Peroneal Tendonitis Treatment | San Diego Sports Chiropractic
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- Опубліковано 18 гру 2022
- Peroneal tendonitis treatment usually involves a variety of treatment modalities. Peroneal tendonitis can be a result of ankles sprains, repetitive strain (ballet dancing, jumping, running), people with high stiff arches in their feet, and from compensation due to other injuries (plantar fasciitis).
Peroneal tendonitis treatment may start with Graston technique to the peroneal muscles (The peroneous longus, peroneous brevis, and peroneous tertius) to help loosen up the muscles while promoting blood flow to the area. Active release technique for peroneal tendonitis may be helpful to break down adhesions and trigger points within the peroneal muscles. Most importantly, loading the peroneal muscles with proper strength training exercises will help stimulate the injured areas of the tendon while providing strengthening to avoid future reaggravation. Peroneal tendonitis rehab exercises are crucial to help the tendons heal properly.
In treating peroneal tendonitis, it is important to discover the root cause. For example, if a patient has very stiff, high arches, this will place more of the body weight on the outer half of the foot which will overly stimulate the peroneal muscles. Another example is peroneal tendonitis due to hallux limitus (when the big toe has limited extension), patients will have a hard time shifting their weight towards their big toe during gait which keeps their weight on the outer half of the foot, loading the peroneal muscles too much.
Other conditions such as plantar fasciitis can lead to peroneal tendonitis due to compensation. When the bottom of the inner heel is painful, patients unknowingly keep the weight of their body on the outer half of the foot to avoid pressing into the painful part of the heel; peroneal muscles again become strained resulting in peroneal tendonitis. Many of these patients experience outer heel pain while walking or outer heel pain while running. Another condition called cuboid syndrome causes peroneal tendonitis as the peroneal tendons run across a portion of the cuboid bone. When the cuboid bone is stiff and not moving well with cuboid syndrome, the peroneal tendons also become stiff resulting in pain.
Do you have pain on the outer part of your heel and ankle? You may be dealing with peroneal tendonitis. Schedule today with one of our sports chiropractors to get a proper diagnosis and treatment plan to help get out of pain, fast. Our sports injury clinic is located in Mission Valley, San Diego! Schedule below:
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ua-cam.com/video/ooNbWt3MZEc/v-deo.html Check out our exam and treatment of Achilles Tendonitis to the difference between achilles and peroneal tendinopathies.
This is probably the best peroneal tendonitis/tendinopathy video I've seen. This really should have more views. Btw, I got this injury from figure skating. Thank you for making this!
Thank you! We really appreciate the kind words! I can see how figure skating can cause this. Figure skating is a beautiful sport :)
I couldn't agree more. Very informative! I got mine from Latin dancing.
Best damn video on the topic! I have watched SO many and this was the most informative by far. Thank you very much for making this clip.
Thank you for the response! Happy to hear you gained something from it :)
Wow guys, thank you so much for this! It all make sense now. I'm a professional ballroom dancer (and dance teacher) and I was told by an orthopedic surgeon to keep my foot in a moonboot (for three months now already!) after an MRI showed I have peroneal tendinosis. My condition only worsened until I threw the moonboot away out of frustration two weeks ago. I started messaging the leg out of instinct and it's already a little bit better. But I still wasn't sure why it happened in the first place or how to correct it. Now I realize the way I walk is incorrect (and yes, jumping in 3inch heels didn't help). Can't wait to get back onto the floor, road to recovery here I come! :) Much love!
Happy to hear you are on the proper road to recovery! Glad the video offered some insight… unfortunately the boot approach is something we see often with patients with tendinopathy. Unsure why orthos/podiatrists still recommend it when the evidence shows otherwise 🤷🏻♂️
Best vid so far!!
Thank you! We appreciate the feedback :)
Agree with commenter above. Best video I’ve seen in terms of not only exercises but explanation of possible causes. I have a history of plantar fasciitis and now I am having peroneal tendonitis. It has been a pain trying to get rid of it.
Thank you for the feedback! I hope you are able to find relief soon. Keep at it, peroneal tendonitis, and plantar fasciitis can be tough to fully get rid of but it is possible. Exercises are key!
This was very helpful! Very thorough I thank you very much.
Thank you, we try to put a lot of thought into the videos. We worry we talk too much lol
As someone else mentioned, really well explained. Thanks
Thank you! We appreciate all the positive feedback :)
Love it! Thank you!
You are welcome! Glad you enjoyed it :)
Excellent informative video - Thank you very much .
Thank you!
Excellent video! I’ve been dealing with this for over four months with severe pain on the outside of my heel where it curves to the bottom of my foot. My evaluation was not as thorough but after watching your video about the stiff big toe I now realize that is a huge part of my problem. I will be working on loosening up that toe. Thanks a bunch guys!
Happy to hear you found some benefit! The big toe is an often overlooked aspect in many foot/ankle/knee conditions!
Very good video. My pain is going into two months now. I’m finally starting to pay close attention to it.
Glad you found the video useful. Hopefully with some of the recommendations and exercises, you will start to see more relief!
Great video, thank you!!!!
Glad you liked it! Thank you for the feedback :)
I came cross this video and it's helping me exercise. Plz do more exercise on peroneal tendonitis exercise
Very helpful video.❤❤
Thank you!
This is the best video I’ve ever seen do you know any physical therapy places in Massachusetts that have the level of knowledge that you do too many places or just giving me band exercises and telling me to ice I wish I was rich I would fly to San Diego every week just to have you work on me
Search Active Release Technique with your city in google or go to their website. Providers with those certifications tend to know the muscles/tendons/mechanics better. I don’t know anyone specifically so search those terms, and read review of the places you find. Hope that helps!
excellent video, some more details on the things you say at the end, that can have an influence as well would be great! Maybe you could give some more information? I have this injury since almost 2 years and it came through another injury which lead me to mislead my foot
Hi Lenny,
Happy to offer insight as best as I can. Is there any specific question you might have regarding your case?
Thank you for your video. I do agree that is the most informative i have seen. I am wearing orthoses to support the arches after ankle and foot injury 5 months ago, with three avulsion fractures, talovavicular, bifurcate and in lisfranc joint.. I was suspecting that the otrhoses are one of the causes of my peroneal inflammation. I had pain under the arches for a while and have noticed the funny way i have started to walk, lifting the inside of the foot and pressing on the outside. Do you think that removing the arch support would be better ? Should i do the eversion and balance exercises though i have a swelling behind the maleolus? You have no idea how difficult is to find a good physiotherapist whee I live. I have seen 5 so far. Here they say that you must walk and do the exercises even if you are in pain and the foot is swollen.
Thank you for sharing this knowledge! Looking forward to trying the exercises and rolling! Will let you know how or if it helps! Almost certain this is my injury, is it common to have shooting pain in the big toe with peroneal tendinopathy?
I hope they help! The big toe pain may be something else... That is not a symptom of peroneal tendinopathy.
Excellent video, very well put together. Thank you for helpful information!
Is there a period of rest for acute injury before beginning to recalibrate with exercises?
Depends. If there is swelling and pain > 4/10 you want to take it easier with exercises. But if pain is manageable, these exercises can performed as soon as possible.
@@PeakFormHealthCenter Thank you very much.
MRI for a different issue caught a moderate split tear of the peroneal brevis tendon. That explains the pain I’m having. The MRI was for pttd which is quite painful. Not sure if the exercises for pttd are working against the exercises you are suggesting for peroneal brevis tendonitis. Any advice on band exercises for both conditions? Thank you.
Hi Terri, sorry to hear you are dealing with those conditions. Hard to be specific online; you will want to work with someone who can "trial and error" exercises with you to find what works. In general, pointing the foot straight down (plantar flexion) will work both muscles without potentially over activity of one side versus the other. But trying to work as much range of motion as possible on both sides will also be effective; depends on pain level, function, etc. For both conditions, following up the leg to address core, hip dysfunction will help as well.
Please suggest me exercises for flat feet
I have an elevated first metatarsal bone causing jamming in the big toe that prevents full flexion. Will these exercises help to lower the bone since it’s connected to the peroneus muscle? Do you have any other suggestions?
Yes they can help. Hard to say over the internet. But you need to do exercises that promote big toe grounding. Any exercise with focus on pushing through the big toe.
Has your practice ever seen a case where peroneal tendinosis leaves redness right along the lateral malleolus? The redness blanches when I rub or push on it.. and comes back. I can't tell if its blood pooling there, or redness from the tendinosis.
It has been red and painful there for over 4 months. I dont know what to do.
Edit: Redness is definitely right in that area you show as the sheath. Also worth noting I had a kenalog injection right in that very spot 6 months ago. Redness appeared there 2 months after the steroid injection. Redness has been there since, for 4 months.
Yes I have seen swelling and blanching like that. When the peroneals are inflamed and swollen, they can have that presentation. Many factors can be involved so definitely get it checked out. If it is simply, the muscles involved, compression sleeves help, rolling, strengthening etc. but if there is let’s say a cardiovascular issue that is causing ankle swelling and blanching, then the heart needs to be addressed. Depends on the case, definitely get it checked out by someone qualified in person.
@@PeakFormHealthCenter Thanks for such a quick response. Appointment scheduled with my primary care physician in a few days. Will be bringing this up. Cheers.
Hello thank you for this video. Had a question - I’m currently 30 weeks pregnant and recently due to swelling in my right foot only in the outside of the foot got diagnosed with Tendonitis.. I’ve not been an active person at all besides normal walking around house for normal chores, not sure what could have caused this tendinitis.. I’ve been in severe pain and my PCP has asked me to stay off my foot and use ice pack. It’s been almost 2 weeks now and my other foot has started hurting too around the outside - same spot as the other foot. I’ll be running out of my medications tomorrow. Please advice what can I do to help me heal sooner given my pregnancy condition.. would really appreciate your response. Thank you!
Hi Aman, during pregnancy, you release a hormone called relaxin. Relaxin causes a loosening of the connective tissues which allows for more flexibility for childbirth through the pelvis. The hormone has a widespread effect meaning it effects all of the connective tissues. So it can effect the ankles creating more laxity, causing more stabilization from the muscles. This leads to overuse of the muscles which can lead to tendinitis. So I think this hormone led to ankle instability causing the muscles to work too hard which led to the tendonitis. Using shoes or supports on the shoes that help support the foot and ankle can help, but keep icing taking pain relievers. After pregnancy, the ligaments should tighten back up
And help with support.
Really good video. If I am understanding this correctly, I should be looking at walking more to the inside of my foot? I have been battling this for a while, and I even got insoles with an arch because I thought this would help. I have been doing balance exercises on the leg that I have it on (which is my non dominant leg). I am going to start moving into the center to inside of my foot and see if this helps.
Correct, many patients we see with this condition have a difficult time shifting their weight through their arch and into their big toe when walking/performing exercises. In *some* cases, arch supports make this worse but preventing that motion from occurring; the build up arch blocks the ability to pronate. Most of the time significant improvement can be seen by being aware of how to walk normally, performing balance drills where you feel your big toe press into the ground firmly; if you search "mobo board" you will find a balance board which helps with this dynamic. No affiliation with them, it just helps.
Hope that helps! Thank you for the reply.
@@PeakFormHealthCenter Thank you. You are referring to one legged balance exercise?
That's the one
What is the difference between a tendon that needs rest (wearing a boot) and a tendon that needs to be strengthened/loaded? How do you distinguish between those two cases?
That is a great question and I wish I had an easy answer for you. It definitely depends on the patient presentation: ability to perform activities of daily living, pain intensity/frequency, if trauma was involved, exercise tolerance, is there swelling/bruising, etc. For the most part, we get patients on an exercise program to promote healing and avoid immobilization methods. Immobilization methods should be reserved for cases that are causing severe dysfunction. We have treated many people who tried the boot, felt better, started walking/going back to activity and pain came right back. The boot deconditions the structures and doesn't promote healing or address imbalances that are causing the symptoms. Hope that helps!
Last year I had walked almost 15 km on an evening, this was the first time since many years that I walked more then 2 km in one stretch. At night I woke up with the most extreme pain I've ever felt, worse then breaking a bone, worse then pneumonia, truly unbearable, the pain was around 4 inches above the ankle bone. I really started to go insane and started begging and praying and luckily the moment this happened I was visiting my son and stayed there overnight for the first time since years. So it was a real strange coincidence but he woke up from my screams and I couldn't explain what was happening, he tried everything possible, stretch, push, twist, turn, I'm 48 years of age 6ft 2 and at that time 200 pnds but I almost cried like a little child, so much pain but also not knowing what it was and what to do made me totally panic, at one point I truly wanted to end my life to get rid of the pain. After many ways of twisting and turning etc the pain slowly went away. I didn't sleep for the next three days, I was so afraid it would happen again! I went to the doctor and got some medicine and he told me it was tendonitis. It has been more than a year ago but I still can feel it hasn't healed and I'm always afraid it will happen again. If I push at the longus around 3 inches under my knee I can feel the pain becomes less. Can someone explain or has someone the same experience?
Wow sorry you dealt with such intense pain! If you notice a decrease in symptoms by pressing into the longus muscle, it is likely one of the culprits. You may have had an intense muscle spasm from the walking. When bad muscle spasms happen, there is a strain (small tear) in the muscle fibers that occurs. After a spasm, stretching, rolling, and strengthening help alleviate the recurring symptoms. I would start with that and see where that takes you. If you are worried about symptoms recurring I would see a specialist in your area for a full evaluation so you can have peace of mind!
@@PeakFormHealthCenter thank you so much for your response. Could you recommend what kind of therapist I should visit or some exercises I could do at home? The things I did myself trying to prevent it from happening again are, I bought some very expensive but more importantly very good high end walking shoes (Meindl), then I started walking with 2 miles in one stretch, this is since march this year, I'm now up to walking 8 miles in one stretch, at times I do it even two times a day just because it relaxes and ease my mind, ( my whole life before, I didn't even walked 1 mile if wasn't absolutely necessary) I do this to strengthen the muscles and also to get my joints and bones get used to it and strengthen them also, I hope you'll agree this is the right thing to do. Next to the walking I also started eating way more healthier and more structured since March this year . I take all the vitamins necessary and only eat natural foods, the good vegetables and fruits and only eat around 400 grams of chicken, fish or beef every other 2 or 3 days. I definitely feel alot better both mentally as physically but like I mentioned, the tendon issue keeps bothering me. I remembered I had broken my metatarsal bone more than 20 years ago, I had forgotten about it but this also took years to fully heal and in fact I thought it never did since I kept feeling it many years after, especially when I stood on the step(rung) of a ladder or when I was biking. Just curious but can this be related?
I don't want to take too much of your time but I truly appreciate your support by the things you wrote. Thanks. Kind regards, Bas.
I get peroneal tendonitis at random, and the pain always begins upon awakening. Even though it certainly didn't happen overnight, it absolutely feels like it 😅 I need to put myself on immediate bed rest starting as soon as I feel the pain, or it becomes so unbearable that even the weight of my own feet causes me pain severe enough that I wish my foot would simply be removed.
That sounds rough. I hope you have had it checked out by a sports chiro or pt?
Can peroneal tendinitis be caused by
Hallux rigidus and the resulting compensation pattern?😮
Yes absolutely. Patients with either rigidus or limitus need to work on getting through their big toe. Usually limitus flexibility/mobility drills work well. Rigidus will likely need a shoe with a good rocker through the forefoot, or an orthotic to help move through the big toe well.
Thank you for this video, you explained everything so well! I have been dealing with pain here for a while especially when I run and after watching this I am pretty sure it is peroneal tendonitis. I recently moved to Los Angeles and I went to get examined and he didn’t even look at my ankle/calf, just told me to stretch and that I probably have a vitamin D deficiency. Too bad I’m not in San Diego, is there anyone in my area that you would recommend seeing?
Well that sounds frustrating :/ What part of LA do you live in?
@@PeakFormHealthCenter yes very! I live in Los Feliz
@@lindseymiller3110 DR. PHIL RICCHIAZZI DC, DR. GOLAN NISSIM DC, DR. STEVEN HOORN DC
Look up those 3, I do not know them personally but they are certified in the same techniques I am. Hope that helps!
@@PeakFormHealthCenter thank you so much!!
Hello. A very important video because I suffer from bilateral plantar fasciitis and have this pain on both feet on the outside, which are now worse than that of my plantar fasciitis. While this pain is sometimes not present at all, the outsides continue to hurt. My physiotherapist denied a connection to my question. Where is another injury supposed to have occurred for me, I have not burdened myself at all since the appearance of the PF and the pain on the outside occurred much later. I also suspect a connection to my customised insoles with Arch Support in connection with my new Altrs with Zero Drop. On the other hand, I have a subpronation, I run my shoes off by nature on the outer shoe sides. My question. Could everything together, except plantar fasciitis, i.e. my subpronation including my insoles with Arch Support and unfamiliar Altra Zero Drop, lead to a collective load? Greetings from Germany, Thomas.
Hi Thomas! Your story is all too familiar. I have had several patients with the same presentation. What I have seen with other patients is compensation around the foot/ankle to avoid the painful symptoms of plantar fasciitis. If I understood correctly you have subpronation meaning you have limited pronation, which means you have high arches or a supinated foot/pes cavus? This type of foot has a difficult time shifting weight to the inner half of the foot, thus overloading the outer foot/ankle. This can be made WORSE with arch supports. Rigid, overly aggressive arch supports further limits the ability of the foot to pronate which shifts MORE weight to the outer part of the foot. This is why your shoes are wearing down on the outer edge of the shoe.
Your foot likely needs more pronation, so neutral without any type of motion control or stability shoe. You will also need to work on walking, running, getting your weight to press through your inner arch/big toe. If you are a runner, have your gait analyzed and look for "cross over gait" where you will step one foot in front of the other which causes excessive landing on the outer edge of the running shoe and a very fast/aggressive pronation moment which can cause all sorts of over use injuries.
Let me know if you have other questions!
@@PeakFormHealthCenter
Good morning. First of all, thank you very much for your quick response. Yes, supination is correct. I have always taken off my shoes on the outsides. When I had my insoles made a little more than a month ago, I looked at the prints of both feet and the prints looked neither flat feet nor high arch. Rather normal. Should I take the customised insoles out of the Altra and try it without? No, I'm not a runner. I got the PF from sudden walking and especially hours of standing on hard floors only in socks. I was able to do all this, also for professional reasons, for decades. Even extended hikes were no problem. Only two months on socks and and I am unable to walk 1 kilometre without going crazy with pain. At 73 kilograms per 182 cm, I would never have thought that. I have a question about plantar flexion. I try to avoid them in any case by pulling my feet to the rail leg while sitting and lying down. What do you think of that? I mean to overload my feet. From time to time I also put my feet in night rails during the day. At night I wear Strasbourg socks. Can Strasbourg socks further worsen these things by putting the ankle in an unfavourable position?I have manoeuvred myself through the calf lifter exercise into a deterioration and first step shorter with my exercises. I wish that I had physiotherapists here in my hometown in Germany with so much overview and background knowledge about the connections as you have them. I look forward to your reply.
I completely forgot to mention. My pain is in the midfoot and lateral under the feet . I also have no stinging pain in my heel. Unfortunately, the pain also radiates.
Can this happen after total knee replacement?
Yes it can. We see a variety of tendinopathies after knee replacements. Treating a couple Achilles tendinitis cases with knee placements right now.
Where are you located?
Hi, thanks for asking! We are located in Mission Valley, San Diego. Our office number is 16198184306, website is www.peakformhealthcenter.com
I have 15 year old soccer player dealing with this. How many times a week should he be doing the Active Release, Rolling, and Exercises?
By the way, you guys give great insight. Much more detailed and supported than most of the other explanations out there.
@@treythorne218 Thank you I appreciate that. Rolling daily, ART/Graston 2-3x per week. Exercises 3-4x per week is a good starting point, adjust from there
Thank you. Does Ice or Heat help at all with this? @@PeakFormHealthCenter
Focusing on using my big toe when walking and being mindful of pressing down with it took away like 70% of my pain instantly!
Sounds funny but I think I've been walking wrong my entire life lol
That is great to hear! Just had a patient yesterday who had the same experience.... Had her focus on walking though the big toe with walking and calf raises, drastically improved symptoms. Doesn't sound funny at all! No one teaches us how to walk, we just do it and we are really good (sometimes to our detriment) at compensating around pain/stiffness, etc. We don't realize we may have been walking in ways that increase strain until pain develops.
I need help I been dealing with this pain almost a month straight I just wanna be able to work and walk again comfortably I’m scared I’ll never heal from this it stresses me out 😢
when should we do the scraping, do we do it right before we start the exercises, right after, a day after the exercise's, before? Also how many time should we do the scraping per week.
Every other day for scraping. Before or after exercises doesn't matter. Sometimes it desensitizes the tissues so the exercises are more comfortable. Others feel its worse doing the exercises after getting it worked on. Experiment and see
@@PeakFormHealthCenter Thanks for answering my question!
Doing physical therapy it’s not getting any better
Sorry to hear that :/ Hopefully you will see improvement with more time/consistency with exercises. If you feel like things plateaued, might be time to find a second opinion as to what might be causing the symptoms.