Wednesday, August 1, 2012

Peroneal Tendonitis: A Common Missed Problem in an Ankle Sprain

Below the outside ankle bone there are two tendons that can be easily injured during an ankle sprain.  These tendons are called the peroneals.  The longer tendon is called the peroneus longus and the shorter one, the peroneus brevis.

Peroneal Tendonitis

The function of these tendons is to turn the foot outward.  Most anklesprains occur when the foot and ankle roll inward causing an excessive amountof tension on these tendons.  The brevis tendon attaches to a bone on the outside of the foot, called the fifth metatarsal.  Due to this, it is very common to have the tendon pull off a piece of bone during a sprain.  When one sprains his ankle, most emergency room physicians will order only an ankle x-ray.  A foot x-ray is also needed to diagnose this fracture.

Ankle sprains are not the only cause of peroneal tendon injuries.  Feet with severe high arches will cause excessive strain on thetendon.  This is because the foot is naturally severely inverted (turned in).  Another culprit of peroneal tendonitis is direct trauma, so anything that hits or rubs against the tendon.  Besides the above causes, improper or abnormal shoe wear is a huge reason people get pain along these tendons.  Flip-flops allow the foot to move in all directions without any support and can cause a myriad of problems.  In addition, shoes with worn out sides cannot support the foot or ankle. 

When you have pain in this region, the doctor will first get an x-ray to rule-out a fracture. The next step is to treat this problem with the RICE method.  This is rest, ice, compression and elevation.  Depending on the severity of the pain or injury, you will either have a removable compression sleeve or a soft cast and a walking boot for a week or two.  If there is a fracture, then a hard cast and crutches might be necessary for 4-6weeks.  In really severe fractures, where the bone is displaced, surgical intervention is required.

Once the initial inflammation calms down, an injection of a steroid (anti-inflammatory) might be needed, as well as physical therapy to strengthen the area as well as to increase mobility and decrease swelling.  The final treatment would be a custom orthotic, which is an insert, made specifically for your foot, which will control the foot’s poor function. Family Foot & Ankle Specialists in Piscataway and Hillsborough NJ also offers a painless FDA approved laser to not only treat the pain but to help in the healing process of the tendon.   In very rare instances, the tendon is bogged down with scar tissue, and surgical intervention is needed to clean it out. 

As you can see, peroneal tendonitis is not something you want to ignore.  If you are suffering with this condition, go see your local podiatrist as soon as possible.  Remember, the faster you treat this, the quicker it will heal and get you back into the game. 


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