Peroneal Tendon Pain: take time off or run through the injury?

With most of my injuries, including what you are describing I have continued jogging easily for 10-30 minutes a day, every day until the injury heals.

This is just personal experience and I'm not saying it would work for you, but..

These easy jogs are always on a flat grass field. They are usually barefoot, however I do sometimes use it as an opportunity to see if any shoe/orthotic/taping combinations make a difference.

I find the gentle movement and warming up of the muscles help the injury heal faster, but again, this is just my experience. However I will not resume normal training until I can jog for 60 minutes everyday on the grass without pain.

This probably didn't help you much at all and to fair, 2 weeks is not a lot of time.

Been there. Run through that. Be smart!

I ran through it w/out seeing doc until I could only get about 1/4 a mile without stabbing pain.... doc said I was a few days from ripping the tendon through which is a surgery type of injury.

So.... fix it before it gets out of control Go to the doc if you can - or at least order an ankle brace off the internet. This isn't the exact ankle brace brand I got from my doc, but it looks similar and you can order it online cheaper than with the Rx....

http://www.dme-direct.com/aso-ankle-brace

My podiatrist is a runner and supports helping me run through stuff... said I could run through it and take longer to heal or rest and heal faster. I ran through it, and I'll be honest, it was over a year before I could ditch the brace on any run over 10 miles...but that's b/c I was so bad before I went in for the appt. If you catch it early, you'll be much better off.

Do the exercises you'll see all over the internet for PT. The one that helped me the most - before you get out of bed - take about a minute to point and flex and stretch out the ankle before you walk on it. I felt the pain the most when I got out of bed in the morning - this exercise really helped that.

Did your pain go away when running barefoot? For me the pain is just as severe when I'm not wearing any shoes. And another problem is I still want to maintain my mileage and fitness because I am more of a 400/800 guy, so I'll need every bit of training to do well in that 8k. Do you think a few days of toned down mileage would help or would that be wasting days I could have been getting in good training?

Also, from what I've read, some people are saying that even with rest it took months for them to be able to run without pain again...from experience how long did it take you guys to recover?

Also, should I go see my normal physician or a sports clinic doc? Obviously the sports clinic would provide a better diagnosis, but if this simple enough to where my physician could provide the same, then I would save 45$

Calf raises! work on calf strength. Single leg donkey calf raises (support yourself with elbows leaning over desk) 3 sets up whatever...keep adding.

I was sidelined for a long time from this. It is relatively simple your calves are weak and you are depending too much on your peroneal muscles.

Also use a stick to roll out those peroneals! don't forget the brevis either down at the bottom.

Stretch them too, use a rope to invert your foot, or a curb.

But seriously it is calf weakness more than anything.

short term fixes to get you through the 8K:

1) get a Stick roller device (or rolling pin, whatever) and roll the hell out of the upper outer calf just below the tendon attachment point. it WILL help relieve the pain in your ankle! see pic on this page that says "peroneous longus trigger point":

http://www.triggerpointtherapist.com/blog/peroneous-trigger-points/peroneal-trigger-points-ankle-pain/

2) do the stretch described on this thread by North Coast:

http://www.letsrun.com/forum/flat_read.php?thread=3417355

3) (optional) wear a walking boot for 2-4 days to completely immobilize the foot & allow the inflammation to subside. i had a bad case of this last fall three weeks out from a HM - wore a boot from Thursday to Sunday, jogged easy on Monday for 15min with minimal pain/soreness. progressed from there & raced. so contrary to what you may think, i think a couple days of letting the tendon completely rest might do some good!

long term stuff you need to do to fix the problem:

1) get a balance disc and do single-leg balancing, 2-3 minutes each day per leg. make it difficult (close eyes, toss ball off wall, do single-leg squats, etc)

2) get a theraband & strengthen your ankles, especially the plantarflexion & eversion movements described here:

http://www.eorthopod.com/content/peroneal-tendon-subluxation

3) and calf raises like the above poster mentioned!!!

do very slowly, full range of motion on stair or stack of textbooks - 3-4 seconds up AND down. the eccentric part will solve your achilles issues!

I've had mild issues with my peroneal tendons twice before and both times they have cleared up within 2-3 weeks when I have easily jogged through it. Like I said before though, this is just my experience and you may be different.

Regarding your question about the barefoot running and the pain disappearing, the easy answer is yes it did disappear. However the slightly longer answer is, yes it did disappear but not right away. Taking off my shoes has never miraculously cured any of my injuries, the only reason I do it is so that I can run a bit more naturally and there is no outside force acting on my legs while I recover. I believe it's the mechanical component of the easy running that helps heal, not the shoes or lack of.

The biggest thing I should say though, is that I have never had an injury so bad that running has been excruciating. I'm not sure I could bring myself to run through a really bad muscle tear or a stress fracture, plus I'm not sure it would be wise. Sure, those easy 10-30min jogs can be pretty uncomfortable, however I'm never in so much pain that I start limping or really getting scared I am doing permanent damage.

If It were me, I would:

A: Go see a medical professional, a physiotherapist has always been where I go. Listen and do what they say (the physio I see tends to agree with my easy jogging medicine)

B: Go for some super easy jogs on grass. If barefoot feels better, go barefoot. If it doesn't feel better then don't run barefoot. Not everyone is able to run in barefeet as easily as others.

C: Once you can run 30 mins pain free, try 45mins then an hour.

D: I would do the 8K race, but only if it more important to you than a fast recovery.

**Disclaimer**

I am not an expert and I am in no way a great runner. My last 10km was only mid 33 so you can take what I say or leave it.

I have peroneal tendonitis right now. I've had it twice.

First experience: Sharp pain started immediately after a race, was on crutches for three weeks, but fine after that.

Second experience: Pain grew to a 5-6 while running, ran 15 miles at that level, pain progressed to the point where I couldn't walk. Had to take four days of cross-training, one Alter-G, biked a few days, and only now am back to workouts a week and a half later, but it's still lingering a little (2 on the pain scale).

My advice would be to knock it out now because 5 while walking and 6-7 after running is a lot of pain, and a single run that's more stressful than the others (faster or longer) might make it so bad you can't walk. I could have knocked this out in two or three days, but because I was impatient I made this worse than it should have been. I went to PT three times last week and that seemed to help. Icing a lot and rolling out my foot also helped. Alter-G was good at 80% when I was recovering. Other than that, bike/aqua-jog.

Two weeks out you're really not going to lose any fitness. Running through this much pain is a large risk with little benefit. The only thing I'd be careful about cross-training is not overdoing it on the bike too close to the 8k try-out, because if your legs aren't used to a lot of biking you will be very sore.

When you get back into it, stay flat and avoid turning in on the bad foot. Think Zoolander:

https://www.youtube.com/watch?v=8hJ1HDcMowk

Also, it might be worth checking to see if you're running on the outside of your feet, since that can cause peroneal problems. Shoes or insoles that are too supportive for you are a common culprit. In my case, I had put in Superfeet two weeks prior in an attempt to knock out my PF. Instead they pushed me onto the outside of my feet.

Another culprit is a really inflexible big toe. If you can't get off your big toe quickly you're going to roll outward. This helped me with the big toe problem:

https://www.youtube.com/watch?v=lv0GT975DI8

Sorry, I did four days XT/biking, one Alter-G, then a few days of easy jogging gradually building mileage again. Not biking.

Everything the bad as Naomi Russell said to do - DO IT.

Massage it - I like to crush the peroneal upper parts with the stick right before bed. Maybe even go to get a sports massage with someone who uses Graston to really dig in there. Massages REALLY help with this, if the provider knows to target the proper areas (upper attachment near the knee).

Strengthen through balance, eccentric calf raises, and using a theraband off the bedpost as resistance against you trying to rotate your injured ankle outward.

Stretch the calves with a ProStretch. Also, do ankle rolling exercises. Sit on a table, leg over the edge, bent at knee with 90 degree angle. Write the alphabet with the injured foot. Write the alphabet forwards and backwards a few times.

Also - if there is significant pain or it gets worse after running. Ice it too.

As for running - depending on how the massage helps you out, consider taking a week or two off.

You should consider that it could be Posterior Tibial Tendon Tendonosis/Dysfunction.

It will also give you that sharp pain right under the outside ankle.

This is a good overview:

http://www.foothealthfacts.org/footankleinfo/pttd.htm

It's no fun. I've been battling with this for a year and a half now.