As the foot goes through the gait cycle of supination to pronation to supination, the Peroneal Brevis and Longus tendons are pulling upwards to pronate the foot and relaxes, yet remains taunt to prevent over supination. Peroneal Brevis and Longus are located just behind the fibula, coming down the back of the leg behind the ankle on the lateral side. The tendons go down under the lateral ankle and attach to the base of the fifth metatarsal. The basic purpose is to stabilize the lateral side of the ankle and to lift the outside of the foot upwards creating pronation and preventing over supination.
Symptom of Peroneal Tendonitis
As you get up and bare weight and the foot goes into an over supination position, stress is applied to the insertion point of the tendon at the side of the base of the fifth metatarsal bone. The pain will be most noticeable at heel strike through toe off if the foot fails to go into pronation. Common with a pes cavus or high arch foot. In the event that we do not have a high arch foot and there isn’t any over supination but over pronation then the pressure on the insertion of the tendons can be irritated by the pressure created by the shoe.
Cause of Peroneal Tendonitis
The cause of Peroneal tendonitis (tear or rupture) is most often due to a trauma, forcing the foot to over supinate severely and quickly. Though trauma is the major reason for the injury, tightness in the calves can have an influence on the trauma to occur. Other underlying conditions that can place stress on the Peroneal tendon would be a Hallux rigidus and leg length differences. The more factors the more susceptible one is to the injury.
Treatment of Peroneal Tendonitis
In the event that this is a rupture of the tendons or the bone at the insertion is broken, surgery will more likely need to be done to repair the damage. If this is a tear or inflammation of the tendon then the foot will probably be put in a walking cast to give the tendon time to heal. You need to have the doctor, physical therapist, or come in to our facility to check for a leg length difference due to the walking cast being higher. This is to prevent any discomfort to the hips. After the tendon has healed and before the foot is taken out of the walking cast, range of motion at the ankle must be tested and if the foot is not allowed to properly bend upwards 15 degrees then the tightness in the calf will cause the foot to over supinate and reinjure. This is to assume that we have a high arched foot to begin with. A stretching program will be needed to loosen up the calf muscle before much weight bearing is done without the cast. The stretching program can be found at the menu for feet hurt. Should tightness in the calf be present and causing further irritation at the site of the injury, putting a heel lift in both shoes will take that stress away while you work through the stretching. In addition it would be wise to discus with your Pedcorthist if some sort of an arch support or a custom made foot orthosis would help you through the recovery or to prevent further damage once it has healed. In the event that over pronation is the cause for further irritation then the arch support will be necessary. Shoes in this case could be of benefit. Wearing a stiff soled shoe with a wide base and a high toe off shoe would help you through the healing process by taking a lot of stress off the peroneal tendons.