What are the peroneal tendons and what is tendonitis?
The peroneal tendons consist of two tendons (peroneus brevis and longus) that run along the outer aspect of the lower leg, eventually coursing along the outer aspect of the ankle and inserting to the undersurface of the foot bones. These tendons function to plantarflex (i.e. point your foot downwards) and evert (tilting of the sole of the foot away from the body’s midline) the foot. Tendonitis usually occurs from overuse and is associated with many activities. Running tends to be the most common. Tendonitis can also occur after trauma. Some patients may also have abnormal anatomy that predisposes their peroneal tendons to increased forces during activities.
Pain around the outside of the ankle that radiates to the undersurface of the foot is usually the most common symptom. This pain tends to worsen with activity, particularly running. The peroneal tendons may sublux (i.e. temporarily slip) out of its proper alignment. This subluxation is often painful and associated with a clicking or snapping sensation. Rest usually decreases pain, yet in cases of severe inflammation, pain may also be present at rest.
An x-ray is typically ordered to rule out fracture and other bony pathology. An MRI may be ordered to further assess for tendon tears and other soft tissue pathology. It is important to note that if the tendon only subluxates with activity, it may appear to be in proper anatomical position at the time of the MRI.
Nonoperative treatment is first-line and primarily consists of activity modification. Inflammation will only worsen if activities that cause pain are continued. It is therefore extremely important to back down on these activities. Patients who do not modify their activities end up worsening their condition and prolonging their recovery.
Physical therapy along with some form of immobilization outside of therapy for approximately 6 weeks is usually recommended. A lace-up ankle brace is worn in the majority of cases. Patients with more severe cases or recurrent tendon subluxation will often be placed into a walking boot for better immobilization and protection. NSAID medications such as Advil or Aleve (so long as not contraindicated) may be recommended to help decrease inflammation. Icing the affected area early on in the disease may also help decrease inflammation and pain.
Surgery is usually considered for cases that have failed nonoperative treatment. Surgical management involves debriding the tendon of inflammatory tissue and securing the tendon in its normal anatomic position in the case of tendon subluxation.
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After surgery, patients will usually stay in a cam boot for approximately 4 weeks and then be transitioned into a lace up brace, followed by physical therapy for at least 6 weeks. Full recovery usually occurs at about 3 months after surgery.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.