Pain on the Outer Part of Your Ankle - Peroneal Tendonitis
by Princeton Orthopaedic Associates
Peroneal Tendonitis
Peroneal tendonitis is a common yet also misunderstood condition affecting the outer portion of your ankle; it can cause you significant discomfort and interfere with your daily activities if left untreated. This condition often arises due to overuse, sudden changes in physical activity, or biomechanical issues that strain the peroneal tendons. While athletes and active individuals are particularly susceptible, anyone can develop peroneal tendonitis if the tendons are subjected to excessive stress. Understanding the anatomy, causes, symptoms, and appropriate care is crucial for effective management and prevention.
Understanding peroneal tendonitis, its anatomy, common causes, symptoms, treatment options, and how to prevent it can help you recover and get out of pain!
What Is Peroneal Tendonitis?
Peroneal tendonitis, also known as peroneal tendinopathy, can also be referred to by other names, including:
Peroneal tendonitis is the most commonly used term.
Peroneal tendinopathy is a medical term that describes any damage or disorder of the tendon without specifying inflammation.
Peroneal tendon inflammation is a more specific name indicating the inflammation of the peroneal tendons.
Peroneal tenosynovitis refers to inflammation of the synovial lining around the tendon, though this is a less common term.
Peroneal tendonitis refers to irritation or inflammation of the peroneal tendons, which run along the outer side of your ankle. These tendons are important for stabilizing your ankle joint and facilitating foot movement. When these tendons become inflamed, they can cause pain, swelling, and reduced mobility. This condition is most frequently seen in individuals who engage in repetitive ankle movements, but it can also arise from acute injuries or biomechanical abnormalities.
Specifically, there are two peroneal tendons involved in peroneal tendonitis:
Peroneus Longus: This tendon runs behind the bony prominence on the outer ankle (the lateral malleolus ) and extends underneath the foot to the arch. It helps turn the sole of the foot outward (foot eversion) and supports the foot's arch.
Peroneus Brevis: This tendon also runs behind the lateral malleolus but attaches to long bone of the outer edge of the foot. It assists with ankle stability and eversion.
Peroneal tendonitis typically develops due to overuse, resulting in micro-tears and inflammation within the tendons. This condition can occur in one ankle (unilateral) or, less commonly, in both ankles (bilateral).
Causes of Peroneal Tendonitis
Peroneal tendonitis can result from various causes, often related to repetitive motion or biomechanical stress. Identifying and addressing these underlying causes is key to both treatment and prevention.
Overuse or Repetitive Motion:
Athletes who engage in activities involving repetitive ankle movement (e.g., running, hiking, or sports requiring quick lateral motions) are at greater risk. Over time, repetitive stress can lead to micro-tears in the tendons, causing inflammation and pain.
Sudden Increase in Physical Activity:
If you have a rapid increase in exercise intensity or frequency, it can strain your peroneal tendons. For instance, starting a new running regimen or abruptly increasing training volume can place excessive stress on the tendons.
Wearing Improper Footwear:
If you wear shoes that lack proper support, they can increase stress on the peroneal tendons. Poor arch support or insufficient cushioning can alter your foot mechanics and contribute to the irritation of your tendons.
Foot and Ankle Misalignment:
High arches or an abnormal gait can increase tendon strain. Individuals with these anatomical variations are more prone to overloading the peroneal tendons.
Previous Ankle Injuries:
A past ankle injury, like an ankle sprain, can increase your risk of developing peroneal tendonitis. If you have a history of ankle sprains or instability, you can be more susceptible because these injuries can weaken the tendons, making them more prone to inflammation.
Ankle instability:
Weakness or poor coordination in the ankle can contribute to stress on the tendons.
Biomechanical issues:
Abnormalities in the way the foot moves (like flat feet or high arches) can lead to additional stress on the tendons.
Underlying conditions, such as inflammatory arthritis or connective tissue disorders, can also weaken the tendons or increase inflammation, predisposing people to peroneal tendonitis.
Symptoms of Peroneal Tendonitis
These are the common symptoms of peroneal tendonitis:
Experiencing pain along the outer side of your ankle: This pain is usually located behind the bump on the outside of your ankle, the lateral malleolus, and may worsen with movement.
Ankle Swelling and tenderness: The affected area of your ankle may become swollen, and the tendons themselves may also be tender to the touch.
Ankle pain that worsens with physical activity and improves with rest: Activities such as walking, running, or standing for long periods typically aggravate symptoms, but they reduce after rest and avoiding said activities.
A sensation of ankle instability or a snapping feeling: In some cases, the tendons may slip out of their normal position, causing a noticeable snapping sensation.
Stiffness or weakness: Individuals may experience stiffness when moving the ankle, as well as weakness during activities requiring ankle stability.
Home Care for Peroneal Tendonitis
If you suspect you have peroneal tendonitis, early intervention with home care is essential for symptom management and recovery. Consistent and proactive home care can prevent the condition from worsening and promote healing. Consider the following steps:
Rest: Avoid activities that exacerbate pain to allow the tendons to heal. Continuing strenuous physical activity can worsen inflammation and prolong recovery time.
Ice Therapy: Apply ice to the outside ankle area for 15-20 minutes. Do this every 2-3 hours to help reduce inflammation. Be sure to use a cloth between the ice and your skin to protect your skin and prevent frostbite.
Ankle Compression: Use an elastic bandage or ankle brace to provide support and minimize swelling. This can also offer additional stability to a weakened ankle.
Elevation: Keep the ankle elevated above heart level when resting to decrease swelling. Elevating the affected limb can reduce fluid buildup and ease discomfort.
Anti-Inflammatory Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve pain and inflammation. Follow dosage guidelines carefully and consult a healthcare provider if you have any concerns.
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While mild cases of peroneal tendonitis may resolve with home care, we recommend you seek medical attention right away if you experience:
Persistent pain despite rest and self-care: If symptoms do not improve within a few weeks, a comprehensive medical evaluation may be necessary.
Significant swelling or bruising: Extensive swelling or discoloration around the outside of your ankle could indicate more severe tendon damage or an associated injury.
Ankle instability or difficulty bearing weight: Persistent instability or an inability to walk comfortably warrants a specialist's assessment.
Popping or snapping during movement: If you feel a popping or snapping sensationd uring movment, this may suggest tendon subluxation (displacement) or a partial tear which would require professional intervention.
Treatment depends on the severity of the condition and may include:
Physical Therapy: Customized exercise programs can restore strength and improve range of motion. Therapists may also use techniques like ultrasound therapy to help promote your healing.
Immobilization: Severe cases may require a walking boot or brace to limit motion and promote healing. Immobilization prevents further strain and allows the tendons to repair themselves.
Orthotics: Custom insoles can correct biomechanical issues and relieve tendon stress. Proper foot alignment reduces the likelihood of recurrence.
Steroid Injections: In some cases, corticosteroid injections may be discussed and can reduce persistent inflammation. Use of these injections will be determined by you and your treating physician.
Surgery: Rarely, surgery is required to repair tendon tears or address chronic instability. Surgical intervention may involve tendon repair, cleaning inflamed tissue, or stabilizing the tendons.
Preventing Peroneal Tendonitis
Proactive measures can reduce the risk of developing peroneal tendonitis, especially for those prone to ankle injuries. Consider incorporating the following strategies:
Strengthening Exercisesfor Peroneal Tendonitis: Targeting the ankle and foot muscles enhances stability and reduces strain. Examples include:
Ankle Eversion Exercise: Use a resistance band to strengthen the peroneal muscles. This improves tendon resilience and stability.
Calf Raises: Improve overall ankle strength by lifting onto your toes and slowly lowering down. Perform both double-leg and single-leg variations for comprehensive strengthening.
Balance Exercises: Perform single-leg stands to enhance proprioception and stability. Balance drills can help prevent future injuries by improving coordination.
Supportive Footwear: Choose shoes with enough arch support and cushioning, especially for high-impact activities. Custom orthotics may also be beneficial if you have high arches or foot misalignment.
Gradual Progression: Increase physical activity levels gradually to prevent overuse. Sudden increases in intensity or duration should be avoided.
Stretching Routine: Regularly stretch the calf muscles and ankles to maintain flexibility. Flexible tissues are less prone to injury and inflammation.
If you're experiencing persistent ankle pain or instability, it's essential to seek professional care. The specialists at Princeton Orthopaedic Associates are here to provide expert diagnosis and personalized treatment plans. Schedule a consultation today to get back to the activities you love with confidence.
