From the Guidelines
Peroneal tendinopathy in dirt bike riders can be managed with a combination of rest, physical therapy, and gradual return to riding, prioritizing reduction of repetitive stress on the ankle to minimize morbidity, mortality, and improve quality of life. The symptoms of peroneal tendinopathy typically include insidious onset of load-related localized pain coinciding with increased activity, described as sharp or stabbing, which may subside after a warm-up period but gradually increases in intensity and duration, potentially present at rest in later stages 1.
Treatment Options
- Initially, reduce or pause dirt biking activities for 2-4 weeks to allow inflammation to subside, as relative rest is recommended to prevent further damage and promote healing and pain relief 1.
- Apply ice for 15-20 minutes several times daily, especially after activity, as cryotherapy provides acute relief of tendinopathy pain 1.
- Take non-steroidal anti-inflammatory drugs like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for pain and inflammation, although they have no effect on long-term outcomes 1.
- Wear supportive footwear with proper ankle stability both on and off the bike, and consider custom orthotics if you have flat feet or high arches, as orthotics and braces may be beneficial based on clinical experience and patient preference 1.
- Physical therapy exercises focusing on peroneal strengthening and ankle stability are crucial, such as resistance band eversion exercises (3 sets of 15 repetitions daily) and single-leg balance exercises, as eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes 1.
Return to Riding and Prevention
When returning to dirt biking, ensure proper boot fit and consider ankle braces for additional support. Modify your riding technique to reduce stress on the ankle, particularly during jumps and landings. This condition occurs when the peroneal tendons become inflamed due to repetitive stress from foot positioning on bike pegs, constant ankle movement during riding, and impact from jumps and rough terrain. If symptoms persist beyond 4-6 weeks despite these measures, consult a sports medicine physician or podiatrist for further evaluation, and surgery may be considered as an effective treatment option in carefully selected patients who have failed conservative therapy 1.
From the Research
Symptoms of Peroneal Tendinopathy
- Lateral hindfoot pain and dysfunction 2, 3
- Persistent lateral ankle symptoms 3
- Posterolateral ankle and lateral foot pain 4
- Functional deficits, such as limited mobility and strength 3, 4
Treatment Options for Peroneal Tendinopathy
- Conservative therapy, including physical therapy and therapeutic exercise 2, 3, 5
- Manual therapy techniques, such as lateral calcaneal glide 2
- Eccentric exercise 5
- Corticosteroids and nonsteroidal anti-inflammatory drugs for short-term symptomatic relief 5
- Surgical treatment options, including superior peroneal retinaculum repair or replacement, groove deepening procedures, rerouting procedures, and bony procedures 6
- Operative intervention should be reserved until conservative measures fail or an obvious operative lesion is present 5