Peroneal tendonitis

definition

The Peroneal tendon is the muscle attachment tendon of two Muscles, the fibula muscle (Fibularis muscle) or. long fibula muscle (M. peroneus longus) and the short fibula muscle (M. peroneus brevis), which are in the immediate vicinity of the fibula and the movements of the Pronation (Inward rotation of the forearm) and Plantar flexion (Bending the foot towards the floor) are involved.

introduction

Parts of the peroneal tendon are also involved in the structure of the Transverse arch of the foot involved. The peroneal tendon runs enveloped in Tendon sheaths, starting from the muscles behind the outer malleolus of the fibula, Lateral malleolus, along and then pulls on the sole of the foot to the Sphenoid bone (Os cuneiform) and the first and fifth metatarsal bones.

Connective tissue plates, the so-called Retinacula musculorum fibularium superius and inferius, give the peroneal tendon additional hold in its position.

A common clinical picture of the peroneal tendon is Inflammation of the tendon itself and also the associated tendon sheaths.

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
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Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Causes of peroneal tendonitis

The cause of inflammation of the peroneal tendon and tendon sheaths is in most cases one Overload or Improper loading

Please also read: Cause of tendinitis

Since the peroneal muscles are responsible for pronation (inward rotation of the foot) and plantar flexion (the bending of the foot in the direction of the sole of the foot), sports, hobbies and occupations in which this muscle group is particularly stressed are responsible for inflammation.
Typical sports are for example ballet, To go biking and To run.

The repeated movements of the peroneal tendon with muscle tension behind the outer ankle cause the tendons to rub against each other on the bone and the tendon sheath.
This leads to irritation of the peroneal tendon and its tendon sheath, which in turn leads to inflammation. Also a minor injury, like one Tear in the peroneal tendon can promote the development of inflammation.

A similar cause is the so-called Peroneal tendon snap, in which the peroneal tendon slides forward from its position behind the outer ankle. With this dislocation of the peroneal tendon, it rubs with its tendon sheath on the outer ankle and can be irritated or even damaged, causing the inflammation.

The peroneal tendon snapping occurs through eversion (inward rotation and upward pulling) of the foot and simultaneous contraction of the peroneal muscle and is facilitated by a flattened outer ankle.

Another cause of inflammation of the peroneal tendon is immunological in nature and occurs after one infection with certain pathogens. During the infection, pathogen-specific antibodies develop, which are later directed against the body's own tissue, such as the peroneal tendon with its tendon sheath, and cause inflammation.

Furthermore, it can occur through direct contact of the peroneal tendon with the environment, for example through a injury, for contamination with bacteria come that one then bacterial inflammation cause.

Symptoms of peroneal tendonitis

A typical symptom of inflammation of the peroneal tendon is pain along the tendon and the tendon sheath near the outer malleolus.
This pain occurs mainly as a result of locally exerted pressure or during certain movements in which the peroneal tendon is tensed. In severe cases of inflammation, there may even be pain at rest.

Depending on the severity, the inflamed area can be swollen, reddened or overheated. However, it can also be completely inconspicuous from the outside.
Due to the pain that occurs when moving, the function of the peroneal muscle is impaired and reduced, at least until the inflammation has subsided.

A common symptom of peroneal tendon snapping is that when the peroneal muscle is tensed accordingly, the tendon jumps out of its sliding bearing, migrates in front of the outer ankle and then, despite possible re-adjustment, an inflammation occurs with the consequences mentioned above.

Read about this too Pain in the lateral heel

Diagnosis of peroneal tendonitis

When setting the diagnosis an inflammation of the peroneal tendon, it is important to get a first impression of the symptom pattern primarily through questioning and a physical examination.

As a rule, those affected report very precisely that the pain caused by the inflammation occurred after overstressing the peroneal tendon through sporting or professional activity. An immunological or infectious cause can also be identified with the help of a anamnese identify.

Usually they are Pain behind the outer ankle, i.e. following the course of the peroneal tendon and radiate slightly into the surrounding tissue.
The pain is triggered by local pressure on the tendon or movement or stretching of the foot in such a way that the peroneal tendon is tensed, for example when the foot is pulled up or turned outwards.

When palpating the foot on the outer ankle and peroneal tendon, this is typical for inflammation thickened and swollen. Also can this reddened and warmed up be.

If the peroneal tendon is dislocated, it can even be felt in front of the outer ankle. For example, an imaging test to support a suspicion of inflammation may include a Ultrasonic- or X-ray examination be.
In the case of an inflammation, an edematous border can be heard around the tendon and its tendon sheath, which indicates the inflammatory process.

Therapy of peroneal tendonitis

The first measure in treating inflammation of the peroneal tendon is Reduction of the tendon overload and Immobilization the same. This should enable the peroneal tendon and the corresponding tendon sheaths to survive the inflammation and to recover from it. On the one hand, you can do this by using a special rail or one Plaster of paris to achieve immobilization. On the other hand, in some cases it is just enough Reduce inflammatory movementuntil there is an improvement up to the initial situation.

A Physiotherapy follow-up treatment help prevent tendinitis

Also a local application of anti-inflammatory and pain relieving ointments can bring improvement.
Likewise can Medicines for pain and inflammation work and help to avoid a gentle posture of the foot caused by the discomfort.

Is there a infection of the peroneal tendon (except for the virus infection), this can be with Antibiotics or similar medication to shut off the trigger.
Even if there is an immunological cause for the inflammation, this should be treated specifically so that it subsides again.

At a Peroneal tendon dislocation this should first be adjusted again. Taking it easy afterwards can usually improve the result.
In chronic cases, an operative measure is recommended in which the peroneal tendon is splinted and thus stabilized. Otherwise, an operation is unlikely to be successful.

Prognosis of peroneal tendonitis

Usually an inflammation of the peroneal tendon can be prevented by appropriate prophylactic and therapeutic measures get a good grip.
The inflammation seldom becomes chronic, which is difficult and often lengthy to treat.

Prophylaxis of peroneal tendonitis

For prophylaxis against inflammation of the peroneal tendon, a Overloading and incorrect loading of the tendon be avoided.
An improvement in resilience can usually be achieved through regular stretching and targeted warming up of the peroneal tendon to reach.
In order to prevent an infection from the outside, one should have this professionally treated in the event of an injury and in any case the wound should be sufficiently disinfect. Autoimmunological processes are unfortunately very difficult to influence.