A tendon is a band of tissue that connects a muscle to a bone. In the foot, there are two peroneal tendons. They run side-by-side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sprains.
Types of Tendon Injuries
Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries.
There are different types of peroneal tendon injuries.
TENDONITIS
Tendonitis is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon or trauma (such as an ankle sprain). Symptoms of tendonitis include:
- Pain
- Swelling
- Warmth to the touch
- Acute Tears
Acute tears are caused by repetitive activity or trauma. Immediate symptoms of acute tears include:
- Pain
- Swelling
- Weakness of the foot and ankle
- The feeling of being unstable while walking on uneven surface or activities such as going up and down stairs
- As time goes on, these tears may lead to a change in the shape of the foot, in which the arch may become higher.
DEGENERATIVE TEARS (TENDONOSIS)
Degenerative tears (tendonosis) are usually due to overuse and occur over long periods of time – often years. In degenerative tears, the tendon is like taffy that has been overstretched until it becomes thin and eventually frays. The signs and symptoms of degenerative tears may include:
Sporadic pain (occurring from time to time) on the outside of the ankle
Feeling of weakness in the ankle
Feeling of being unstable while being active or going up and down the stairs
An increase in the height of the arch
TENDON SUBLUXATION
Tendon subluxation occurs when one or both tendons have slipped out of their normal position. This can occur after an ankle sprain, can be the result of having a variation in the shapes of the bone (fibula) or can be the result of having an extra or low lying muscle belly in the area.
Damage or injury to the tissues that stabilize the tendons (retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation may include:
A snapping feeling of the tendon around the ankle bone
Sporadic pain behind the outside ankle bone
Ankle instability or weakness
Early treatment of a subluxation is critical, since a tendon that continues to sublux (move out of position) is more likely to tear or rupture. Therefore, if you feel the characteristic snapping in the back of the ankle bone, please contact a Foot & Ankle Surgeon immediately.
Diagnosis
Your Foot & Ankle Surgeon will start by examining your foot and ankle. The doctor will be looking specifically for signs of:
- Pain
- Swelling
- Warmth
- Weakness
- Instability
- Subluxing tendons
- Residual symptoms of ankle sprains
X-rays will be ordered to assess for any underlying bone abnormalities or structural deformities. Often an MRI or ultrasound will be ordered to assess the integrity of the tendons and evaluate the full extent of the injury. These extremity MRI’s only take about 30 minutes for the study and only requires the patient put their foot into a painless machine avoiding the uncomfortable claustrophobia that some MRI devices create.
Treatment
Treatment depends on the type of peroneal tendon injury. However, some of the potential non-surgical treatment options are below.
REST, ICE, IMMOBILIZATION AND ANTI-INFLAMMATORY MEDICATIONS
These are usually the first line treatment for many tendon injuries.
BRACING
Sometimes wearing a small brace in your gym shoes can help with swelling and feelings of instability.
ORTHOTICS
After the acute pain and instability resolve, orthotics can sometimes be used to help stabilize the foot while in shoes, particularly during sporting activities.
PHYSICAL THERAPY
Physical therapy can help regain strength and proprioception to the injured ankle.
Non-Invasive Procedures
With pioneered non-invasive treatments for chronic tendon injuries. Extracorporeal Shockwave Treatment (ESWT) has successfully treated this condition for years. Also other minimally invasive treatments such as PRP or Stem Cell therapy have shown promise for these types of conditions.
Surgical Treatment
Surgical treatment is recommended when non-surgical treatments fail to alleviate pain. Surgical treatment options can include the following:
TENDON REPAIR
This typically includes removing all portions of the damaged tendon and repairing the remaining tendon. Sometimes this will need to be augmented with synthetic products.
CORRECTION OF ABNORMAL CONTOUR OF THE FIBULA
If this is present and the underlying problem, your Foot & Ankle Surgeon can remove a small portion of the bone in order to correct this problem.
REPAIR OF THE PERONEAL RETINACULUM
If a weak or torn retinaculum is causing your tendons to sublux and snap around the outer bone in your ankle (fibula), the retinaculum can be repaired and the underlying bone deformity can be corrected during surgery.
ANKLE LIGAMENT TEARS
Ankle sprains are a common cause of peroneal tendon injuries. If the ligaments of the ankle are torn, they can be repaired at the same time as the tendons.
CAVUS FOOT DEFORMITY
A high arched foot can leave the foot at risk for future tendon and ligament injuries. Repair or reconstruction of a cavus or high arched foot can help with underlying tendon injuries and can be done at the same time as surgical repair of the tendons.
After surgery, your course of care will depend on the procedures performed. However, you can expect to be off your foot for a couple of weeks with a good chance of returning to your pre-injury activity level.
If you feel that any of these problems affect you, then make an appointment with the podiatrist today.