Peroneal Tendonitis

I’ve struggled with it on/off for a few years and getting PT on it has helped. More specifically getting dry needling up the leg b/c it usually comes from higher up. Also, it can come from your mechanics being off or typically over supinating or rolling your ankle too much. Whatever you do, don’t get a cortisone shot. I got one of those and I ultimately ended up rupturing it two years later and I’m now recovering from the surgery. It’s a tricky injury but if you can figure out what may be weak up the kinetic chain, you’ll be good in the long run.

Thanks for the response. Fortunately, I do think I know the cause: over supinating as well as having weak ankles. This is why I'm trying to add a lot of ankle strength and mobility exercises, but right now it just feels as if it's never going to go away.

if it's the peroneal down by the ankle i recommend this. stop running for a few weeks. make the focus first on strengthening the ankle. a lot can change in 3 to 6 weeks. stand in place . put your feet into position as if you were running. one foot behind you. visualize that you were taking off from the ground with the foot behind you. freeze that foot in position and put it under you. look how far lower than the ball of the foot your heel is at take off. a part to strengthen includes the lift from heel dropped below ball of foot. this will tend to be ignored when lifting in shoes and when lifting from stances with feet directly under you. but if you put the ball of your foot on a platform/low step. and can drop your heel slightly lower than the ball of your foot, preferably with a support to land on, you can gradually regain this strength.at which point, if your trouble is continuously rolling ankle/ tearing down near ankle, you willl likely be protected and can then have more luck returning to running. you will want to do reps of calf raises standing on both feet. not the worst idea to start with crutches and drop into position from the up point before trying to raise from low. using crutches to take weight off and test range of motion. starting with the heel lower than the ball of the foot. very gradually increasing load. from nothing. to body weight . for example if i am 150 lb. i want to lift another 150 say 4 to 12 reps. maybe 3 to 5 weeks after starting with nothing. and of course get it up to 200+ added lbs. before doing much with one leg. but by the time you can do 3/4 your body weight of added weight. things start getting much safer vrs ankle tears. but if you only do the raises with ball of foot starting flat on ground, then, during your take off, the forces one ankle needs to endure will likely lead to continued tears. 3 sets of 8 no where near max ability starting with no added weight. going up 5 lb every few days. by 6 weeks you can be in a way safer situation. in my own situation , simply running was not enough to regain the ankle. with the ankle i could never tell i was hurting it when it hurt. had to wait until the next day. except maybe twice when i was trying to just run through it. so i prefer bringing the running back in ways that can be paced very carefully. treadmill was helpful. since its mainly a gambling game. and going by feel fails. so climb up gradually.

Fantastic response, thank you.

I'm unfortunately coming to the realisation that 1 week off is probably not enough time.

This week I started doing slow two-footed calf raises (flat ground) and didn't feel much so I moved to one-footed ones, but perhaps I was doing them incorrectly and moving to one-footed calf raises so quickly is perhaps what has re-inflamed the tendon. Plus, I've been doing a lot of peroneal theraband exercises as well as stability disc exercises.

Perhaps it was inevitable that I was going to re-inflame the tendon by introducing this many ankle/peroneal exercises this quickly, and I need to take another few weeks off like you say.

bump

Just getting over this which followed 7 mths of PF. The ortho doc had me in an ankle brace which helped, and he encourage me to lightly run.

In addition to the exercises, for me it helped to avoid super cushioned/sloppy shoes. I read where one rather prominent runner recommended the Beacon 3. It seems to help.

fj wrote:

Just getting over this which followed 7 mths of PF. The ortho doc had me in an ankle brace which helped, and he encourage me to lightly run.

In addition to the exercises, for me it helped to avoid super cushioned/sloppy shoes. I read where one rather prominent runner recommended the Beacon 3. It seems to help.

Thanks for the response, happy to hear you're getting over it.

I have a few questions if you don't mind:

1. How long did you continue to run on it in the onset of it? What made you step back from running and decide to tackle the injury head-on? I'm pretty new to running and have been ramping up the mileage and consistency over the past few weeks and as a result I'm in the mindset that this is something my body will just learn to deal with, but at the same time I'm very aware that that is a dangerous path to take.

2. How much mileage did you run whilst dealing with it? I've read from multiple threads on here that completely avoiding running on it is a bad idea

3. Do you have any theories about why avoiding cushioned shoes helps? I've been predominantly running in quite cushioned shoes so this is a super interesting point

Well, again, Plantar Fasciitis - which I never had in decades of running - got me after a very rocky downhill trail run in a pair of loose-fitting Torrent 1s. Anyway, 7 mths later after the treatments, including a cast and cortisone shot, it finally subsided and left me w/ a case of perineal - which the doc said was common. BUT, he fitted me w/ a soft ankle brace, high compression socks, and said to jog/run unless pain is severe.

What worked for me: ** Lots of rolling the IT band, fibula and tibia area - which are key to this injury, and the hamstrings; sitting on a table using ankle weights for clockwise and counterclockwise reps of 100; advil at night; and of course resting the bottom of the foot on ice after walking/running.

Everybody's different. Historically, I've trained in shoes similar to the adios 5, boston 6-9, the old Zoom Elite 9, etc., with never an injury. Going to the trendy high stack shoes was stupid for me. I find that the excess cushion allows unnecessary movement for my foot inside the shoe. Some folks can handle it. I can't. Anyway, even the Mach IV aggravated the perineal, which is weird. So did the Floatride Energy 3. The NB Beacon 3, and strangely enough the Atreyu Base model elicit no pains or aches.

My suggestions - keeping in mind we're different - definitely a soft ankle brace that does that X-shape across the foot, along with serious rolling of the lower leg - outer and inner muscles/tendons 2-3x daily, and a somewhat firm shoe that's not too narrow. Walk to warm up. Jog a bit. Walk a bit. Back off if there's pain. (128lbs, 5'6" slightly pronate w/ right foot - usually these days around 30-50 miles a week.)

Wish you the best...

I don’t suggest you do this but I just ran through it. The pain was really insane but I ran through both peroneal and posterior tibial tendinitis. I think I took two days off each time (for each injury) and just ran. Fortunately it ended up going away after a few weeks. I was running 80-100 mpw at the time. My peroneal flared up after 60 miles in three days

Do you have an example of the type of brace you are talking about?

JAKIR wrote:

I don’t suggest you do this but I just ran through it. The pain was really insane but I ran through both peroneal and posterior tibial tendinitis. I think I took two days off each time (for each injury) and just ran. Fortunately it ended up going away after a few weeks. I was running 80-100 mpw at the time. My peroneal flared up after 60 miles in three days

Thanks for the reply.

The thing for me is the pain isn't insane at all. Before I took this week off it was just this dull, inflamed feeling that would start happening when I supinated too hard during the run and then after the run when walking up/down stairs.

Being new to running, I've had no injuries before so I don't really have a good measure for how painful it should be before I stop running to prevent the injury nightmares I've heard about: ruptures, surgery, etc.

Your post about insane pain fills me with slight optimism that I'm probably not at that stage and I have some more running in me before I need to make a decision about taking more time off

Thanks for the great reply.

I'm definitely going to employ your advice here. I don't warm up before I run and usually feel quite a lot of stiffness in the ankles, perhaps this is playing a part. I'm going to try doing some dynamic stretches before running as well as increasing my foam rolling significantly, and see if it improves things.

I’m sure they’re many flavors but this is the variation I used successfully- had to remove one of the plastic stays though - irritated my ankle bone

https://www.simplymedical.com/ossur-formfit-black-ankle-brace-with-figure-8-for-either-foot/450999pa?sku=613428EA&msclkid=95da4afb54021b902d542bfdb1b6048a&utm_source=bing&utm_medium=cpc&utm_campaign=(ROI)%20Shopping%20-%20Catch%20All&utm_term=4585650685692196&utm_content=All%20Products

Are you positive it's peroneal tendon? Meaning, have you had imaging to rule out other things? I only ask because I was certain I had peroneal tendon issues and it turned out I had a calcaneal stress fracture. So taking time off was the only option

I recommend taking more time off - this injury is tricky. Consider getting an x-ray to see if your talus bone is not in alignment, as this would be contributing to the injury and supination (this can happen if you never really treated an ankle sprain). And, if you ankle mobility is poor right now, your glutes are probably weak. Find exercises that will strength your glutes and hips while you wait for the pain to subside.

I found that wearing an ankle compression sock helped me walk comfortably during my recovery. I also used a Strasburg sock and it seemed to help too (this is usually for plantar fasciitis).

There are a ton of strength resources online - check out Dr. Jo's peroneal tendonitis video. It's a good start.

Hey, I struggled with this for six months three years ago. I was miserable and tried every non invasive thing (rest, PT, tens, night splints, a boot, ect). I finally just got a steroid shot and have never suffered since then. Now I just work hard to keep my calves loose, my hips strong and have orthotics. Hope this helps in some way

Thanks for your replies, really useful. Was your pain in the foot region?

Mine is almost entirely above the ankle which seems somewhat less common from what I've researched online