From the Guidelines
Peroneal tendonitis typically presents with pain, swelling, and warmth along the outside of the foot and ankle, particularly behind the ankle bone and along the lateral foot, with symptoms worsening with activity and improving with rest. The symptoms and signs of peroneal tendonitis can be identified through a combination of clinical examination and imaging techniques. According to the study by 1, MRI can achieve high sensitivities in diagnosing ankle tendon tears, including peroneal tendinopathy and tendon tears, with sensitivities and specificities of 83.9% and 74.5%, respectively, for tendinopathy.
Key Symptoms
- Pain along the outside of the foot and ankle
- Swelling and warmth, particularly behind the ankle bone and along the lateral foot
- Symptoms worsen with activity, especially running or walking on uneven surfaces
- Symptoms improve with rest
- Morning stiffness is common
- Instability or weakness when walking
- Tender to touch, with possible visible swelling or redness
Clinical Examination
The clinical examination is crucial in diagnosing peroneal tendonitis, as MRI evidence of peroneal tendon pathology should be treated with caution due to the high prevalence of asymptomatic tears, with up to 34% of asymptomatic patients having a tear of the peroneus brevis tendon 1. A thorough clinical examination can help identify the affected area, assess the severity of symptoms, and guide treatment decisions.
Imaging Techniques
Imaging techniques, such as MRI and US, can be used to confirm the diagnosis and assess the extent of tendon damage. However, it is essential to consider the clinical context and correlate imaging findings with clinical symptoms, as the positive predictive value of MRI evidence for clinical findings is only 48% 1.
Treatment
Initial treatment for peroneal tendonitis includes rest, ice application, compression, and elevation of the foot, as well as over-the-counter anti-inflammatory medications like ibuprofen or naproxen to reduce pain and inflammation. Proper supportive footwear, possibly with custom orthotics, is essential during recovery and for prevention of recurrence.
From the Research
Symptoms of Peroneal Tendonitis
- Lateral ankle pain and swelling 2, 3, 4
- Instability of the ankle 2, 3
- Pain due to peroneal tendinopathy, tears, or subluxation 5
- Chronic lateral hindfoot pain and dysfunction 6
Signs of Peroneal Tendonitis
- Tears of the peroneus brevis tendon 2
- Peroneal tendon tears or tendinopathy 5
- Subluxation or dislocation of the peroneal tendons 3, 4
- Intrasheath subluxations and peroneal tendonopathy and tenosynovitis 4
- Hypomobile talocrural joint 6
- Limited dorsiflexion and unilateral heel raises 6
- Abnormal Star Excursion Balance Test results 6