The tendon is a band of tissue which attaches muscles to the bone. In each leg, there are two peroneal tendons which run side by side down the fibula (the lower leg bone) and the lateral malleolus which is located behind on the outside of the ankle. One peroneal tendon runs underneath the foot and attaches itself to the inside of the arch and the other attaches itself to the outside of the foot at the base of the fifth metatarsal (little toe).

The work of the peroneal tendons is to provide stability to the ankle and protect it from sprains when it is bearing weight. They also help stabilize the arch when walking and also turning the foot.

Types, Causes and Symptoms of Peroneal Tendon Problems

Peroneal tendon problems can be acute (occur suddenly) or chronic (develop over a period of time). These types of injuries mostly occur in athletes who participate in sports which require repetitive ankle motion. Also, people with higher arches are more prone to developing peroneal tendon problems.

The common types of peroneal tendon problems include:

• Tendonitis: This is inflammation of the tendons, and it can occur in one or both of them. The inflammation is caused by the overuse or repetitive use of the tendon as well as the trauma to the ankle. Symptoms include:
• Pain
• Warm to touch
• Swelling
• Acute tears: These are caused by trauma or repetitive activities. Symptoms include:
• Swelling
• Pain
• Instability or weakness of the ankle and foot
• Tendinosis (Degenerative tears): These are chronic and are caused by overuse of the tendon. The tendon in tendinosis conditions looks like something that has been overstretched till it’s thin and fray. The symptoms of tendinosis include:
• Ankle weakness or instability
• Sporadic pain on the outside of the ankle
• Increase in the arch’s height
• Subluxation: This is when the tendons have slipped out of place, usually one or both of them. It can occur due to trauma to the ankle or an individual can be born with a variation on the shape of the muscle of bone. Injury to the tissues which are responsible for stabilizing the tendons (retinaculum) may lead to chronic tendon subluxation. Symptoms include:
• Instability or weakness of the ankle
• Sporadic pain behind the outside of the ankle
• Feeling of the tendon snapping around the ankle bone

Early treatment of a subluxation is important since a tendon that continues to move out of place (sublux) is at a high risk to rupture or tear.

Diagnosis of Peroneal Tendon Problems

Your physician will first discuss with you your medical history as it can point out if you’ve been overusing the peroneal tendons and the kind of activity that caused the injury. He/she will also have to make sure that the pain is in the peroneal tendons rather than the fibula (calf bone).

A physical examination will be carried out and your physician will use a variety of techniques to look for symptoms by generally moving the ankle and foot into various positions and applying pressure.

Tests such as x-ray, MRI or ultrasound may also be done to identify any abnormal swelling or scar tissue, and to rule out any possibility of broken bones.

Treatment of Peroneal Tendon Problems

Treatment for peroneal tendon problems usually depend on the type of tendon problems you might be having. The treatment options include:

• Medication: Injection or oral anti-inflammatory drugs can be administered to help relieve the inflammation and pain.
• Immobilization: This involves using a splint or cast to keep the ankle and foot from moving hence allowing the injury to heal.
• Physical therapy: Ultrasound, heat or ice therapy can be used to reduce the pain and swelling. Other exercises may be added as the symptoms improve to strengthen muscles and also improve the balance and the range of motion.
• Bracing: A brace may be used for a short term or during activities which require repetitive ankle motion. When a patient does not qualify for surgery, bracing can be an option.
• Surgery: This is rare, and it is usually recommended as a last resort if the other treatments fail to work. It involves the surgeon either repairing or removing the impaired tendon.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service, from initial consultation through to final diagnosis and treatment and beyond. Our multidisciplinary team of expert doctors, nurses, physio therapists are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.