tendon.
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Sitting down or resting for too long
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Try to avoid prolonged rest. Break up periods of sitting by getting up and moving every 20-30 mins.
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Exercising through pain and for prolonged periods.
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Use the reaction rules guide below to ensure that you do not cause a painful reaction.
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How do I know if I am doing too much?
It is common to get a painful reaction if too much load is put through the tendon. If this pain is more than 5/10 (with 10 being the worst pain imaginable) and lasts for more than 24 hours, check what you have been doing and ease back, not necessarily stop/avoid in future.
Once this has settled you can start to gradually introduce your activities and exercises again. If you have a mild aggravation (pain is less than 5/10) and this settles within 24 hours then keep going with your exercises and gradually return to full activities (see below).
Pain relief and injections
Painkillers can help you keep moving. However, it is important to discuss this with your GP, especially if you are taking any other medication.
Injections are not recommended for this problem.
Ice
You could try applying ice after activity to help reduce pain and/or inflammation.
If you experience reduced sensation, numbness, or have circulatory problems you should discuss the use of ice with a healthcare professional prior to using them. Ice can burn skin; therefore, you should always use a towel to cover the area and check their skin regularly for any changes and signs of burning. A damp towel is more effective when applying ice.
Always mark the packet of frozen peas before putting them back in the freezer as they would be unsafe to eat after being defrosted numerous times.
What about sports or work?
You should use the previously mentioned reaction rules to highlight whether a return/adaptation to sport or work is advisable.
Do I need any tests?
Peroneal Tendinopathy is diagnosed clinically. Scans and other investigations are often not recommended as they are not required.
What are the aims of Physiotherapy?
The aims of physiotherapy are to improve muscle strength, load tolerance and pain in your tendon. This should allow you to return to your previous activities.
General measures to help
Weight control
If you are overweight, try to lose some weight as the extra burden placed on your tendon can make symptoms worse. Even a modest weight loss can make quite a difference.
Poor diet, high cholesterol and diabetes are linked to an increased risk of developing a tendinopathy and poorer healing.
Exercises for Peroneal Tendinopathy
Do not work into pain but it is ok for your muscles to feel tired. If the number of repetitions or length of the hold is too long, back off slightly, but aim to build up to the stated level.
Use the reaction rules to guide your exercise intensity. If pain is stopping you engaging in rehab, you should speak to your GP about pain relief promptly.
Flare-ups may happen; if it doesn’t settle in a couple of weeks, then seek further advice.
What actions can I take to improve my health?
Evidence tells us that making healthy lifestyle choices can have a big impact on influencing problems with your muscles and bones and can play a major role in your overall health. Some of the most effective areas to address are below:
Maintaining a healthy weight:
Link: www.nhs.uk/live-well/healthy-weight/
Increasing levels of physical activity
Link: www.nhs.uk/live-well/exercise/
Avoiding poor sleep patterns
Link: www.nhs.uk/live-well/sleep-and- tiredness/how-to-get-to-sleep/
Reducing alcohol consumption
Link: www.nhs.uk/live-well/alcohol- support/calculating-alcohol-units/
Stopping smoking
Link: www.nhs.uk/live-well/quit-smoking/
Maintaining a healthy mind
Link: www.nhs.uk/conditions/stress-anxiety-depression/
The good news is that you are able to influence lots of these by modifying your lifestyle. Therefore it is important that you consider addressing these areas alongside your current treatment.
You may wish to discuss any of these factors with your treating clinician who will be able to work with you and guide your long term management and support you to improve your wellbeing.
There will be information about the local services that exist within the waiting areas of the physiotherapy department and your treating clinician will be able to help signpost you to appropriate services.
The websites listed below give more information on local services available:
• Blackburn and Darwen - https://refreshbwd.com/
• East Lancashire - http://www.upandactive.co.uk/
If your symptoms fail to improve within 6-8 weeks with this regime you should contact your doctor for a physiotherapy referral.
If your symptoms are improving (even slowly), continue for up to 3 months.
