Peroneal tendon problems/ tendonitis

What are the peroneal tendons?

These are two tendons which wind around the outer aspect of the ankle joint and pass into the foot. They are palpable just behind the fibula which is the bony bump of the outer aspect of the ankle.

peroneal tendonitisperoneal tendonitis


What is peroneal tendonitis?

In common terms it is inflammation of the tendon which causes pain and swelling at this site. This occurs due to micro tears in the fibres of these tendons and the body constantly trying to repair these tears.

 

When can these tendons become painful?

  • Inflammation of the tendons might cause pain and swelling
  • Acute injury to the tendons may cause a rupture of the tendons or cause them to dislocate.
  • Chronic repetitive stress can cause micro tears in these tendons giving rise to tendonitis as described above.


What are the symptoms caused by this condition?

  • Acute swelling or pain along the course of these tendons at the outer aspect of the ankle
  • Snapping tendons if they dislocate in and out of the groove behind the fibula
  • Thickening of the tendon
  • Swelling that is present all the time and gets worse throughout the day with activity


 

How is this condition diagnosed?

Your consultant will examine your foot clinically. This usually makes the diagnosis clear. Xrays and MRI scan will also be done to confirm the diagnosis and plan further treatment.

 

Can the condition worsen?

If the symptoms worsen, it may progress to a complete rupture of the tendon. It is advisable to have yourself assessed by a foot and ankle specialist.

What treatment options are there?

Options are based on the specific problem affecting these tendons. Most patients are seeking advice and reassurance. Broadly there are non surgical and surgical options.

For acute peroneal tendon inflammation

• Rest: In acute flare ups, rest in a boot may be necessary for a few weeks. It will also be important to reduce the intensity and exercise levels.

• Painkillers: regular anti inflammatories taken for a short duration will help with pain and the swelling.

If symptoms are irritating, surgery may be necessary. This involves either removing the entire nail or a wedge of the nail and treating the nail bed with a chemical to ablate (destroy the cells) responsible for nail growth.

For chronic peroneal tendinosis:

• Shock wave therapy: This can be used if the above methods fail with good results. • PRP injections: This involves injecting platelet rich plasma around the tendons, but results are not very predictable and there is a risk of tendon rupture.

Is surgery necessary?

The decision to proceed with surgery should be taken after non surgical options described above have been exhausted. If symptoms continue to affect lifestyle and function then surgery may be discussed with your consultant and he will advise you regarding the pros and cons of surgery.

What are the surgical options?

For dislocating peroneal tendons:
Surgery involves relocating the tendons in the groove of the fibula and repairing the tunnel to hold the tendons in place.

For peroneal tendinosis or tears:

Surgery involves trimming the torn bits of the tendon and repairing it. In some instances if the tendon is completely torn and nonfunctional then a tendon transfer or graft may be required. Further details about the specific procedure required will be discussed in detail at your consultation

 
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