Everything You Should Know About the Peroneal Tendon Repair Protocol
When you’re a regular runner, you’re bound to get injured from time to time. You can take all the precaution you want, but sooner or later it’s going to happen. When it does, it’s important to deal with it properly and apply the correct treatment.
However, even when you get better, you need to go through the proper rehab process to run like you used to. If you try to get straight back into your old regime, you’re just going to hurt yourself.
So, today I will be discussing the proper peroneal tendon repair protocol that you need to take when you injure your peroneal tendon, one of your most important leg muscles.
What is the Peroneal Tendon?
The peroneal tendon is the extension of the peroneal longus muscle. The peroneal longus muscle is one of the largest muscles in the lower leg, and it starts at the head of your fibula, running down the entire length of the bone down to the ankle. It wraps around the lateral malleolus of the ankle – the little bony protrusion on the outer side – and it continues down the foot. At its end, it attaches to the medial cuneiform as well as the first metatarsal bone.
The peroneal longus muscle becomes the peroneal tendon somewhere around the end of the fibula when it starter wrapping around your ankle. There are two of these tendons, and they run side by side. The main function of these tendons is to stabilize your ankle, your foot, and your leg. They protect your ankle from sprains and absorb most of the impact that you incur through walking, standing or running.
Of course, this is also what makes these tendons so prone to injuries. Since they are put under so much pressure on a daily basis, they can get overworked, especially if you’re a regular runner.
Injuring your Peroneal Tendon and Treatment
Since your peroneal tendon is under so much strain, it’s not a surprise that there are many different conditions that might affect it. Some of them are acute while others might chronic and can leave permanent consequences.
One of the most prominent and most talked-about issues with the peroneal tendon is peroneal tendonitis. In short, this is the inflammation of one or both of the peroneal tendons, and you can get it by overusing your legs or through an injury, like an ankle sprain. The common symptoms of this issue include pain, swelling, redness, and warmth.
This issue can be acute as well as chronic, but it can be prevented and treated. Treatment includes massage, anti-inflammation medicine, and some ice – in severe cases, it could include surgery. Proper exercises are also necessary, but I’ll get to that in a minute.
Another serious issue with your peroneal tendons is acute or chronic tears. Acute tears can be caused by overuse or trauma, and common symptoms include pain, swelling and muscle weakness or instability. In time, repeated tearing might lead to changes in the shape of your foot, making your arch higher.
Chronic tears, also called degenerative tears or tendonosis, are even more serious. They also occur due to chronic overuse of the muscles or repeated injuries. Because of this, the tendon starts to fray and becomes thinner, which causes chronic pains on the outside of the ankle, instability, and weakness as well as a higher arch.
In the case of acute tears, immobilization, rest and medication can help the injury heal over time, and some surgery might be necessary in certain cases. In the case of chronic tears, though, there’s not much that can be done. Physical therapy can relieve the symptoms and surgery can increase the range of movement or even function by applying tendon grafts, but the tendon won’t be as good as new ever again.
Subluxation is the last major peroneal tendon condition I’ll mention, but not the least important. It’s a condition in which the tendon slips out of its normal position. Most tendons are held in place by supportive tissue like a ligament or retinaculum – if that tissue is damaged, the tendon will slip out of position.
One of the main causes for this condition are ankle sprains. During a typical inversion during a sprain, the foot rolls inwards, which forcefully stretches the peroneals and sometimes rips the retinaculum keeping them in place. When this happens, they snap out of the bone groove they are usually situated within, but usually snap back into place immediately.
However, if the injury to the ligament and retinaculum is overlooked, the subluxation can occur later on, and it might become chronic. If you wonder what it feels like, it’s similar to a popping or snapping sensation along the outer edge of your ankle. You might feel some pain, tenderness and swelling along the tendons when it happens.
The correct treatment usually involves surgery. Non-surgical treatments are less successful and usually only treat the symptom. Putting the leg in a cast and resting is necessary for at least four and up to six weeks. After that you can get around and using the best shoes for peroneal tendonitis will help further.
But, even after the condition is treated you will still need to rehabilitate your tendon properly, and that’s what I’ll cover next – the peroneal tendon repair protocol.
How to Recover Your Peroneal Tendon
When the condition which affected your peroneal tendon is finally treated, and you can get back on your feet, there’s still a recovery period you have to go through before you can return to your regular activities.
Depending on the condition you had, and how it was treated, this will involve different rehabilitation protocols and exercises.
In the case of peroneal tendonitis the exercises you need to do to rehabilitate your muscles involve a lot of different calf stretches. Seated or standing calf raises are a good start and they will help your muscles get stronger and more resistant to further injury.
However, if you’ve had an operation, you must follow a different recovery protocol. For the first two weeks, you should put a lot of pressure on the foot, and you should do simple straight leg raises and toe curls. Walk with a crutch or a similar tool.
For week two to six, you may move on to some straight leg lifts and standing hamstring curls. You can perform twenty repetitions of the straight leg lifts, two times per day and twenty repetitions of the hamstring curls, once daily.
After week four you can begin incorporating some ankle movements into that and performing some ankle flexes. These should be without the brace, moving the ankle in an up-down motion – don’t try to force it through the pain, move it only as long as it is pain-free. Repeat this exercise 20 times, three times per day.
During weeks six to ten, you should start with some strengthening exercises. Ankle inversion, eversion and dorsiflexion exercises are recommended along with ankle plantar flexion.
Using some tubing and wrap it around the injured foot, then anchor it around the healthy foot and slowly turn the injured foot outward. This is the ankle eversion, and you should do it 30 times per day.
For ankle dorsiflexion, anchor the tubing to a solid object then pull the foot towards your knee. Do this 30 times each day. When it comes to ankle inversions, you should cross your legs, with the operated foot underneath, then anchor the tubing to the healthy foot and slowly turn the other foot inward. Repeat 30 times as well.
The ankle plantar flexion is the most important exercise and should also be repeated 30 times each day. It is also the most simple – just pull on the tubing, wrapped around the injured foot with your hands while pressing the foot downwards.
For weeks 10 to 16 you may return to running and perform some advanced strengthening exercises with weights. After week 16 you can return to full weight bearing and wear regular shoes. In essence, that is all.
Recovering from subluxation involves some differences from this. If you just had a cast put on you until your retinaculum healed, you can perform this same regime for ten weeks and be almost fully rehabilitated. However, your recovery time might differ and last for up to six months, so you should consult with your doctor.
This is especially pertinent when subluxation is treated with surgery. There are many different types of surgery for treating subluxation, depending on the cause and they all have different and extremely specific rehabilitation regimes that you must adhere to. Don’t try to make one for yourself in that case.
The regime I described above is also used for rehabilitation from peroneal tendon tears and surgery that repairs them. You can apply in that case as well unless your doctor says otherwise.
Well, there you have it – practically all you need to know about peroneal tendon injuries and the peroneal tendon repair protocol. If you want to know more about the particulars you can check out some of my other articles on similar subjects. I might cover some extensively in the future as well, so keep an eye out for that. You should also check out some of the best running shoes for peroneal tendonitis. Until then I hope your legs stay healthy and keep running!