Peroneal Tendonitis: Part 1

Remember when I wrote about how I hit the wall at the 22 mile mark during my first marathon last year? It wasn’t from physical or mental exhaustion; it was from my right foot hurting so much that I could barely walk.  A week after the race in October, I visited a podiatrist in DC for the first time and got my official diagnosis: peroneal tendonitis.

What is Peroneal Tendonitis?

Tendons are the fibrous tissue that connect bones to muscles.  The peroneal tendons (there are two) are attached to bones in the leg and go to muscles in the foot.  The peroneus brevis inserts into the base of the bone right before the pinky toe (fifth metatarsal), and the other, peroneus longus, goes more under the foot and inserts into the bottom of the arch.

tendon-sheath-of-ankleperoneal-netter1

Tendonitis is the injury and inflammation of tendons caused by small tears in the collagen fibers.  It occurs from overuse, in my case the excessive strain on the foot caused by lots of running.  There are other types of foot tendonitis, like Achilles Tendonitis (back of ankle), Flexor Tendonitis (deep back of ankle), Extensor Tendonitis (top of foot), and Posterior Tibial Tendonitis (instep of foot).

What does it feel like?

For me, it was the bottom edge of my foot that hurt to the point that I couldn’t walk that well the first few days after the injury.  Curling my toes inwards was nearly impossible as well.  A tendon can be injured in different ways, which will affect where the pain presents.  Since mine was closer to the bottom of the foot rather than the side, I suspect my injury was insertional tendonitis (close to the insertion site in the foot).

How do I treat it?

Most cases of tendonitis go away by resting the area and letting the tendon heal.  My doctor recommended not running for at least a week, or until my foot didn’t hurt while running.  He also told me to ice my foot and take an over-the-counter NSAID (non-steroidal anti-inflammatory drug – like ibuprofen or aspirin) to reduce the inflammation and pain.  A note about pain relievers: Do not take medication to reduce pain so that you can train! That’s a quick way to escalate a small injury to a serious and/or permanent one.
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When you first experience the pain, you should take a break from running for a few days and ice the area for 20 minutes at a time.  If severe pain continues for more than a day or two, or if you find yourself still unable to run after a week of rest, you should see a doctor to find out what’s going on.  I recommend seeing a doctor in any case so you can be properly diagnosed (i.e. I thought my injury was plantar fasciitis) and given the right treatment.

How do I avoid peroneal tendonitis from happening to me?

I think there are three possible root causes of peroneal tendonitis (my analysis, not a doctor’s!), and with each comes different solutions.
(1) Overuse of the tendon, plain and simple. To avoid this root cause, you either have to reduce your mileage, or stretch and strengthen the tendon.  I have a link below for peroneal tendon strengthening exercises.
(2) Incorrect posturing of the foot while running.  You’ve heard of over-pronation, under-pronation, etc, right? The tendon can be stressed based on how you are using your foot and ankle.  In my case, I tend to curl my feet inside my shoes a little when I run faster, which puts more stress on the outside and bottom muscles/ tendons of the feet.  You can try being more mindful of your foot posture as you run – if you tend to curl your feet like me, try relaxing them inside your shoes – probably easier said than done.  You can also try different sneakers to find the shoe with the best support for you.  To get you an even better fit, your podiatrist may recommend orthotics.  There’s no solution that fits all cases here, but try out some of these suggestions and see if it helps!
(3) Genetics.  Feet come in all shapes and sizes, and different shapes can mean you’re pre-disposed to certain types of injury.  For example, those with high-arched feet are apparently more likely to get this type tendonitis.  I think that orthotics could likely help here as well.

My progress:

Within two weeks, my foot was back to normal and I was able to go back to running.  I started out with easy runs, and worked my way up back to longer distances and faster runs as I assessed how my foot was feeling.

When I started training for a half marathon this year, I noticed that the pain was back on some of the longer runs.  My foot was fine walking around afterwards, so I wanted to take early action to prevent full-blown tendonitis this time.  Which led me to see the podiatrist again about orthotics: read about my experience!

Other resources:
http://foothealth.about.com/od/achillestendonitis/a/Tendinitis.htm
http://www.buzzle.com/articles/peroneal-tendonitis-exercises.html

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7 thoughts on “Peroneal Tendonitis: Part 1

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  4. Evi

    Dawn thanks for sharing- it is very reassuring reading about similar injuries and how they resolved! I believe I also got peroneal tendonitis about 8 days ago – although for me it is on the outside, lower side of the ankle. Any thoughts on orthotics or running shoes that helped?

    1. Hi Evi, so sorry to hear about your tendonitis issue. I would definitely go get it checked out by a podiatrist or orthopedist to assess the nature of the injury. Personally, a few weeks of rest and rolling my foot did the trick! I haven’t had any luck with orthotics, but one of my coworkers found they really helped prevent his plantar fasciitis from recurring, so it may be worth trying out. Good luck!

    2. Evi

      Dawn I hope people with similar issues come across your post often- I think you are providing some great advice. I made an appointment with a sports medicine doctor and a podiatrist, so hopefully I can get a diagnosis and treat accordingly. Thank you so much for taking the time to reply! Sadly I am out of the marathon I signed up for, but hopefully it will not be too long before I can resume running with a healthy and strong ankle! Thanks again!!

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