Peroneal Tendonitis

[PinkLady]

I hate having to post here.

Well, at least my current issue isn't an overuse thing. During the Army Run, in the last third I had tightening and eventually cramping of a thin muscle on the outside of the right calf, which my chiro eventually diagnosed as the peroneus longus. Had some ART & Graston. Now a week later the muscle seems fine, but I learned yesterday that the peroneus longus eventually connects to tendon near the ankle bone, and, guess what?

Yup, tendonitis! Oh yay!

I was really worried after my run yesterday that I might have some PF too, because my arch was tight and aching, but I actually now think it's an overcompensation thing.....the peroneal tendon controls eversion of the foot, and now that it's inflammed and 'lumpy' feeling my foot is tending to roll in, hence the sore arch and hot spots/blisters on my instep (which I've never had before). I massaged the crap out of my foot yesterday, and it feels fine and normal today. Phew.

So the pain area is exactly what this picture shows. It's not agonizing, more lumpy feeling, and sometimes can 'zap' up the length of the muscle.



It's also worse in the morning and does loosen up after moving around, so there might still be muscle stuff going on too.

I tried compression sleeves, made it feel worse, probably because it's still 'acute' and inflammed so the sleeve was just trapping the inflammation. I'm going to try the KT Tape method for peroneal tendonitis today:

http://www.youtube.com/watch?v=jAgxpcx5pyk

I am so frigging SICK of getting tendonitis. Thankfully, at least, I don't have any big races I'm training for, and only a 10K right now on Oct 22. I have some stretches I'm doing, I'm also icing and taking Advil. My chiro showed me some calf raise variations to target the muscle, but I'm waiting till it's not sore anymore to do them.

Has anyone had this before? Any tips for recovery? My Googling reveals suggestions of everything from "tape it up and go again" (uhm, no), to rest for at least 2-4 weeks, to getting custom orthotics . I'm okay with not running, but aside from spinning, don't know what is/is not compatible with this type of tendonitis....in particular the plyo work in bootcamp, which I love but I don't know if it will aggravate the condition. (Obviously don't do it when it's still acutely sore, but is plyo stuff ok when it 'feels' ok to do it? Or will I live to regret it the next morning?)

ETA: Found this list of stretches/exercises to do for peroneal tendon injuries, posting for my own future reference:
http://www.summitmedicalgroup.com/libra ... exercises/

[fe.RMT]

I've had it.

[PinkLady]

I've had it.

Any recovery tips? Or is the general advice of 'don't do anything that makes it hurt' good enough?

[fe.RMT]

I personally would classify it as a tenosynovitis (but that's kind of splitting hairs). The longus and brevis share a common tendon sheath at the outside of the ankle. If the pain is felt at the outside of the ankle, then the sheath and two tendons are likely all involved. If you believe it is a tendinitis then, then it is probably safe to say it is a repetitive strain injury. Tendinitis/tenosynovitis is rarely, if ever, a traumatic injury.

There are two possibilities: the muscles could be shortened due to excessive eversion of the foot (possibly pronation) or the muscle(s) could be lengthened due to excessive inversion of the foot (supination). Both of these scenarios have the capacity to create pain/discomfort for different reasons and obviously both of them have very different treatment approaches.

You could have something else going on in your ankle that caused inflammation which then caused the tendons and the sheath to adhere to each other which decrease the glide between the structures causing pain and discomfort. This is maybe unlikely as you would have noticed that kind of inflammation in the ankle.

Usually the key to healing any repetitive strain injury is to avoid the motion/action that causes the pain. I wouldn't recommend complete rest, but avoidance of the activity is best. But I don't want to contradict anything that your health care provider has suggested.

[PinkLady]

I personally would classify it as a tenosynovitis (but that's kind of splitting hairs). The longus and brevis share a common tendon sheath at the outside of the ankle. If the pain is felt at the outside of the ankle, then the sheath and two tendons are likely all involved. If you believe it is a tendinitis then, then it is probably safe to say it is a repetitive strain injury. Tendinitis/tenosynovitis is rarely, if ever, a traumatic injury.

There are two possibilities: the muscles could be shortened due to excessive eversion of the foot (possibly pronation) or the muscle(s) could be lengthened due to excessive inversion of the foot (supination). Both of these scenarios have the capacity to create pain/discomfort for different reasons and obviously both of them have very different treatment approaches.

You could have something else going on in your ankle that caused inflammation which then caused the tendons and the sheath to adhere to each other which decrease the glide between the structures causing pain and discomfort. This is maybe unlikely as you would have noticed that kind of inflammation in the ankle.

Usually the key to healing any repetitive strain injury is to avoid the motion/action that causes the pain. I wouldn't recommend complete rest, but avoidance of the activity is best. But I don't want to contradict anything that your health care provider has suggested.

Wow, ok. That's a lot to consider. Thanks for taking the time to explain!

I've thought for awhile that I had some biomechanical bad habits that have been going on for awhile...I think I 'flick' my right foot a little as I run, which would be constant eversion, and there are probably some muscle imbalances/weaknesses that aren't helping...likely it wasn't a one-off during the Army Run that caused it, but the extra strain of racing that distance might've just pushed it over the edge. It's not visually inflammed now, and never has been, nor is it warm to the touch. I'm just assuming some inflammation because of the way it feels.

So, sounds like I can still do activity that doesn't trigger any discomfort, including tightness/twinging/etc. I will be asking my bootcamp instructors to show me some mods to any move that has excessive torquing or toe-off force, and I was going to limit my running in the next few weeks to treadmill runs only, that way I can stop immediately if anything acts up at all (and not in, say, the middle of a 10k run!)

I'm thinking the essential thing is to keep plugging away at those strengthening exercises (calf raises and whatnot) to strengthen everything around the ankle/lower leg. The KT taping method made it feel a whole LOT better, wow.

[Cupcake Girl]

I mangled that muscle six weeks ago in a bike crash. Still not running because it is very slow to heal.

I can do everything but run, so I do plyo, ride, swim etc. I just skip stuff that has me bouncing on one foot as I can't toe-off in running motion. But for some reason I can make it work in other stuff and it's getting better, not worse. So I'm still in good cardio condition.

You sound like this is a chronic issue, perhaps tons of ankle work and orthotics, although I recall you dismissed this before.

Kinesio tape may work but I found it didn't do much good for me.

You may also find your toes hurting - Morton's Neuroma - that is caused by the tight muscles squishing the toe tendons. Acupuncture works for that.
Good luck.

[PinkLady]

I can do everything but run, so I do plyo, ride, swim etc. I just skip stuff that has me bouncing on one foot as I can't toe-off in running motion. But for some reason I can make it work in other stuff and it's getting better, not worse. So I'm still in good cardio condition.

You sound like this is a chronic issue, perhaps tons of ankle work and orthotics, although I recall you dismissed this before.

Cool, it's good to know that you've been able to do plyo work. I seem to be walking around, climbing/descending stairs just fine today, the only time I feel the peroneal twinge is with weight-bearing on the toes (like, a one legged calf raise, or with toe-off/push off like one legged hops). The peroneal in particular has not been chronic, this particular injury is new to me (oh joy!), but, lower leg and ankle related 'stuff' has been rather chronic. (Previously it was a bout with post-tibial tendonitis). I need to do heaps and heaps and heaps of ankle and lower leg strengthening, and stability/proprioception/balance stuff in general. It's for sure my weakness.

[ceileigh]

I had very similar to you several weeks before the Army Run and feared PF too. Your description pretty much matches mine. My ART said that the tendon gets trapped on the bottom of the foot (I can't remember exactly how she explained it but it was along those lines). She did one treatment. Foot hurt like hang that evening. I had to ice it several times that day. I was pain free by the next day. Couldn't believe it! She said she sees a lot of runners with it. I have to keep my foot well stretched out to keep it from coming back though.

[PinkLady]

I had very similar to you several weeks before the Army Run and feared PF too. Your description pretty much matches mine. My ART said that the tendon gets trapped on the bottom of the foot (I can't remember exactly how she explained it but it was along those lines). She did one treatment. Foot hurt like hang that evening. I had to ice it several times that day. I was pain free by the next day. Couldn't believe it! She said she sees a lot of runners with it. I have to keep my foot well stretched out to keep it from coming back though.

Sounds like the symptoms can radiate anywhere up around and above the ankle, or through the arch of the foot, since the tendon extends over that whole area. My foot/ankle feels pretty good right now.....been icing it 3-4 time daily and stretching the foot and the peroneals....Right now it's more of a discomfort around and above the knobby ankle bone that makes my ankle feel a little unstable. No pain though!

What kind of stretches are you doing? Are you back to running as usual pain-free?

[fe.RMT]

I had very similar to you several weeks before the Army Run and feared PF too. Your description pretty much matches mine. My ART said that the tendon gets trapped on the bottom of the foot (I can't remember exactly how she explained it but it was along those lines). She did one treatment. Foot hurt like hang that evening. I had to ice it several times that day. I was pain free by the next day. Couldn't believe it! She said she sees a lot of runners with it. I have to keep my foot well stretched out to keep it from coming back though.

the brevis attaches at the base of the 5th metatarsal, so pain at the attachment site would be right at the lateral edge of the foot. The longus shares an attachment with tibialis anterior at the base of the first metatarsal and medial cunieform, so pain at the attachment would be more around the big toe and the arch of the foot.

[ceileigh]

It was the ''zap' comment that really made me think of what I had. Having been injury free all season I was discouraged thinking ...

One treatment to free the tendon, break adhesions, and get things loose. I was pain free within 24 hours and took 48 hours off running that was it. I basically do foot flex / stretches especially on a step (calf raise type) including post every run. It came back a bit post army run but I had an ART app't the day after and she worked it out for me again.

[PinkLady]

It was the ''zap' comment that really made me think of what I had. Having been injury free all season I was discouraged thinking ...

One treatment to free the tendon, break adhesions, and get things loose. I was pain free within 24 hours and took 48 hours off running that was it. I basically do foot flex / stretches especially on a step (calf raise type) including post every run. It came back a bit post army run but I had an ART app't the day after and she worked it out for me again.

Yes! The 'zap' feeling makes sense if it's nerves getting pinched/entrapment. My foot doesn't seem to be as involved as yours was, as my discomfort is almost all around the ankle bone area.....the arch was just tight after my run on Sunday. I do get the funky zappy feeling around the ankle bone.....it almost sets my teeth on edge, so maybe that's the tendon twinging against something. I've been stretching like a crazy person every time I sit down and every time I'm close to stairs, I'm stopping to stretch. It does seem to be helping, it felt a little 'lumpy' upon getting up this morning, but better than yesterday.

I'll continue to do my rehab ankle exercises and calf raises, and was planning on starting to run again tomorrow....but only on the treadmill, so I can stop right away if it starts to feel worse. It's very encouraging to hear you were successful with getting right back to running without much time off. Sounds like stretching is the key to getting rid of this issue for good.

[ceileigh]

For me it started with the zap on the outside of my ankle going up my leg (well not far up but that direction). As a barefoot (VFF) runner I have to be careful as my feet do get tight but I did not notice anything extra going on that way. After a bit I did notice my foot felt tight when I'd start to run and it hurt. I'd have to warm up and then it would be just fine. That was when I started to think PF. When she worked it and released it I was shocked at how well it worked. The trick then was to keep it loose. The foot / calf raises on a step have been key for me but they are also recommended when you bf run anyway to help your feet / calf stay loose

[PinkLady]

The foot / calf raises on a step have been key for me but they are also recommended when you bf run anyway to help your feet / calf stay loose

Good to know!!

Wow, I'm thinking it probably is sooooooo not a good idea for me to try transitioning to neutral/minimalist shoes like I was going to do, if I'm getting this issue in *stability* shoes. Yikes. Okay, I have a lot of work to do in ankle/foot/lower leg strengthening first.

[ceileigh]

I changed to VFF's post an injury that had me out of running for just over 3 months. I went right back to 10 minutes of running. Figured if I was ever going to try it now was the time. It worked well for me but I don't know how someone does it if they want to keep doing a lot of running and/or keep at races. For me once I was use to the VFF / BF thing I did not want to run in shoes any more. Within a month I was running only in VFF's. Now, 9 months in, I have run 2 half marathons but would not consider going past that distance (though I may start to go further now, just not before). My feet have developed muscles I didn't know feet could have. I no longer use / need my orthotics. I have way less issues / injuries. But it truly is slow going to develop the foot strength to support distance running. I would like to run a full but am not sure if I will try next year or stick to halfs another year to make sure things are good and settled first!

I have had 2 issues since I switched to VFF, this one (which I caught early so it responded and does not progress, truly a non issue), and tight hips which I have always had My ART recently learned some new techniques which finally released my hips and hoo-boy did that change things for me! I love my VFF's and the change has really helped me but I know they don't make a huge change for everyone and I'm not looking forward to winter running

[PinkLady]

I changed to VFF's post an injury that had me out of running for just over 3 months. I went right back to 10 minutes of running. Figured if I was ever going to try it now was the time. It worked well for me but I don't know how someone does it if they want to keep doing a lot of running and/or keep at races. For me once I was use to the VFF / BF thing I did not want to run in shoes any more. Within a month I was running only in VFF's. Now, 9 months in, I have run 2 half marathons but would not consider going past that distance (though I may start to go further now, just not before). My feet have developed muscles I didn't know feet could have. I no longer use / need my orthotics. I have way less issues / injuries. But it truly is slow going to develop the foot strength to support distance running. I would like to run a full but am not sure if I will try next year or stick to halfs another year to make sure things are good and settled first!

I have had 2 issues since I switched to VFF, this one (which I caught early so it responded and does not progress, truly a non issue), and tight hips which I have always had My ART recently learned some new techniques which finally released my hips and hoo-boy did that change things for me! I love my VFF's and the change has really helped me but I know they don't make a huge change for everyone and I'm not looking forward to winter running

Your experience makes me think that now is not a good time for minimalist for me......at this point, I'm definitely working on getting ready to run longer, and pretty much all road running to boot. Perhaps, though, this peroneal issue cropping up does indicate weaknesses in my ankle/feet that need addressing, and cross training in barefeet (dance classes, etc) might be a great idea to train those muscles.

Yikes, winter in VFF's do *not* sound fun!

In any case, I do think this is a sign that I should probably shelve even transitioning to neutral shoes until I've rehabbed the causes of the peroneal tendonitis.

[Cupcake Girl]

PinkLady wrote: Perhaps, though, this peroneal issue cropping up does indicate weaknesses in my ankle/feet that need addressing, and cross training in barefeet (dance classes, etc) might be a great idea to train those muscles.

Do plyometrics (P90X), jump rope training etc. You need to cross train. Ballet may work, but only if you like it. Other types of dance won't do much for you as they are more grounded.

[PinkLady]

PinkLady wrote: Perhaps, though, this peroneal issue cropping up does indicate weaknesses in my ankle/feet that need addressing, and cross training in barefeet (dance classes, etc) might be a great idea to train those muscles.

Do plyometrics (P90X), jump rope training etc. You need to cross train. Ballet may work, but only if you like it. Other types of dance won't do much for you as they are more grounded.

I agree. Jump rope training is definitely going to be in the mix once this tendonitis heals up. I actually did ballet for my childhood years (through high school), so I'm quite partial to dance workouts. I found a class at my gym called "Beaming". Stupid name, but the description sounds like it might really work for me: "A program taught barefoot that harmonizes fitness movements with mind-body disciplines to infuse balance, core and stability training on a resilient, low grounded beam."