Ankle tendinitis (Peroneal Tendinosis)
Ankle tendinitis, also known as peroneal tendinosis, is the inflammation of one or two of the tendons that surround the ankle joint. It is usually an overuse injury, meaning it occurs over time from repeated movements in sports or daily activities that put too much strain on the ankle. For this reason, ankle tendinitis is fairly common in long-distance runners and athletes of a number of other sports.
What causes ankle tendinitis?
Tendons are thick bands of tissue that connect muscles to bones and enable the movement of joints. The foot and ankle are connected by two peroneal tendons—the peroneus longus and peroneus brevis—that run behind the rear bone of the ankle (fibula) and connect on either side of the foot. The main function of these tendons is to stabilize the foot and ankle and protect them from injury. When one—or both—of these tendons becomes inflamed for any reason, the condition is called ankle tendinitis.
Inflammation means that the tendon has become larger from thickening and/or swelling. In the majority of cases, this is an overuse issue that occurs from participation in sports. When athletes of certain sports train too hard without taking enough time off, if they are not training properly or if they make any sudden increases in training intensity, it can lead to this inflammation and ankle tendinitis. Marathon and long-distance runners—especially those who run on sloped surfaces regularly—and gymnasts, dancers and some basketball and football players are all at an increased risk of developing ankle tendinitis. Athletes who have high arches, heels that turn inwards or weak calf muscles are also more susceptible, and even wearing the wrong type of shoes can contribute to its development. Less commonly, ankle tendinitis can come about from a single injury like an ankle sprain, or from an inflammatory condition like arthritis.
What are the symptoms?
Unless there is a sudden injury that causes ankle tendinitis, symptoms will arise gradually over time. Patients will typically experience an aching pain on the outside and back of the ankle. There may also be some swelling, tenderness and warmth in this region—especially when touched—that can get progressively worse if not treated. The pain tends to increase during physical activity and upon waking in the morning, but will often be alleviated with rest. Some patients will also experience pain when turning their foot inward, walking or running on a sloped surface, or pushing off the ball of the foot while walking or running.
What is the treatment?
If you’ve been experiencing symptoms that suggest ankle tendinitis on a regular basis, you should see a medical professional like a physical therapist as soon as possible for a diagnosis and treatment plan. Failing to get treatment for this injury can make patients more likely to tear their peroneal tendon, which is a much more serious injury. Your medical professional will conduct a thorough examination that includes an interview, an evaluation of your gait (how you walk) and a number of motion and strength tests of the ankle.
If ankle tendinitis is confirmed, a treatment program will be prescribed that usually includes the RICE protocol and physical therapy. Most cases will heal without the need for surgery, but because it is an overuse injury, lots of rest will be needed and it can take several months before symptoms completely settle down. The following steps may help manage injury symptoms:
- Rest: avoid putting pressure on the ankle and any activities that make symptoms worse; try low-impact options like swimming and cycling instead
- Ice: apply an ice pack or cold compress to the ankle for 15-20 minutes, about three times a day until symptoms start to subside
- Compression: wear a compression bandage or support brace to support the injured area
- Elevation: when resting, keep the ankle elevated above the heart
Depending on how severe your ankle tendinitis is, your physical therapist may prescribe an ankle brace or even a boot to address symptoms. Your treatment program will consist of a number of components that will all be focused on reducing pain and increasing function, and will typically include the following:
- Passive modalities: your physical therapist will often use ice, heat, ultrasound and soft-tissue massage to alleviate pain and symptoms; passive means that these treatments are being performed on the patient without any effort on their part
- Manual therapy: hands-on techniques to mobilize joints and loosen tightness
- Range of motion exercises: these will help to increase flexibility and help the ankle and foot to move properly, which will make walking and running easier
- Strengthening exercises: resistance bands, weights and exercise balls may be used to build back up the strength of the ankle, foot and lower leg
- Functional training: for athletes or those injured due to an activity, there will be a set of specific exercises to help you return to your previous level
- Education: your therapist may also help you select proper footwear for certain athletics and give you advice on how to prevent another injury
Only in extreme cases will surgery be needed. This applies if there is a large tear of the peroneal tendon or a bony growth that further irritates the tendon. Surgery will be performed to clean up the tendon(s) and repair the tear. Recovery from surgery can take quite a while and will require a splint and additional physical therapy.
Can ankle tendinitis be prevented?
Since it is an overuse injury, there are some steps you can take to reduce the chances of developing ankle tendinitis:
- Keep your hips, knees and ankles strong and flexible, especially if you’re an athlete
- Make sure you are always wearing proper footwear for walking, running and during any other physical activity, and be sure to change shoes when necessary
- Never increase your training load of any physical activity too rapidly; gradually increase its duration, speed and intensity, and be sure to take enough time to rest and recover
- Avoid running on hills or uneven terrain on a regular basis; if you do, try to add them into your routine gradually
- Using a brace or compression tape on the ankle during sports may also help; ask a medical professional for more guidance