Peroneal tendinitis

According to my Injury classification system, peroneal tendinitis is considered Level 2 Injury, therefore there are two structures compromised, the alignment and the soft tissue muscles/tendon layer. Peroneal tendinitis (inflammation) or tendinosis (degenerative), is a debilitating condition that causes significant pain and discomfort at the outer part of the heel with possible radiations towards the bottom of the foot and the back of the calf area. Morning stiffness and difficulty with the first morning steps are usually common reports by patients.

Mechanism of Dysfunction

The main predisposing factor for the development of peroneal tendinopathy is the impaired foot mechanics caused by a compromised of the arches (see Flat foot page for detailed information), specially the lateral arch, causing the cuboid to drop resulting in increased sheering forces at the peroneal tendon eventually causing inflammation (tendinitis) and if left untreated it develops into a degenerative process (tendinosis).

Assessment Protocol

The entire lower extremity biomechanical chain must be evaluated as part of the foot/ankle analyses as per the neurological and mechanical influences of the spine, hip, and knee.

Clinical assessment to identify the key joint dysfunctions of the Ankle/Foot that have contributed to a compromised arch. Soft tissue analysis to pinpoint the level of irritation in the tendon.

X-ray analysis

Anterior – Posterior (AP) X-ray ankle view is essential for proper diagnosing the master joint of the ankle (Tibia-Talus) as the origin of poor arch mechanics starts from a dysfunctional ankle joint leading to hypermobility compensations that causes

Lateral Xray view is important to check the degree of the total arch compromised, specially the medial arch as per the direct influence it has with this deformity and to visualise the alignment of the calcaneus which is the main misaligned bone in this dysfunction.

MRI

Foot MRI is essential for:

Locate the exact injury point; Allows the treatment to be more specific during the application of the treatment modalities, in addition aids to identify the type of tendinopathy (tendinitis or tendinosis) and the corresponding appropriate treatment care.

Identify the extent of tissue damage and the presence of scar tissue; Provides valuable information regarding prognosis and the application of friction soft tissue modalities to aid on scar tissue removal.

Rule out any other condition that might mimic tendinopathies; There are rare disorders that may create similar patterns of dysfunction, is advisable to rule out these conditions prior to the start of the treatment.

Treatment protocol

Due to the influences the foot arches have in the development of this tendinopaty, arch rehabilitation must be incorporated as part of the overall treatment.

The treatment care should aim to restore the foot/ankle alignment and the soft tissue muscles/tendon layer.

Foot Arch treatment: Specific adjustments of key bones of the ankle and foot (Talus, Navicular, Calcaneus and Cuboid) followed by a rehabilitation regime to strengthen the entire soft tissue arch support of the foot. In addition, application of tape and corrective orthotics may be needed as part of the early rehab program.

Tibialis anterior tendon treatment

Ankle and cuboid adjustment

Application of Low-level Laser and PEMF to aid on the cellular level of heling as well as improving the microcirculation for the area.

Friction soft tissue therapy helps to reduce dysfunctional scar tissue

Specific stretches and strengthening to improve the resilient of the soft tissue support

Functional tape might be used to reposition the heel bone to reduce the stress on the tendon

Specific selected essential oil application to enhance healing

Depending on the level of arch compromised and chronicity of the tendinopathy a minimum of 6 weeks up to 12 weeks of treatment care may be necessary to resolve this deformity.