From the Research
Peroneal tendinopathy treatment should prioritize conservative measures, including eccentric exercises, as the most effective treatment option to improve pain and function, as evidenced by the systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments 1. The treatment of peroneal tendinopathy typically begins with nonsteroidal anti-inflammatory drugs, activity modification, physical therapy, and immobilization, with surgery typically reserved for those failing nonoperative treatment.
- Key components of conservative treatment include:
- Rest and activity modification to reduce stress on the peroneal tendons
- Anti-inflammatory medications, such as NSAIDs, to reduce pain and inflammation
- Physical therapy, focusing on eccentric strengthening exercises, ankle proprioception, and stretching of the peroneal tendons
- Supportive footwear with proper arch support and custom orthotics to correct biomechanical issues
- Corticosteroid injections should be used cautiously due to the risk of tendon rupture, as reported in the study on clinical outcomes and complications of peroneal tendon sheath ultrasound-guided corticosteroid injection 2.
- If conservative treatment fails after 3-6 months, surgical options, including tenosynovectomy, tendon repair, or groove deepening procedures, may be considered, as discussed in the study on the surgical treatment of peroneal tendinopathy 3.
- Recovery from peroneal tendinopathy can take several months, and gradual return to activities is important to prevent recurrence, highlighting the importance of a comprehensive treatment plan that prioritizes conservative measures and careful consideration of surgical options. The most recent and highest quality study, a systematic review of systematic reviews, found that eccentric exercises were the most consistently effective treatment for tendinopathy, regardless of location, and should be the primary treatment option for peroneal tendinopathy 1.