Peroneus Tenonditis

What is peroneal tenosynovitis?
Peroneal tenosynovitis is an inflammation of the peroneal tendons and their common ulcer. Most susceptible are athletes who perform repetitive motion of the ankle, such as marathon runners. The causes of peroneal tenosynovitis are overuse, sudden increase in training intensity (especially in running and jumping), improper training techniques and improper footwear. Predisposing factors are high arches, and muscular imbalance of the lower limbs.

Analysis of the peroneal muscles
There are three peroneal muscles: the long peroneal, the short peroneal, and the third peroneal. The long peroneal is the most superficial muscle of the outer compartment of the tibia. It arises from the head of the fibula, is carried around the external malleolus on the peroneal groove and lodges in the medial sphenoid and the 1st metatarsal. The short fibula arises from the lower two thirds of the fibula, is carried under the outer hammer on the outer surface of the heel and is attached to the base of the 5th metatarsal. The tendons of the long and short fibulae shall be brought together in the fibular groove in a common sheath and shall be held in place by the upper forefoot vertical ligament. Both the long and short peroneum are innervated by the superficial peroneal nerve. Their action helps in pronation and dorsiflexion of the foot.

What are the symptoms of peroneal tenosynovitis?
Peroneal tenosynovitis can either be acute, meaning it occurs suddenly, or it can be chronic, meaning it develops over time. The most common symptoms are pain, swelling and redness at the back of the ankle that worsens during activity and decreases during rest. Instability of the ankle may also be observed. MRI can also be used to rule out any tears, detect abnormal swelling or scar tissue and further aid in diagnosis.

What does treatment of peroneal tendinitis tendinitis involve?
Treatment of peroneal tenosynovitis includes rest and avoiding walking or any other activity that may aggravate the injury until the pain is gone. In cases of severe pain, shin splints, ice therapy and non-steroidal anti-inflammatory medications can be used to help relieve pain and swelling. Physiotherapy is helpful, particularly exercises to strengthen muscles and improve balance. In persistent cases, cortisone injections can be made into the peroneal tendons, but there is a possibility of rupture. Rarely, as a last resort, and if conservative treatment fails, surgical treatment involving the cleansing of the inflamed tissues is applied.

Chronic peroneal tenosynovitis leads to the formation of scar tissue that makes the tendons more prone to rupture. Also, tendon insufficiency can lead to ankle instability and multiple sprains that can cause damage to the ankle cartilage. Prevention of the condition includes the use of proper footwear, stretching of the gastrocnemius and other muscles.

Both early diagnosis and an appropriate physician are essential steps for effective treatment. Dr. Antonios Pettas is a specialist in Orthopaedic Surgery and Traumatology, from Norrtälje, Danderyd and Karolinska University Hospital, Stockholm. He has also specialised in Foot Joint Surgery at the private Nacka Hospitals in Stockholm and then in Basel, Switzerland under the world renowned Professor Hintermann. For more information about peroneal tendinitis and its treatment, contact Orthopedic Surgeon Antonio Petta.