Description

The Peroneal tendon starts as the fibularis brevis and fibularis longus muscle at the outside(lateral) of the lower leg and travels towards the bottom(plantar) lateral foot. The main role of the peroneus brevis tendon is to stabilize the ankle to prevent the ankle from rolling laterally. It is prone to tendinopathies where the tendon attaches (inserts) onto the outside of the foot at the 5th metatarsal bone. A tender bony lump can often be felt at the insertion point.

Causes

This tendon can be injured from both acute and chronic conditions. The most common way of injuring the Peroneal tendon is during a foot inversion(turns in) during an ankle sprain. Other reasons include having high arches (Pes Cavus). Chronic injuries and inflammation can lead to the development of tendonitis as the tendon sheath (covering) can thicken. The tendon itself often thickens or grows larger.

Symptoms

The most common symptom for peroneal tendon disruption is pain to the outside (lateral) ankle. There may be swelling to the area and pain along the bottom of the middle of the foot as well.

Treatment
  • Rest. Avoiding movements that exacerbate your pain.
  • Ice can be applied to reduce pain and swelling. Apply for 20 minutes at a time, several times a day, to keep swelling down. Do not apply directly to the skin.
  • Bracing
    • FS6 Compression sleeve can be used to reduce the swelling
    • Air cast boot – Temporary use of an aircast boot for activity for 2-4 weeks can allow the tendon to rest
    • Gauntlet ankle brace
  • Custom soft orthotics with lateral support wedge
    • To treat this condition, the outside edge of the foot needs to be supported to prevent the foot from rolling laterally. This decreases the strain and workload on the peroneus brevis tendon to allow for healing
  • Physiotherapy
    • Shockwave therapy, laser therapy
    • Stretching
  • Medications
    • Nonsteroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you. Consult your physician if you have any questions.
    • Topical anti-inflammatories
      • Compound Topical Creams
      • Voltaren
  • Injections
    • Steroid (Depo-Medrol, Kenalog, Decadron)
    • Blood (PRP – Platelet Rich Plasma)

Most of the treatment options for PTTD is conservative and non-surgical. However, failing conservative treatment options and in certain patients, surgery is an option and should be discussed with the physician.