Peroneal Tendonitis

Has anyone had this injury before? It's what my doctor thinks I've got. Any advice on how to treat it and promote its healing would be very appreciated. It started hurting about three weeks ago during a long trail run. I've been trying to lay off it ever since, but I ran about two hours last Saturday, because it was feeling better and I'm afraid I may have set it back. I guess it's the bike for me for a while. It's very frustrating.

I also bought some Superfeet insoles for my running shoes. Any experience on whether these help?

Hey sgdesertrat,
I've just got over something similar, Peroneal Nerve Entrapment, would start to hurt about 4 miles into a run then it would relax. The next morning, I would walk like the old zombie movies, for 3 or 4 days. It continued to get steadily worse with less mileage & would last longer. After better than 8 months of Sports MDs, PTs, massage therapy and no improvement & lots of cash outlay, I finally diagnosed myself . Took my chiro about 15mins to straighten it out & I was in the rebuilding phase till I tore a calf skiing. The other docs in the know had me doing heel lifts & insoles & stretches(like all runners do anyway) but I was paying them to tell me to do them, only to find out they had no idea what my problem was anyway. I spent about 4 hours looking on the internet, before I found it. Do the research sometimes it pays off or in this case might have saved me time & money. Jeff

Hi there! I'm new to the forum, and should have posted an intro when I first joined, but didn't.....DER!

Anyway, I wanted to comment on this because while I've never had it, I've treated it (I just retired from 8 years in private practice as a podiatrist....career change, long story, best told over some cold beers after a long run).

Your best bet to treat peroneal tendonitis, is, unfortunately, to suck it up and stop running. As a runner of 25 years, I tried to avoid telling athletes to stop doing their activity, like most PCP's will. But, there are times you just need to stop all aggravating activity and rest it by not running for at least 2 weeks. And ice, ice baby! As I'm sure everyone here knows, ice is Your Best Friend when something starts to hurt.

In an acute case of pretty much any type of tendonitis, I'd employ what I would refer to as "shotgun therapy" - that is, do several things all at once:
1) stop offending activity, assuming it was athletically-caused (which most of the cases I saw unfortunately were NOT)
2) ice 20-40 min. 3-4x/day
3) mild immobilization (ie, ACE wrap or coban) for compression
4) short NSAID use (ie, Motrin, Alleve) for 3-7 days at most

Resume activity gradually, and if there is the slightest bit of pain in the area, stop again.

For more resistant/chronic cases, I'd put patients in a Cam walker and have them do the RICE thing as well. Judicious use of cortisone injections with cam walker immobilization can work as well...

What you DON'T want to do is try and train through the pain - that can lead to degenerative changes within the tendon, stenosing tenosynovitis (more common with the peroneal tendons than others), whereby the tendon sheath scars and essentially sticks to the tendon. If that happens, you are looking at surgery to clean the scarring out of the tendons, and even then it might not work.

Good luck, and if it keeps bothering you, try to find a sports med doctor or a podiatrist who has a clue about how to treat athletes (many don't, unfortunately). DEFINITELY do cycling as cross-training in the meantime!

They should, actually, as they will reduce the frontal plane motion in your feet that the peroneal tendons (well, p. brevis anyway) work to stablize. I had a really good working relationship with the hiking store in the town I just moved from (Prescott, AZ) and Dave there would give me all sorts of OTC insoles to try; I have the Superfeet in my backpacking shoes and I love them! I have also been wearing custom orthotics (ha - go figure that!) since '95, when I was doing my residency, and I keep those in my trail shoes. My road shoes have Lyncos OTC insoles and I recommend those highly as well.

Best bet: find a specialty athletic shoe store (read: NOT Big 5) that carries a few different types of insoles and try 'em all on with your running shoes. Go w/ the one that feels the best, which is totally subjective of course :-).

Hope that helps!

Sonya, who misses the awesome trail running Prescott and northen AZ had to offer....

Wow. Thanks a lot. I'll start more aggressively icing it. I've done some icing, but not a lot, because there isn't any visible swelling, but I guess that was wrong. My symptoms are pretty different from yours Jeff. Mine is sorest first thing in the morning and starts hurting pretty quick during a run. My Dad is an orthopedic surgeon (retired) and raised me to be biased against chiropractors, but it's probably something I should try to get over. Thank you both for your advice.

Awesome information, Sonya! Welcome to the forum. I'm looking forward to more of your expertise. Was the focus of your practice on the feet only, or do you also have experience with knee problems?

Glad it was helpful! (hopefully)
To answer your question, yes, my focus was on the feet and anything pertaining to them from the skin on down....I didn't deal with knee problems directly, although biomechanical issues with feet can definitely affect the knees. Sometimes, getting a patient into custom or OTC orthotics and new shoes would take care of some knee/hip/back problems. Otherwise, I'd send them to an orthopod (many of whom also dislike podiatrists, unfortunately). I was trained in forefoot and some rearfoot surgery, which I enjoyed, and while I never did surgery specifically on the peroneal tendons that I recall, I did do other tendon surgeries, including those on the Achilles and posterior tibial tendon.

BTW, just to clarify: peroneal nerve entrapment and peroneal tendonitis are completely different entities - the only thing they share is the name "peroneal". Etiologies, symptoms and treatments are totally different.

Cheers,

SJ

Thanks Sonyaj,
After re--reading the post I realized I had misread the original. Sorry about that!
DISREGARD MY INTRUSION! Jeff

Ok! Now I'm having more peroneal problems! After the nerve thing and another delay & layoff, I am now getting a pain in what I think to be the "peroneus longus" muscle (approx. 10" up from the bottom of my heel, towards the outer side, off center of the calf, about crew sock top level) It seems to start to tighten & ache around 1/2 mile. Seems to be more pronounced at pushoff part of the stride.
Hoping Sonjai or anyone can help! Looks as if I might of gotten a little too much too soon! Planning on using the RICE approach for the next 5 -7 days Anyone?
Thanks in advance! Jeff

I'd do some balance exercises.
When trail running the peronei and various other muscles in the foot are having to co - contract really hard to keep the foot - and thus the rest of the body- in balance. I always find that if I suddenly increase off road distance my peronei will hurt for a few days after for that reason.
Just standing on one foot with your eyes closed is a start, you can then work out various progressions yourself - stand on one leg throw a ball against a wall (remember to open our eyes again first!) throw the ball so you have to reach further out of balance ...... etc
I agree with the shoe comments above. Resist the temptation to just stick and insole in your shoe as this just raises the oot higher in the shoe and can add compressio to the common peronal nerve. Also remember that if you are using a non - trail shoe for trail running the shoe tends to be higher making the peronei work still harder to maintain balance
Hope this help - Jane Chartered Physiohtherapist based in the UK
Just realised this post is now 12 months old - I saw May 17th and assumed it was two days ago, not 12 months and 2 days. I'll post the reply anyway the info may help someone else

Thanks for your reply, janeho. I'm sure anyone suffering from Peroneal Tendonitis who happens to read this thread will be glad for your insight.

sonyaj,

are you still on this forum? I have been having all symptoms for peroneal tendonitis, although my doctor and MRI tests don´t agree (the doctor does not know what is it that I have, and MRI showed nothing. I have not been running for months, and now he says I should not swim either. And here I go with medicine again- Arcoxia this time, for 2 weeks. What do you think?
Please excuse my english, it is not my native language.

Adriana, Brazil

Hi Adriana. I'm not a trail runner but I think I have the same injury (from soccer) and have been doing a lot of research on the issue over the last few days.

I found this link (http://www.orthogate.org/patient-education/ankle/peroneal-tendon-problems.html) very useful for understanding how peroneal tendonitis is diagnosed. For me, the pain is especially intense when trying to use my ankle to point my toes upward against downward pressure (like my hand or other foot).

I'm also responding because I just came across this post (http://www.runnersworld.com/community/forums/injury-prevention/injuries/peroneal-tendon-injuries-kind-of-long), near the bottom of the thread, about someone having several negative MRIs only to have the tear confirmed by an ultrasound.

Hope this helps.

I just came across this thread, I don't know if it is still active though. I have been having chronic peroneal tendonitis for MANY years and I agree with one of the other people above- the only thing that really works is REST! Orthotics and insoles (I've tried a bunch) help to keep it at bay I guess, along with stretching before AND after running. Keeping my sneakers in the newer side helps as well. But once it is in full flare mode, nothing touches it but rest! I don't agree with the person above that says that surgery may be needed, apparently that's really rare, I read that here: http://www.samuraiinsoles.com/peroneal-tendonitis-treatment

Thank you!- Sandy