Peroneal Tendinopathy (Pain on the outside of the ankle)
Peroneal tendinopathy is an injury to one or both of the Peroneal tendons that run along the outside of the ankle. These tendons subsequently degenerate and become inflammed. Often this injury develops after a simple ankle sprain.
Risk Factors:
Peroneal Tendinopathy is very common in individuals who participate in multi-directional sports eg tennis, football. But is also very common in:
- Individuals with a supinated foot type/high arch foot type
- Inversion injury of the ankle eg lateral ankle sprain
- Overuse of the foot and ankle
- Trauma
- Hypermobile ankles and feet
- Persistent Lateral ankle sprains
- Chronic ankle instability
- Weak ankles
- Excessive jumping activities
- Increasing training intensity, distance, speed too quickly
Symptoms
- Pain and inflammation along the outside of ankle just under the ankle bone. The pain may course around the outside of the ankle bone either below or above
- There may be obvious inflammation
- Weakness and instability of the ankle and giving way
- Clicking and popping noises around the outside portion of the ankle (snapping of the tendons may also occur where they pop out of the normal location)
Peroneal Tendinopathy is easily diagnosed with palpation methods along the course of the tendons and with stress testing of the tendons. Ultrasound scans can easily pick up degeneration of the tendons and they can often pick up tears as well. Sometimes an MRI is required to assess for split tears and more serious injuries.
Treatment
- The initial aim of the treatment protocol should be to reduce stress in the tendons and splint the tendons.
o This should include compression of the injured area
o Strapping techniques to reduce motion, movement and stress on the tendons
o If there are tears in the tendon a walker boot or ankle brace will be required
o Footwear
o Orthotic therapy
- Reducing pain with topical anti-inflammatory medication, contrast therapy, heat
- Reduce tension in the peroneal muscles with soft tissue and trigger pointing techniques
- Improving ankle range of motion with mobility exercises for the calf complex and ankle joint
- Activity modification and complete rest is often needed
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