Peroneal Tendonitis, Peroneal Tenosynovitis

There are a number of tendons in the foot which helps control movement while you are mobile (walking, running). The two major tendons that go around the outside of the ankle are called the peroneal tendons. They are important tendons because they balance the ankle and the back of the foot and prevent the foot from turning inwards repetitively, causing lateral (inversion) ankle sprains. Overuse and injury of these tendons causes weakness and mobility dysfunction. Normally, these tendons pass behind the bone on the outside of the ankle (fibula). In some instances, injury can cause the natural restraining mechanism to fail and allow the tendons to slip over the bone (Peroneal tendon dislocation). They are slightly weaker than the muscles and tendons on the inside of the ankle and are prone to injury as the ankle turns, rolls or becomes sprained.

Peroneal Tendon Dislocation / Tearing

Tearing or dislocation can occur in one or both of these tendons. This leads to pain, swelling, sensitivity and a sense of instability behind the outside of the ankle. They can also pop out of the supporting ligaments that hold them in place (a dislocation); once this occurs, continuous or recurrent dislocation and tearing is inevitable without immediate attention and repair. Stitching and at the worst, tendon replacement may be required for patients suffering from torn or dislocated peroneal tendon(s).

Treatment

Ultrasound is an excellent tool for reduction of swelling and pain when treating the injury. If treatment does not require surgery, rest the area, apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day up to 3 days. Moist heat may be used after the acute swelling is improved and rest prevents further muscle injury. Ice will reduces initial inflammation and swelling and the moist heat circulates blood through the area to speed the healing process. This can be further helped by the use of ultrasound applications over the affected area, as it reduces swelling quickly and increases blood flow to the area, helping the tendon heal more quickly.

If stitching of the tendon is required, do not use ultrasound on the area until all scabbing or wounds on the skin surface are gone. On this occurs, regular ultrasound use will "work" the tendon, increasing its flexibility and softening scar tissue in the area.

The trick to any tendon injury is getting it to heal with minimal scar tissue formation and with as much realignment of tendon fibres as possible - something Radiant Energy and Ultrasound are great at! Even with optimum healing there is always less elasticity in a previously injured tendon. The trick is to make sure you heal this the best you can, that way your chance of reinjury down the road is much lower than average.

The most common cause of an tendon inflammation (tenosynovitis or tendonitis) is overuse of the affected tendon. Rest of the affected tendon is all that is required in some cases. Other treatments such as anti-inflammatory drugs or a steroid injection are sometimes needed. Infection of a tendon is an uncommon cause but needs treatment with antibiotics if it occurs.

What is tenosynovitis and tendonitis?

* Tendonitis means inflammation of a tendon. (It is sometimes spelled as tendinitis.)
* Tenosynovitis means inflammation of the sheath that surrounds a tendon (the sheath is called the synovium). Tenosynovitis can be caused by calcium deposits, repeated strain or trauma, high levels of blood cholesterol, rheumatoid arthritis, gout, or gonorrhea.
These two conditions often occur together.

Never use Ultrasound over an area injected with a steroid (ie. cortisone) for at least 30 days.

Never use Ultrasound after surgery until your physician recommends and approves of it.