The peroneal muscles, formerly called the fibularis muscles, consist of the peroneus longus and peroneus brevis which lie on the outside of the lower leg. As the name implies, the peroneus longus is the longer of the two muscles. It originates up at the top of the tibia and fibula. The muscle runs down the lateral lower leg where midway down it tapers into a long tendon which continues along the outside of the ankle and beneath the foot. The peroneus brevis originates on the bottom two thirds of the fibula bone. Its tendon also runs along the outside of the ankle but it inserts on the outside of the foot.

These two muscles work together to evert the foot or move it outward and they assist in pointing the foot, an action known as plantarflexion. They also stabilize the ankle against inversion forces such as when you accidentally roll your ankle outward. Finally, the peroneus longus helps maintain the arch of the foot. Together these muscles play an important role in normal gait as well as in more athletic motions such as running, jumping, cutting and more.

TENDONITIS AND TENDINOPATHY OF THE PERONEAL MUSCLES

Tendons are a type of fibrous connective tissue that connect muscles to bones. Tendons have unique properties and serve important functions including:

• Tendons help to move our bones and amplify the effect of muscle contractions
• They act as shock absorbers
• Tendons are strong but they are not designed to stretch or deform easily
• They can become weaker or stronger/stiffer in response to a training stimulus
• Training can make a tendon more prone to or more resilient against, injury.

An aching pain on the outside of the ankle that increases with activity and often decreases with rest. Pain and weakness when trying to move the ankle outward or push off the toe Swelling and tenderness behind the outside ankle bone where the tendons lie Pain when running, walking across a sloped terrain, jumping or changing directions quickly

PHYSICAL THERAPY FOR PERONEAL TENDONITIS

My team of therapists and I will always create an individualized treatment plan for your ankle symptoms but below are some general treatment approaches for peroneal tendonitis or tendinopathy:

As mentioned above, physical therapy to address tendonitis is a two-pronged approach. Providing symptom relief is a primary goal of physical therapy for this condition but in order to minimize the likelihood of recurrent bouts of tendonitis, tendinopathy or a more severe tendon injury, addressing tendon stiffness plus identifying underlying contributing factors and making a plan to address them is vital.

If inflammation is present around the tendon in the early stages of injury your physical therapist may utilize modalities like ultrasound, electrical stimulation or ice to address inflammation and ankle pain. They will educate you on how to modify activity and minimize discomfort and irritation around the ankle. Then they focus on restoring strength, flexibility and ankle mechanics.

Many of our clients seek care when their tendon injury has become chronic. With tendinopathy, inflammation is often not the culprit of your symptoms and a more active approach to tendon recovery is indicated. In this case there will be more emphasis on interventions that will help remodel the structure of the tendon. The goal of treatment for tendinopathy is to apply graded stress to the tendon and increase its stiffness so that it becomes more resilient to the repetitive forces of your work tasks and favorite sports.

To do this correctly, your PT will guide you on appropriate dosing of specific ankle exercises which place more load on the tendon over time. They may also utilize tools such as ASTYM or Graston to encourage collagen production and remodeling. Finally, addressing other contributing factors such as impairments in strength, flexibility, coordination and motor control in adjacent muscles and joints can help ensure excessive stress is not placed on the peroneal tendons as you return to your previous activities. All of these things together will help you resume your previous activities with greater confidence, resilience and a knowledge of how to manage this condition in the future.

Peroneal tendonitis can certainly put a damper on your favorite activities but physical therapy can help you find a lasting solution. Stop the cycle of rest and repeat and call Evolve Physical Therapy today. Our team of physical therapists is ready to help you heal that tendon and get back to the activities you love.