Peroneal Tendinopathy: Difference between revisions
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== Diagnostic Procedures == | == Diagnostic Procedures == | ||
A thorough subjective and objective examination from a physiotherapist can be sufficient to diagnose peroneal tendonitis. Diagnosis may be confirmed with an MRI scan or ultrasound investigation showing oedema<ref name="tjin">Tjin A Ton ER, Schweitzer ME, Karasick D. MR Imaging of peroneal tendon disorders. 1997 AJR:168:135-140.</ref> | A thorough subjective and objective examination from a physiotherapist can be sufficient to diagnose peroneal tendonitis. Diagnosis may be confirmed with an MRI scan or ultrasound investigation showing oedema<ref name="tjin">Tjin A Ton ER, Schweitzer ME, Karasick D. MR Imaging of peroneal tendon disorders. 1997 AJR:168:135-140.</ref> | ||
Patients with this condition usually experience pain behind and distal to the lateral malleolus during activities putting stress on the peroneal tendons(lateral running, fige-8 running), or following these activities or following a rest period, especially upon waking in the morning. There may be associated swelling in the acute phase. There will also be pain when testing resisted foot eversion.<ref name="heckman" /><ref name="Omay" /> | Patients with this condition usually experience pain behind and distal to the lateral malleolus during activities putting stress on the peroneal tendons(lateral running, fige-8 running), or following these activities or following a rest period, especially upon waking in the morning. There may be associated swelling in the acute phase. There will also be pain when testing resisted foot eversion.<ref name="heckman" /><ref name="Omay" /> | ||
The pain associated with peroneal tendonitis tends to be of gradual onset which progressively worsens over weeks or months with the continuation of aggravating activities.<ref name="heckman" /> | The pain associated with peroneal tendonitis tends to be of gradual onset which progressively worsens over weeks or months with the continuation of aggravating activities.<ref name="heckman" /> | ||
You can isolate the peroneal muscles from each other when you use the peroneus longus | You can isolate the peroneal muscles from each other when you use the [http://www.physio-pedia.com/index.php5?title=Peroneus_longus_and_brevis_tests peroneus longus and brevis tests] .<ref name="castro">Castro WHM,Jerosch J, Grossman TW. Examination and diagnosis of muscluloskeletal disorders- clinical examination. Imaging Modalities, Stuttgart ,Georg Thieme Verlag, 2001, 252-253.</ref> | ||
'''Peroneus brevis:''' | '''Peroneus brevis:''' | ||
Revision as of 20:38, 5 June 2011
Original Editors - Jacobs Pieter
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Search Strategy[edit | edit source]
Key words: peroneal muscles, Peroneal tendonitis, Peroneal tendinitis, Tendinopathy/therapy, Tendon Injuries/diagnosis, Tendon Injuries/therapy.
Databases: PubMed, WebOfKnowledge, Pedro, American Journal of Sports Medicine, library Vrije Universiteit Brussel
Definition/Description[edit | edit source]
Peroneal tendonitis is a condition that can be acute or become chronic whereby there is irritation to one or both peroneal tendons with subsequent degeneration and inflammation.
Clinically Relevant Anatomy[edit | edit source]
The peroneus longus and peroneus brevis muscles reside in the lateral compartment of the lower leg and are innervated by the superficial peroneal nerve. The m. peroneus longus arises from the head and proximal two-thirds of the lateral surface of the body of the fibula and the origine of the peroneus brevis is located on the distal two-thirds of the lateral surface of the body of the fibula, medial to the Peroneus longus. The peroneus longus tendon turns medially between the cuboid groove and the long plantar ligament and inserts onto the plantar surface of the base of the first metatarsal and the lateral aspect of the medial cuneiforms. The peroneus brevis tendon continues directly to its insertion onto the tuberosity of the fifth metatarsal.[1]
The actions of the peroneus longus and brevis are plantarflexion and eversion.
Epidemiology /Etiology[edit | edit source]
Peroneal tendonitis is common in running athletes, young dancers, ice skaters and sports requiring frequent change of direction or jumping such as basketball.[1][2] Contributional factors to the development of peroneal tendonitis are tight calf muscles, inappropriate training, poor foot biomechanics such as overpronation of the foot or excess eversion of the foot, inappropriate footwear and muscle weakness of the m. peroneus longus.[2] Other causes include severe ankle sprains, fractures of the ankle or calcaneus, and peroneal tubercle hypertrophy.[1]
Characteristics/Clinical Presentation[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
A thorough subjective and objective examination from a physiotherapist can be sufficient to diagnose peroneal tendonitis. Diagnosis may be confirmed with an MRI scan or ultrasound investigation showing oedema[3]
Patients with this condition usually experience pain behind and distal to the lateral malleolus during activities putting stress on the peroneal tendons(lateral running, fige-8 running), or following these activities or following a rest period, especially upon waking in the morning. There may be associated swelling in the acute phase. There will also be pain when testing resisted foot eversion.[1][2]
The pain associated with peroneal tendonitis tends to be of gradual onset which progressively worsens over weeks or months with the continuation of aggravating activities.[1]
You can isolate the peroneal muscles from each other when you use the peroneus longus and brevis tests .[4]
Peroneus brevis:
Patient position:
Semi-lateral position on the contralateral side with the ankle in neutral position.
Instructions therapist and patient:
Immobilize the distal calf with one hand proximal to the ankle while pressing to the lateral margin of the foot into eversion with the other hand. Instruct the patient to evert the foot and the talocalcaneoavicular joint in a neutral position. Make sure that the long extensors are relaxed and the toes are held in slight flexion.[4]
Peroneus longus:
Patient position:
Semi-lateral position on the contralateral side with the ankle in plantar flexion.
Instructions therapist and patient:
Immobilize the distal calf proximal to the ankle with one hand. At the same time, press with the other hand against the head of the first metatarsal to elevate it, invert the foot, and move the ankle into dorsiflexion. Instruct the patient to evert the foot and bring the head of the first metatarsal into plantar flexion. Make sure that the toe extensors are relaxed for this manoeuvre.[4]
Outcome Measures[edit | edit source]
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Examination[edit | edit source]
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Medical Management
[edit | edit source]
Patients diagnosed with peroneal tendinitis can be treated with non steroidal anti-inflammatory medication , physical therapy(see below), and rest.[1][2][5]
If nonoperative treatment is ineffective, an open tenosynovectomy is recommended.[1][2][5] Postoperatively patients are made nonweightbearing during the first 2 weeks. The, they are placed in a short leg weightbearing cast or boot. Range of motion and strengthening activities (eccentric exercise) are started 2 to 4 weeks after surgery.[1]
Also the use of lateral heel wedges can help managing mild cases peroneal tendinitis.[5]
The use of corticosteroid injections is not recommended. [1][2][6]
Physical Therapy Management (D)[edit | edit source]
Treatment for peroneal tendonitis includes a program of stretching, strengthening, mobilisation and manipulation, icing, ankle bracing or taping during contact sports.[1][2][6]
There is fair evidence for the use of eccentric exercise.[6]
The use of a biomechanical ankle platform (BAPS), deep tissue friction massage, ultrasound electric stimulation can also be included in the physical therapy. [1][6]
Also extracorporeal shock wave therapy (ESWT),acupuncture are used to treat tendinopathy. But there is only limited evidence from studies for these treatments. [6]
Key Research[edit | edit source]
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Resources
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Heckman DS, Gluck GS, Parekh SG. Tendon Disorders of the Foot and Ankle, Part 1: Peroneal Tendon Disorders. Am J Sports Med. 2009;37:614-625.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Omey ML, Lyle J M. Foot and ankle problems in the young athlete. Medicine & Science in Sports & Exercise. 1999;31(7):470-486.
- ↑ Tjin A Ton ER, Schweitzer ME, Karasick D. MR Imaging of peroneal tendon disorders. 1997 AJR:168:135-140.
- ↑ 4.0 4.1 4.2 Castro WHM,Jerosch J, Grossman TW. Examination and diagnosis of muscluloskeletal disorders- clinical examination. Imaging Modalities, Stuttgart ,Georg Thieme Verlag, 2001, 252-253.
- ↑ 5.0 5.1 5.2 Wukich DK, Tuason DA. Diagnosis and Treatment of Chronic Ankle Pain . The Journal of Bone&Joint surgery 2010; 92(10):2001-2016.
- ↑ 6.0 6.1 6.2 6.3 6.4 Pfefer MT, Cooper SR, Uhl NL. Chiropractic Management of Tendinopathy: a literature synthesis. Journal of Manipulative and Physiological Therapeutics. 2009; 32:41-52.
