What is the treatment for thickening of the peroneus brevis tendon at its insertion at the base of the fifth metatarsal?

From the Guidelines

The treatment for thickening of the peroneus brevis tendon at its insertion at the base of the fifth metatarsal should begin with conservative measures, including relative rest, icing, and eccentric strengthening exercises, as recommended by the American Family Physician in 2005 1.

Key Components of Treatment

• Relative rest to decrease repetitive loading of the damaged tendon, as suggested by 1
• Icing for 15-20 minutes several times daily to reduce inflammation and pain
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for 1-2 weeks
• Physical therapy focusing on gentle stretching and strengthening exercises for the peroneal muscles, performed 2-3 times weekly for 4-6 weeks
• Proper footwear with adequate arch support and possibly lateral heel wedges to redistribute pressure

Additional Considerations

• A temporary walking boot or ankle brace may be necessary for 2-4 weeks in more severe cases
• If conservative treatment fails after 6-8 weeks, corticosteroid injections around (not into) the tendon may be considered, as mentioned in 1
• Surgery is rarely needed but may be an option for cases resistant to conservative management for 6+ months, as discussed in 1

Underlying Causes

• Overuse, biomechanical issues like overpronation, or acute injury causing inflammation and thickening of the tendon where it attaches to the fifth metatarsal bone
• Addressing both the symptoms and underlying causes is essential for successful treatment, as emphasized by 1

From the Research

Treatment of Thickening of Peroneus Brevis Tendon at Insertion at Base of Fifth Metatarsal

• The treatment for thickening of the peroneus brevis tendon at its insertion at the base of the fifth metatarsal is not directly addressed in the provided studies.
• However, the studies provide information on the anatomy and biomechanics of the peroneus brevis tendon and its insertion site, which can be useful in understanding the treatment options 2, 3.
• The study by 4 discusses the treatment of peroneal tendon injuries, including tendinitis and avulsion of the insertion, but does not specifically address the treatment of thickening of the peroneus brevis tendon at its insertion site.
• The study by 5 discusses the treatment of peroneal tendon disorders, including immobilization, laterally posted orthotics, and physical therapy for progressive tendon loading, but does not specifically address the treatment of thickening of the peroneus brevis tendon at its insertion site.
• The study by 6 discusses conservative treatment options for tendon injuries, including nonsteroidal anti-inflammatory drugs, corticosteroid, eccentric exercise, and other modalities, but does not specifically address the treatment of thickening of the peroneus brevis tendon at its insertion site.
• Overall, the treatment for thickening of the peroneus brevis tendon at its insertion at the base of the fifth metatarsal may involve a combination of conservative treatment options, such as physical therapy and orthotics, as well as surgical options, such as debridement or repair of the tendon 4, 5, 6.

Anatomical Considerations

• The peroneus brevis tendon inserts at the base of the fifth metatarsal bone, and its anatomy can vary between individuals 3.
• The study by 3 found that the peroneus brevis tendon can be classified into three types based on its attachment to the base of the fifth metatarsal bone, which can affect the forces exerted on the bone and the mechanism of fractures involving this structure.
• Understanding the anatomy of the peroneus brevis tendon and its insertion site is important for developing effective treatment options for thickening of the tendon at this location 2, 3.

Biomechanical Considerations

• The peroneus brevis tendon plays a crucial role in the stability of the foot and ankle, and its function can be affected by thickening of the tendon at its insertion site 2.
• The study by 2 found that the peroneus brevis tendon can exert a deforming force on the proximal fragment of fractures at the base of the fifth metatarsal, which can affect the healing potential of these fractures.
• Understanding the biomechanical properties of the peroneus brevis tendon and its insertion site is important for developing effective treatment options for thickening of the tendon at this location 2.