Peroneal Tendonitis
Peroneal tendinitis is a condition that can be acute or become chronic (peroneal tendinopathy) whereby there is an irritation to one or both peroneal tendons with subsequent degeneration and inflammation.
Symptoms
Patients with peroneal tendonitis present with pain and occasionally, swelling and warmth in the posterolateral aspect of the ankle along the course of the peroneal tendons.
Peroneus brevis tendonitis is usually symptomatic from the lateral malleolus distally to its insertion at the base of the fifth metatarsal.
Peroneus longus tendonitis is characterised by tenderness over the lateral calcaneus, often extending distally to the plantar aspect of the cuboid.
Patients may relate exacerbation with rising onto the ball of the foot, running (lateral running, figure-8 running), cutting, jogging, or walking on uneven surfaces or following these activities or following a rest period, especially upon waking in the morning. The pain tends to be of gradual onset which progressively worsens over weeks or months with the continuation of aggravating activities. Acute tendonitis presents with recent (<6 weeks) onset of pain along the lateral ankle and foot
Causes
Peroneal tendonitis is common in running athletes (particularly endurance running due to a high number of cyclic muscle contractions), young dancers, ice skaters and sports requiring frequent change of direction or jumping such as basketball, skiing and even horse riding. The lesion may be due to partial tears, complete ruptures, subluxation, tenosynovitis, a fractured os peroneum, or damage to the peroneal retinacula. Chronic lateral ankle instability and excessive subtalar and ankle varus rotation may cause damage to the peroneal tendons and their associated structures. Contributional factors for the development of peroneal tendonitis are tight calf muscles, inappropriate training, poor foot biomechanics such as over-pronation of the foot or excess eversion of the foot, inappropriate footwear and muscle weakness of them. peroneus longus. Other causes include severe ankle sprains, repetitive or prolonged activity, direct trauma’s, chronic ankle instability, fractures of the ankle or calcaneus, and peroneal tubercle hypertrophy.
Tendonitis, in general, occurs when an individual returns to activity without proper training or after a period of extended rest. Specifically for athletes, the type of footwear, training regimen and training surface can contribute to the problem. For workers increased hours, changes in workstation or changes in the type of labour can contribute to symptoms.
Diagnosis
A thorough subjective and objective examination from a physiotherapist can be sufficient to diagnose peroneal tendonitis.
Plain film radiographs do not reveal soft tissue abnormalities; however, they are useful for excluding arthritis, bone abnormalities such as pes cavus, or fractures.
Diagnosis may be confirmed with an MRI scan or ultrasound investigation showing oedema. Ultrasonography may be used for detecting all types of peroneal lesions.
In chronic cases, or in cases which may be difficult to differentiate from lateral ankle ligamentous injury, computed tomography or magnetic resonance imaging may be helpful. T2-weight MR images often show visible accumulation of fluid within the peroneal tendon sheath. Thickening of the synovial lining may be appreciated with high-definition images. Tenography may be especially helpful in the chronic setting with suspected stenosis within the tendon sheath.