Inflammation of the peroneal tendon

General

The peroneal tendons are the muscle tendons of the two lower leg muscles Peroneus brevis et longus muscle, better known today as Musculus fibularis longus et brevis.
In peroneal tendon syndrome there is an inflammation of these muscles, to be more precise it does Inflammation of the tendons (Tendonitis).

causes

The cause of peroneal tendonitis is usually the permanent overexertion or overloading of the calf muscles.
But even with inexperienced athletes who do a lot of sport from one day to the next and thereby strain their calf muscles, the muscle can be overly stimulated, which in turn causes individual fibers and the tendons of the muscle to become inflamed.

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Especially patients who do not do warm-up exercises are therefore often affected by such a peroneal tendon syndrome.
If, without the necessary warm-up, there is suddenly too much tension on the muscles, for example through a sprint, this can lead to some muscle fibers due to the acute exposure tear. In addition, it can happen that the sensitive tendon is suddenly pulled hard over the bone.
If this happens a few times, it comes to one Inflammatory response in the area of ​​the tendon or ankle joint with a swelling and one effusion connected is what is supposed to protect the tendon from being stressed again by the strong pull over the bone.
Another cause of one Inflammation of the peroneal tendon is wearing wrong or inappropriate shoes. Particularly on longer runs, it should be ensured that the foot is embedded in a suitable shoe and that it is not constricted or additionally stressed by the shoe.
A badly fitting shoe can cause it to Bad posture come, which ultimately lead to the Lower leg muscles is incorrectly loaded and thus, for example, the peroneal muscles (fibularis) are overloaded. This can then lead to inflammation of the peroneal tendon.
Anatomical events can also lead to this, especially the so-called If onewhere the knees are too far out, similar to a rider. Due to the misalignment of the legs, the muscle tendons are permanently overloaded and become a Inflammation of the ankle to lead. This then leads to frequent inflammation in the tendon area.
Thus, anatomical misalignments for a Inflammation of the peroneal tendon to be responsible. In some cases this is what is called Peroneal tendon syndrome also chronically caused, which is why it is difficult to find an exact cause for the pain. In this case, the patient should concentrate primarily on therapy and alleviating the symptoms.

Also read: Tendonitis on the sole of the foot

Symptoms

In the case of peroneal tendon syndrome, the inflammation leads to pain in the area of ​​the outer lower leg, which can radiate into the foot. This pain usually occurs during or after exercise, but it can also be stress-independent.
In addition to the pain, there is often swelling, which is mainly localized in the area of ​​the outer ankle, as this is where the tendon pulls over the bony structures of the ankle and is therefore most irritated.
Pain and swelling can increase if the patient tilts their foot outwards, as the tendons are tensed and thus experience even more friction.
Since the tendons relax again in rest, so-called "Starting pain“Come because the tendons are then stressed again.
In rare cases, peroneal tendon syndrome also results in the patient limping slightly with the affected side due to the permanent overload and pain and not being able to put any weight on the foot at all. This is particularly the case in later stages, when the patient continues to strain the tendon despite the pain and it is not only inflamed but begins to tear.
The inflammation-related swelling can irritate or narrow the sural nerve, which then leads to burning or tingling, and rarely to sensory disturbances in the area of ​​the foot. Since the nerve mainly supplies the outside of the foot, these sensory disorders occur (Sensory disturbances) especially there.
If the ankle is also affected by the swelling, in rare cases water retention (Edema) or small bruises (Hematomas) come.

Duration

Inflammation of the peroneal tendon is a very protracted disease.
Even with strict adherence to the prescribed therapy, that too Sports ban and Immobilization those affected must be patient. Until the symptoms have subsided sometimes Weeks pass away.
How long the inflammation lasts varies from patient to patient.
What is certain is that one renewed exercise only after full recovery may take place. Otherwise, the recovery process could be disrupted and the duration of the illness could be significantly extended.

diagnosis

To be able to make the correct diagnosis, a doctor-patient conversation, also known as anamnesis, is sufficient for many doctors. It is important that the patient describes when the pain occurs.
For example, there are patients in whom the pain caused by the peroneal tendon syndrome only occurs under exertion, while in others, when they have not done sport for too long.
Based on the conversation, the doctor can already collect the first important diagnoses and then carry out additional examinations.
The next step is the inspection, during which the doctor looks at the patient and can thus determine whether there are any anatomical misalignments, such as a bowleg (Varus), and thus explain the peroneal tendon syndrome.
In addition, the doctor may notice a wide-legged gait, a hollow foot or an incorrect foot position.
One of the most important methods of diagnosing peroneal tendonitis is duplex sonography. This is a special ultrasound examination in which the vessels are examined.
An inflamed tendon has many vascular injections, whereas a healthy tendon is vascular-free. This can be seen well with the help of the duplex ultrasound and thus also the degree of inflammation.

Read more on the topic: Doppler sonography

An X-ray examination can also help with the diagnosis, but it mainly shows bony irregularities and is therefore less suitable for assessing the tendons or the degree of inflammation.

therapy

There are several ways to treat peroneal tendon syndrome.
First of all, the patient should try to keep the stress on the tendon as low as possible. On the one hand, this means that the patient no sport should drift, to the other, he should be on appropriate Footwear respect, think highly of. Only in rare cases is one Splint of the lower leg and ankle are necessary in order not to put any strain on the tendons.
In most cases, however, it is not enough to reduce the strain on the tendon; instead, one is also required anti-inflammatory (anti-inflammatory) Therapy. Here will be anti-inflammatory drugs used which often also have a pain-relieving effect. These include the Non-steroidal anti-inflammatory drug, NSA for short.
Often it helps the patient additionally if he has the help of a Physiotherapists Can work out exercises that strengthen the tendon but at the same time do not stress too much. In addition, the physiotherapist can correct possible misalignments or gait postures and thus prevent the peroneal tendon syndrome from occurring again.
However, patients may experience various movements over a long period of time, especially when they are jerky load the lower leg muscles, can no longer perform.
Does a patient suffer from a particularly high level Arch of the foot, which in turn causes peroneal tendon syndrome, can be specially made medical insoles help. There are also a few Home remedieswhich can relieve pain and inflammation-related swelling. For one thing, most patients feel very good when they are cool envelopes Apply to the affected area. Cool too Quark envelopes can help as they also have an analgesic effect.
Potato wrap are felt by only a few patients as pain reliever as they get very warm and therefore better for Back pain are suitable as for pain relief in a peroneal tendon syndrome.
In rare cases, a operative therapy can be used to relieve the symptoms of peroneal syndrome. If the tendon tears, it is important to remove the effusions that have formed (Debridement) and repair the tendon again.
In some cases, the canal in which the tendon runs must also be smoothed to avoid renewed rubbing of the tendon in this canal. In most cases, however, such a surgical procedure is not necessary.

physical therapy

If there is no pronounced damage to the tendon itself when the peroneal tendon is inflamed, the disease is primarily treated conservatively, i.e. without surgery. As part of conservative therapy, anti-inflammatory and analgesic medications, as well as support bandages and cold compresses, are used.
Above all, however, the affected extremity should be spared. Admittedly, adequate immobilization of the ankle is essential in order to prevent the disease from progressing, but it must be borne in mind that Long-term immobilization can in turn delay the healing process and can even lead to further damage to muscles and bones.
Physiotherapy can help reduce inflammatory processes moderate activation of the diseased leg to subside faster. It also helps to counteract the breakdown of muscles and bone substance that inevitably occurs after long periods of rest. The affected ankle should only be exercised under the guidance of an experienced physiotherapist.
Jerky and sudden movements, especially slides and sudden changes of direction, must absolutely be avoided. These would worsen the symptoms and could cause lasting damage to the tendon.
Occur when there is inflammation of the peroneal tendon structural damage the tendon itself on must possibly operated on become. After an operation, the patient is usually not allowed to appear for six weeks. The doctor can also prescribe physiotherapy during this phase and beyond to support the healing process.

Taping

The so-called Kinesio taping it is a therapy that can also be used as part of conservative measures. The treatment concept is based on the application of self-adhesive, elastic adhesive strips to the skin.
The water and air permeable adhesive plasters are used in many orthopedic diseases and can help the muscles through inflammation of the peroneal tendon Lowering the resting tone to relieve. Some techniques are said to be by stimulating skin receptors Relieve swelling and pain associated with swelling.
Kinesio tapes can be put on by orthopedists or physiotherapists with special training and are enjoying growing popularity among patients and therapists.
The benefits of the colorful adhesive tapes have not yet been sufficiently scientifically proven. This is due, on the one hand, to the novelty of the method and, on the other hand, to the difficulty of carrying out suitable studies on the topic.

prophylaxis

A peroneal tendon syndrome is on the one hand by a adequate footwear often to avoid, on the other hand, the patient should sufficiently exercise before exercising warm up.
Also should jerky movements should be avoided and the patient should try to adapt his performance to his existing abilities.
In addition, it also applies again and again during hard training phases Breaks insert in order to give the tendons the opportunity to recover and not put them in a permanent state of stress.

forecast

Peroneal tendon syndrome usually has one good prognosis, as it is caused by overload in many patients. An adequate therapy can therefore usually achieve success.
However, there are also patients who suffer from chronic peroneal tendon syndrome for no apparent reason. Here it applies, regularly Physiotherapy lessons to be proven in order to strain the eyes in the right way and not to strain them.