Patient Education

Ankle Tendon Injuries

Description

The two peroneal tendons run tight behind the rather pointy bone on the outside of your ankle. One then attaches to a bone on the outside of the middle of your foot, and another runs underneath the foot to connect on the opposite side, helping to strengthen the arch. These are the tendons that make it possible for you to turn your foot outward, and they provide stability and balance for your arch and ankle, making it just a bit more difficult for you to get a sprain. Unfortunately, sometimes these tendons can get damaged. As with other tendon problems, this damage may come from sudden injury, or may be a result of long-term (or chronic) issues.

Ankle sprains or repeated stress on the tendons (usually from overusing them) can cause tendonitis, which is basically inflammation of the tendons. The problem might be with just one of the tendons, or both together.

Sprains or repeated stress can also cause the tendons to develop acute tears. If these tears go unhealed or untreated, they can begin to make the arch of the foot raise up.

Long-term overuse of the tendons can lead to degenerative tears, where the tendons themselves are stretched so much that they begin to fray and tear. This type of injury usually occurs gradually, sometimes over years.
When the peroneal tendons decide to make a break for it and slip out over the ankle bone, its called subluxation. Despite the cool name, this problem is pretty serious and definitely needs early treatment. Subluxation can happen because of the shape of a persons ankle bones or musculature, or can be a rather severe result of a sprain or other sudden injury. If the area is damaged enough, the subluxation problem might become chronic.

Symptoms

Tendonitis, like other forms of inflammation, will usually make the area feel warm to the touch, swollen, and painful, particularly along the outside of the foot and ankle.

Acute tears will likely manifest themselves somewhat similarly, causing pain in the area and swelling. The ankle or foot is also likely to feel somewhat unstable (which is understandable since those stabilizing tendons arent working quite up to snuff).

Instability or weakness will also show up with degenerative tearing, and pain will tend to occur intermittently (it likely wont be constant). The arch might also start to rise.

When those tendons slip over the ankle bone (subluxation), youll most likely feel a snapping sensation in the area. Pain will hit intermittently, and the ankle will feel pretty weak.

Diagnosis

If you suspect you may have a peroneal tendon problem, get in touch with your podiatrist promptly. He or she will likely check the ankle for weakness and instability, ask you about any pain you may be experiencing, and will check to see if the area is swollen or warm to the touch. The podiatrist might also use imaging equipment such as an MRI or an ultrasound to get a look inside your foot or ankle to see what the problem is.

Treatment

If the problem with the tendons is mild, an anti-inflammatory treatment may be sufficient to allow the area to heal. Your podiatrist may suggest rest plus anti-inflammatory medication, which may be taken by mouth or might be injected into the area. However, immobilization may be necessary. Your podiatrist might use a cast or splint to keep the ankle still, or give you a brace to wear (always an attractive fashion accessory) during times of activity.

He or she may also suggest physical therapy, which usually includes using cold or heat to reduce swelling and promote healing, ultrasound therapy, and exercises to strengthen the area, such as calf muscle stretching. Orthotics can also provide long-term support.

In some cases, particularly when the tendons have torn, or when subluxation has occurred, surgery may be necessary to correct the problem. Your podiatrist will determine the best course of action for you, and may use a combination of the above treatments to get your peroneal tendons back in working order.