Your tendon is a band of tissue connecting a bone to a muscle. Behind and running side-by-side your outer ankle bone are a couple peroneal tendons in your foot. One of them runs under your foot and connects close to the inside of your arch, while the other connects to the outer part of your midfoot. Your peroneal tendon's primary function is to stabilize your ankle and foot protecting them from sprains.
Symptoms of Peroneal Tendonitis/Dislocation/Subluxation
When one or both of your tendons become inflamed, it's known as tendonitis. Certain activities that require you to use your tendon repetitively can cause this inflammation. Other things such as overuse of your tendon, or an ankle sprain, or similar trauma can contribute to the inflammation as well.
Some classic symptoms you may experience with peroneal tendinitis include:
- Warm to the touch
- Instability or weakness of your ankle and foot
With time, tears like this can cause your foot to change shape and result in a higher arch. Tendinosis (degenerative tears) typically happen when you overuse the tendons for long lengths of time. The tendon becomes overstretched and resembles taffy in degenerative tears until it eventually becomes thin and frays. You are also at a higher risk of developing a degenerative tear when you have high arches.
As a result of an ankle sprain or other ankle injury, the tissue that holds the tendons in place can be torn, resulting in the tendons slipping forward over the malleolus. When this happens, the peroneal tendons may dislocate from their normal place, causing damage to the tendons. This type of injury is seen in skiers, and baseball, football, and basketball players.
This is where one or both of your tendons slip from their regular position. Occasionally, subluxation occurs when you are born with an abnormality in the shape of your muscle or bone. In other cases, it happens after an ankle sprain or other trauma.
Tissue injury or damage that stabilizes your tendons, known as retinaculum, could and sometimes result in chronic tendon subluxation. It is important that you get treated for this condition right away, because if you allow your tendon to continue to move out of position (sublux), there is a higher risk of it rupturing or tearing.
Causes of Tendonitis/Dislocation/Subluxation
This type of injury can be chronic (coming on gradually) or acute (coming on suddenly). You are at a higher risk of the condition if you participate in any sports that require constant ankle motion.
Diagnosis of Tendonitis/Dislocation/Subluxation
Since it’s easy to misdiagnose peroneal tendon injuries and can get worse when left untreated, immediate evaluation by a Pensacola orthopedic surgeon is necessary. He or she may take X-rays or other types of advanced imaging studies to evaluate your injury fully. It's essential that you get a proper diagnosis since prolonged pain following a slight sprain can indicate additional problems.
Treatment Options for Peroneal Tendonitis/Dislocation/Subluxation
There are several types of non-surgical treatment options that will depend on the type of injury you have. Some include:
Immobilization. This is where you are placed in a splint or cast to avoid moving your foot and ankle and give your injury time to heal.
Medications. Injected or oral anti-inflammatory medications can help alleviate inflammation and pain.
Physical Therapy. To reduce your pain and swelling, the doctor may use heat, ice or ultrasound therapy. After your symptoms are relieved, he or she may add exercises to improve your balance and range of motion and strengthen your muscles.
Bracing. You may be required to wear a brace for a brief period during activities that require you to use repetitive ankle motion. It's also an option if you are not a good candidate for surgery.
Surgery, which may include retinaculum repair, groove reconstruction, or bony blocks, may also be needed in some cases to repair your tendons and supporting structures of your foot. You will discuss your peroneal tendon surgery repair options with your Pensacola orthopedic surgeon to decide on best treatment for you based on your lifestyle and condition. If you do have surgery, it is likely that the doctor will put you into a physical therapy program after the procedure for rehabilitation.
Frequently Asked Questions
Q: What does peroneal tendonitis feel like?
Peroneal tendonitis generally causes swelling and pain along your peroneal tendon. When you have this condition, you could experience pain around the outside of your ankle, foot or lower leg, especially, during activity like exercising, walking or standing. When you have peroneal tendonitis, your affected ankle joint will likely be unstable. Your discomfort may come on slowly and increase over time if you continue activities that are aggravating.
Q: What causes peroneal tendonitis?
Peroneal tendonitis is when the peroneal tendons of your foot become inflamed. The peroneal tendons — of your peroneus brevis muscles and peroneus longus, run from your lower leg lateral side (outside), behind your ankle and down the lateral side of your foot.
Peroneal tendonitis typically occurs in people who play in sports involving repetitive ankle motion. Additionally, if you have higher arches, you also have a higher chance of developing injuries to your peroneal tendon. Three standard types of injuries to your peroneal tendon include tears, tendinitis and subluxation.
Q: How can peroneal tendonitis be prevented?
You can prevent peroneal tendonitis in a variety of ways, including:
- Run on level surfaces
- Myofascial release/foam rolling
- Cross training and strength training
There are various aspects that encompass fitness, including strength, cardio, flexibility, muscular endurance and power. Therefore, you should ensure your routines have plenty of variety.
Q: What happens if it goes untreated?
If left untreated, you'll experience immobility and severe pain. By getting treated early, it can help you avoid ruptures. Surgeons may treat the instability or peroneal tendonitis if caught early. They'll start off with immobilization, taking NSAIDs and avoiding exacerbating activities. Surgical treatment may be necessary, however, if your tendon has secondary changes.
Q: How to prevent subluxation of the tendon?
To prevent subluxation, begin by stretching your ankles before you begin any type of workout. You can place one set of toes on your wall, placing your heel several inches from the wall on the floor while you lean into the wall. You may want to wear an ankle brace when you work out. Your physician can recommend ways to keep your ankles strong.
Q: How common is Subluxation?
Peroneal tendon dislocation or subluxation is common if you're an athlete and your ankles are unstable. While peroneal tendon injuries are common, they're not always significant clinically. Peroneal tendon subluxation occurs most in athletes or those who participate in athletic activities. Snow skiing is a common sport that causes this type of injury. Other high-risk sports include basketball, football and soccer. However, even non-athletes can suffer from a subluxation.
Q: Will dislocating peroneal tendons heal itself?
If you have an acute injury, your Nilssen Orthopedics Foot and Ankle Center Pensacola orthopedic surgeon may advise you to keep weight off your foot with crutches. Typically, the doctor will apply a compression wrap or splint to reduce swelling. He may recommend ice or anti-inflammatory medications to also reduce swelling.
The doctor is able to tell you how serious your injury is once your swelling goes down. If you only have a mild injury, your treatment may just be non-surgical, conservative methods while your dislocated peroneal tendon heals itself.
Q: How can dislocation of peroneals be prevented?
Quickly diagnosing the issue and receiving timely intervention can help prevent chronic peroneal instability, dislocation and tears. Also, you’ll want to be extra careful when you engage in any athletic activities like those mentioned above.