- Rest. Avoid activities that increase the pain or swelling. …
- Ice. To decrease pain, muscle spasm and swelling, apply ice to the injured area for up to 20 minutes several times a day. …
- Compression. …
- Stand to face a wall, one foot extended out in front of you, toes pointing up.
- Slowly lean forward until you feel a stretch in the back of your lower leg.
- Hold for 30 seconds and repeat three times.
It’s pretty common for all runners (not just athletes) to develop trigger points in the muscles of the leg and foot.
Trigger points in the ankles not only refer to pain, but by making their host muscles shorter and less efficient, they may often become the route cause of common knee, hip, and pelvic injuries.
When treating clients (especially those who run on hard surfaces), it’s important to check for even the smallest signs of ankle pain and/or stiffness.
Don’t overlook the small superficial muscles of the foot and ankle.
The tendons of the peroneus longus and peroneus brevis run from the peroneal muscles in the lateral calf to the foot.
The peroneal muscles are involved in stabilizing the foot and providing support to the ankle to prevent lateral rolling of the joint. Peroneal tendonitis is most commonly a result of overuse of the peroneal muscles or of inversion sprains that stretch the peroneal tendons.
It can be caused by excessive pronation of the foot as the peroneal muscles have to work harder to stabilize the foot when it is pronated.
Running and jumping involve repeated contraction of the peroneal muscles and can lead to inflammation of their tendons.
Runners who often run on uneven surfaces or have excessive pronation often develop peroneal tendonitis.
Cause of injury
Over-pronation of the foot during running or jumping. Prior ankle injury leading to an incorrect path of travel for the tendons.
Signs and symptoms
Pain and tenderness along with the tendons. Pain is most severe at the beginning of the activity and diminishes as the activity continues. A gradual increase in pain over time.
Complications if left unattended
Unattended tendinitis can lead to a complete rupture of the tendons. Peroneal tendonitis can lead to subluxations.
Chronic inflammation can also lead to damage to the ligaments surrounding the tendons.
Over time the body will trigger holding patterns as a response to the injury.
These holding patterns may manifest in active trigger points in the muscles of the hip and leg, and may in turn lead to further seemingly unconnected complications of the hip and knee.
Rest, especially from running or jumping activities. Ice. Anti-inflammatory medication.
Rehabilitation and prevention
Stretching of the calf muscles and a gradual reintroduction into activity is important for rehabilitation.
During the recovery period, it is important to identify and correct any foot or gait abnormalities that may be contributing to the problem.
Prevention of this condition requires strong, flexible muscles of the lower leg to support the foot and ankle.
With proper treatment, peroneal tendonitis will usually heal completely with no lingering effects.
In rare cases, the tendinitis may not respond to traditional treatment and may require surgical intervention to relieve the pressure causing the inflammation. Orthotics to support the medial arch may be required in some cases.
Trigger points in the peroneal muscles tend to refer to pain down the leg over, above, and behind the lateral malleolus (the bony prominence on each side of the ankle).
Pain can also be felt over the anterolateral aspect of the ankle and the outside of the calcaneus (heel bone).
Clients with these trigger points often complain of numbness or pins and needles in the toes, especially the third, fourth, and great toes.
Trigger points in the peroneal muscles may be a causative factor in peroneal tendinitis, it is important also to identify and treat trigger points in all the muscles of the leg and foot.
Peroneal tendonitis occurs when the peroneal tendons become inflamed. This happens when there is an increased load and overuse of the tendons, leading to them rubbing on the bone.
This friction causes the tendons to swell. Over time, the tendons will thicken in size to try and manage the increased load more efficiently.
Peroneal tendonitis is particularly common in athletes and especially runners, as they are more likely to make their feet roll outwards, causing friction between the tendon and bone.
The peroneal tendons are located in the foot, attaching muscle to bone. They assist with weight-bearing and stability.
A tendon is a band of tissue that attaches muscle to bone.
There are two peroneal tendons in each leg. They run side by side down the lower leg bone (fibula) and behind the bony lump on the outside of the ankle called the lateral malleolus.
One peroneal tendon attaches to the outside of the foot at the base of the little toe (fifth metatarsal). The other tendon goes underneath the foot and attaches to the inside of the arch.
The peroneal tendons provide stability to the ankle when it is bearing weight and protects it from sprains. They also help turn the foot out and stabilize the arch when walking.
People who take part in a sport that involves repetitive ankle motion are most prone to peroneal tendonitis.
Factors that can contribute to peroneal tendonitis include:
- a sudden increase in training, particularly weight-bearing activities, such as walking, running, and jumping
- improper training techniques
- inadequate or unsupportive footwear
There are also some other issues that can increase a person’s risk of developing peroneal tendonitis:
- higher foot arches
- lower limb muscles and joints not working well together
- imbalanced muscles in the lower limbs
If someone fails to complete a rehabilitation program following an ankle injury, such as a sprain, they are also more likely to develop peroneal tendonitis.
Over time, the damaged peroneal tendons will thicken as scar tissue tries to repair the damaged area. This makes the tendons weaker and more prone to tearing.
Peroneal tendonitis can either be acute, meaning that it comes on suddenly; or it can be chronic, meaning that it develops over time.
In both cases, there are some common symptoms:
- pain at the back of the ankle
- pain that worsens during activity and lessens during rest
- pain when turning the foot in or out
- swelling at the back of the ankle
- instability of the ankle when bearing weight
- the area is warm to the touch
To begin with, the doctor will discuss the person’s medical history with them. This will often point to overuse, increased activity, or some other cause of peroneal tendonitis.
It is important to determine that the pain is in the peroneal tendons and not the fibula, as this could indicate a different problem.
A physiotherapist or doctor will use a variety of techniques in a physical exam to look for symptoms, generally by moving the foot and ankle into different positions and applying pressure.
An X-ray, ultrasound, or MRI scan might also be used to rule out any breaks, identify abnormal swelling or scar tissue, and further help with diagnosis.
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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