The peroneal muscles are two specific muscles, the peroneus longus and the peroneus brevis. They originate from the outer side of the leg. The tendons run from behind the outer ankle bone and they go towards the outer side of the foot. One tendon attaches to a bone on the outer edge of the foot and the other goes just beneath that region and actually crosses the sole of the foot and inserts close to the bone that attaches to the ball of the foot. These tendons can develop inflammation, when this occurs it is called peroneal tendinitis. Sometimes a patient may complain of snapping or popping in this area. the outer covering around the tendon that holds it to the groove behind the bone may become loose or insufficient. The tendons then sublux around the bone-sometimes the patient states that they actually make a popping sound-snapping peroneal tendon. These tendons can become inflamed as a result of compensatory problems existing elsewhere in the foot and causes the foot to stress its outer or more lateral margin. For example, a patient may suffer from inflammatory pain on the inner side of the heel secondary to plantar fascitis and after a long period of time when trying to reduce pain on the inner side of the heel, the patient may compensate and walk more on the outer side of the edge of the lateral side of the foot. When doing so it is not uncommon for the patient to complain of pain along the outer margin of the foot or ankle. This condition is called peroneal tendinitis.
How Is Peroneal Tendinitis Treated?
Conservative therapy involves the use of an appropriate device to stabilize the ankle and prevent the foot from tilting along the outer side. Various ankle braces are beneficial and can temporarily help stabilize the foot and allow the tendon to heal. Further treatment would involve radiographs, possibly obtaining MRIs in order to determine the degree of tendon injury. Various oral anti-inflammatory agents or injectable medications may be necessary for the resolution of the condition. Sometimes custom made orthotics or braces may be necessary to resolve the condition. In the more chronic cases surgical intervention may be necessary. Procedures selection is based on both the MRI findings as well as the clinical evaluation at the time of the surgical intervention. Various procedure that are carried out for this problem consist of debridement with tendon repair, possible tenodesis between both the peroneal tendons as well as sometimes lengthening procedures.If the tendons are popping or snapping this too can be repaired by reconstructed the soft tissue that holds the tendon adjascent to the fibula ( retinculum ). It is not uncommon for these problems to be associated with lateral ankle instability.