Peroneal Tendinopathy / Tendinitis: Causes & Treatment (Education | Strengthening | Stretching)

today i'm going to discuss peroneal tendinopathy which is also often referred to as peroneal tendinitis the peroneal muscles are located in the outer compartment of the lower leg the peroneus brevis originates on the lower portion of the fibula and inserts on the base of the 5th metatarsal the peroneus longus sits over the top of the peroneus brevis originates higher up on the fibula and travels around the bottom of the foot to attach to the planar aspect of the medial cuneiform and base of the first metatarsal both tendons wrap around the lateral malleolus the bump on the outer portion of your ankle and are held in place by the superior and inferior peroneal retinocula in a non-weight-bearing position the peroneals act as plantar flexors pointing the foot downward and everters turning the sole of the foot outward during walking the peroneus longus provides stability to the transverse arch of the foot and keeps the first ray in contact with the ground there are three primary types of peroneal tendon injuries that i'm going to categorize as traumatic or non-traumatic an acute peroneal tendon subluxation in which the tendon has slipped out of its groove behind the lateral malleolus may occur when the superior peroneal retinoculum is torn the mechanism of injury often involves a contraction of the peroneals when the ankle is in a dorsiflexed and non-neutral position during stopping landing or a cutting maneuver in sports such as skiing gymnastics soccer basketball and football complete rupture of a peroneal tendon may also occur during a high force mechanism of injury additionally after any traumatic injury to the foot or ankle the ottawa ankle rules will be used by a health care professional to rule out the possibility of a fracture they'll assess if you have the ability to walk four steps or have tenderness at the lateral malleolus base of the fifth metatarsal medial malleolus or navicular if any of these traumatic injuries are suspected consultation with a medical doctor is recommended immediately because surgery or immobilization may be warranted now let's discuss the non-traumatic category and when i say non-traumatic i'm focusing on injuries that are not acute in nature and don't require prompt medical attention for example it's possible to have chronic peroneal tendon subluxations or a partial tear while having little to no symptoms or loss of function peroneal tendinopathy refers to pain and loss of function associated with loading of the tendon this may be an overuse injury related to activities like running or playing sports or associated with recurring lateral ankle sprains it's not uncommon for chronic ankle instability and peroneal tendon issues to go hand in hand symptoms may be reproduced with palpation of the tendons stretching of the tendons into dorsiflexion and inversion or contraction of the tendons into e-version if chronic subluxations are suspected because of a history of snapping or popping this may be recreated with resisted dorsiflexion and e-version the non-traumatic category is the focus of the exercises and recommendations in this video particularly peroneal tendinopathy the purpose of the exercise progressions that i'm going to present is to train the function of the peroneals improve their tolerance to various stressors and positions and increase the strength and range of motion of the feet ankle and legs in general key targets will be plantar flexion strength eversion strength dorsiflexion range of motion and single leg stability during dynamic movements level one for the single leg strength progression is a bodyweight squat gently tap your butt to a chair and stand back up if it's too challenging shorten the range of motion or use your hands for assistance aim for 3 sets of 20 reps level 2 is a step up use a stair or objects stacked six to seven inches high you don't want to push off with the back leg so focus on putting all of your weight through the working leg if it's too difficult decrease the height or use your hands for assistance aim for 3 sets of 20 reps per leg level 3 lateral step down same exact cues except this movement will allow for a little more ankle dorsiflexion aim for 3 sets of 20 reps per leg level 4 forward step down or elevated lateral step down you can either step forward off the step or continue to perform the lateral step down while gradually increasing the height of the step aim for three to four sets of eight to fifteen slow and controlled reps per leg for the dynamic balance progression you want to ensure that the base of your big toe stays planted on the ground if it helps you can place an object under that area for feedback such as a coin level one single leg balance work your way up to standing on one leg for three sets of 60 seconds level two single leg rdl stand on one leg while keeping a slight bend in both knees hinge at your hips until your trunk is almost parallel with the ground and then return to the starting position repeat this movement without touching your foot to the ground if this is too challenging use your hands to help with balance shorten the range of motion or tap your foot to the ground aim for three sets of 12 to 15 reps level 3 3-way rdl reach your arms in three directions to the left middle and then to the right that counts as one rep aim for four to five reps total level four three-way rdl with knee drive you can progress the previous movement by adding a knee drive for the heel raise progression you want to keep even pressure on the ball of your foot so that you aren't rolling off the big toe or little toe level 1 double leg heel raises on flat ground aim for 3 sets of 25 slow and controlled reps use your hands for balance as needed level 2 single leg heel raises on flat ground aim for three sets of 15 reps level three single leg heel raises on a step aim for three to four sets of eight to fifteen reps over time you can add weight as needed for ankle e version you can use a band or a weight attached to your foot and sideline let's walk through the setup for ankle eversion on the left leg wrap a resistance band around the end of your left foot bring it across the bottom of your right foot and hold it firmly with your right hand your left hand is going to ensure that you don't compensate by performing external rotation of the hip as opposed to e-version of the ankle which involves moving your foot outward work up to three sets of 25 reps using the most challenging resistance band you can find the other option is to line on your side with your top leg hanging off the bed bench or table without rotating your hip bring the outer part of your foot up toward the ceiling slowly lower down and repeat add an ankle weight if needed and aim for 3 sets of 25 reps more complex exercises like a single leg heel raise with a band pulling outward on the midfoot are often suggested to simultaneously train the plantar flexion and eversion actions of the peroneals rehab can always get as creative as you want but i think it's important to master and progress the basics first before laying out a structured program for you i want to mention three things one the exercise progressions are meant to serve as a framework rather than an individualized prescription for everyone watching this video it's important to tailor the exercises to your symptoms function and goals two the exercises should always be tolerable and not cause a flare-up of symptoms the following day if they do cause a flare-up it probably means that you did a little too much and need to scale back at the next session three if you intend to return to sport or higher level activities you'll need to include additional exercises to help get you there examples include hopping jumping and running progressions more challenging single leg exercises that place your ankle in compromising positions and just a gradual exposure to your desired activity if you do perform the exercises outlined in this video you'll likely want to train at least two times per week with at least two days of rest between sessions for example you might go through this routine on mondays and thursdays as your tolerance and function improve you might add a third training day with the same exercises or other exercises that serve a similar purpose in this example you might implement the movements on mondays wednesdays and fridays in either scenario it would be helpful to incorporate general physical activity such as walking or cycling for up to 30 minutes per day as you manage symptoms associated with the peroneal tendon injury it's important to modify aggravating activities as needed for example if you're a runner you may need to lower the mileage pace or frequency of your runs additionally it might be beneficial to focus on flat ground running initially rather than trail running or running on sloped surfaces if you have problems with walking and navigating your daily life tracking your steps is crucial it'll help you determine your baseline level of function and tolerance so that you can slowly improve both over time although it seems simple walking can be a critical component of rehab what about shoes and orthotics the main consideration is that you probably don't want either forcing you into a supinated position especially if you've had previous ankle sprains and perform activities that put you at risk for future ankle sprains a podiatrist is someone you can consult with to discuss this topic further in summary peroneal tendon injuries can be generally categorized as traumatic or non-traumatic traumatic incidents that involve an acute peroneal tendon dislocation or subluxation complete rupture of the tendon or a fracture require immediate consultation with a medical doctor as surgery or mobilization may be warranted for most non-traumatic issues that are more chronic in nature such as peroneal tendinopathy non-operative management is recommended rehabilitation may include exercises that train the function of the peroneals improve their tolerance to various stressors and positions and increase the strength and range of motion of the feet ankle and legs in general exercise should be tolerable and performed two to three times per week additionally it's important to modify aggravating activities track your daily steps and implement a gradual return to sport or your desired activity this video is meant to serve as a framework rather than an individualized prescription it's important to tailor the exercises to your symptoms function and goals or seek the assistance of a qualified health care provider thank you so much for watching if you enjoyed the video please hit that like button subscribe turn on notifications and leave any questions or comments down below peace you

Channel: E3 Rehab

Views: 226,259

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Id: 0fsR5-oqcVU

Length: 13min 12sec (792 seconds)

Published: Sun Jun 05 2022