It’s probably best if you imagine the peroneal tendons (or at least one of them) as a sort of stirrup that helps support the foot. You see, the two tendons run from the outside muscles of the calves down the leg, then pass behind the outside of the ankle. From there, one tendon stays on the outside part of the foot and attaches to the base of the fifth metatarsal (the long thin bone that connects the base of your pinky toe to the middle part of your foot). The other tendon actually passes underneath your foot and attaches near the arch of the foot. Together, these two tendons help to stabilize and balance the foot and ankle.
Unfortunately, like any other tendon (and stirrups too, for that matter), the peroneal tendons can become damaged over time or injured, such as during an ankle sprain. They may become inflamed (develop tendonitis), or they might tear (either abruptly or develop numerous small tears over time). In some cases, the tendons may even experience subluxation, in which they move out of their proper position and come up over the ankle bone, usually due to a weakening or tearing of the surrounding tissue that keeps the tendons in place.
Problems with the peroneal tendons can happen to anyone, (unless we’re talking about aliens who walk around on tentacles rather than feet-they probably have their own sets of medical to-dos), although certain groups are more likely to develop issues than others. For instance, individuals with high arches tend to experience unusual strain on the peroneal tendon, which can eventually result in inflammation or injury. Sports that require a lot of repetitive ankle motion may also put you at risk, such as skiing, football, soccer and basketball. (Playing Duck-Duck-Goose for several hours straight may also result in injury, and not just to your dignity.) Also, if your calves are unusually tight, they may put more strain on your peroneal tendons, which, again, can lead to damage.
Some people may have a slightly abnormal bone structure that puts them at risk for subluxation of the peroneal tendons. Most people have a groove in the back of the fibula where the peroneal tendons move around (no doubt complaining from time to time about inadequate space). However, about a quarter of the general population do not have this groove, and thus may be more likely to experience subluxation of the peroneal tendons.
The symptoms exhibited by the various types of peroneal tendon injuries vary a bit, although they do have some points in common.
Let’s talk first about tendonitis. Like many other forms of inflammation, tendonitis in the peroneal tendons is characterized by pain, warmth, and swelling. Most of these symptoms are due to an increase in blood being sent to the injured area (your body’s attempt to promote healing).
Tearing of the tendon comes in two different forms: acute (sudden) and chronic (or tears that develop and accumulate over time). With either type of tearing, you’re likely to experience some instability in your ankle and foot (since those stabilizing peroneal tendons aren’t exactly in top form). You may also notice that your foot, or more specifically, your arch begins to change shape, and may appear to become higher. Pain may be a bit more constant with tears due to sudden injury, but pain from overstraining over time may be more sporadic, and is likely to be on the outside of the ankle. Swelling is more likely to be an issue with acute tearing than chronic.
When your tendons sublux over the fibula, you’re likely to experience a popping or snapping sensation which may or may not be accompanied by pain. (However, even if you don’t experience pain, it’s important to get your ankle checked out by a foot doctor. Pain and other symptoms may only develop over time, and the longer your injury goes undiagnosed, the worse it may get.) If pain is present, you’re likely to feel it around the place where the peroneal tendons usually sit: around the back of the fibula. You may also find that your ankle has become somewhat unstable.
As much as he or she would like to simply glance at your ankle and pronounce a diagnosis, your podiatrist will probably need a few more clues to figure out what’s causing your pain. In the case of peroneal tendon injuries, your podiatrist will probably perform a physical examination, checking for the symptoms listed above, like swelling behind the outside of your ankle bone, tenderness, and instability in your foot or ankle.
You may find yourself getting X-rays if the podiatrist wishes to rule out other possible causes of your pain, or find out if there are any additional problems with your bones. Or, an MRI might be used to get a good look at the tissues inside your foot and enable your podiatrist to spot any tearing that has occurred.
Your treatment will really depend on the severity of your injury. For instance, if the damage isn’t too severe, your podiatrist may opt for more conservative treatment. Reducing swelling and other signs of inflammation will probably be the first order of business. This is often accomplished by using anti-inflammatory medication (either oral or injected), ice, rest, and immobilization. You may find yourself becoming familiar with immobilization devices, such as casts or cast boots. These will help tissues to keep still so they can calm down a little and get down to the business of healing. If you’re very lucky (and have been a good girl or boy) you may even get to run around on crutches for a while.
Physical therapy may also be quite helpful. Your podiatrist may recommend exercises to stretch your calf muscles, which should reduce the strain on your peroneal tendons. Ice or heat, or even ultrasound therapy may also be used. Other devices such as braces or orthotics (prescription shoe inserts) may help provide stability and support for your foot and ankle.
If your peroneal tendon problems fail to respond to conservative treatment, or if your injuries are more severe, then surgery might be the best way to get your tendons back to working order. Torn tendons may be stitched together, or if necessary, replaced with new tendons. These replacements might be taken from your own body, (often your leg), or they may be permanently borrowed from someone who doesn’t need them anymore. Yes. You might be the recipient of a tendon transplant from, well, a dead person (more properly referred to as the cadaver bank). The nice thing about tendon transplants is that they don’t tend to get your immune system all worked up the way organ transplants do. And it’s kind of nice to think that a piece of someone else will keep on doing good work for your body.
Occasionally, if you happen to be one of those people without a peroneal groove in the back of your fibula, your foot surgeon may create one for you in order to help prevent future dislocations of your peroneal tendons. This and other surgeries may require hardware to keep everything in place while your body heals.
Recovery from surgery can vary depending on the type of procedure you’ve had done, but count on several weeks (often four to six) of being off your feet, plus another few weeks in a cast or cast boot, with another few weeks of physical therapy after that.
But don’t despair. It may seem like a long road, but really all of these treatments are designed to get your stirrup tendons back in working order, so you can (what else?) get back in the saddle again.