Peroneal Tendon Injuries and How to Treat Them

Ankle and foot pain can be debilitating, or at the very least it can interrupt daily activities. These parts of the body are used in many things, from driving to walking to standing. When the ankle becomes injured, it can significantly impact our enjoyment of life by causing chronic pain.

There are many potential causes of injury to the peroneal tendon.

Anatomy and Injuries

The ankle joint consists of three bones, the tibia, and fibula in the shin, and the talus in the foot. This joint is protected by many soft tissues. Some of the most crucial soft tissues protecting the ankle joint are the peroneal tendons.

The peroneal tendons of the foot and ankle consist of two tendons that begin with an attachment to the calf muscle and end in attachments to the arch of the foot and the outer part of the foot. These tendons are used mainly for arch support and stabilizing the joint, which can prevent injury.

The most common injuries of the peroneal tendons include:

• Spraining or “rolling” the ankle: a motion that stretches the tendons to the point where they might snap or tear. Individuals who have experienced a sprain may feel pain, weakness, tenderness, or an inability to put weight on the affected ankle.
• Tendonosis: general degeneration of the tendon tissue which occurs naturally over time. The weakening of the tendon tissue can cause small tears which can result in pain, swelling, or instability in the joint. People who have high arches are at a greater risk of forming this injury over time.
• Tendonitis: an umbrella term for general tendon malfunction. This can be caused by small or large tears, degeneration, or injury. This is what occurs when the tendon is not functioning properly. This is characterized by swelling, pain, and tenderness in the ankle and foot.
• Subluxation: when a part of the body is out of place, it is referred to as a subluxation. This can be caused by natural degeneration causing structural changes, an injury that dislocates the tendons, or a structural abnormality beginning at birth. This particular injury is often categorized by a popping sensation in the ankle, often accompanied by pain.

Diagnostic tests can determine the underlying cause of ankle pain, which leads to more effective treatment.

Each injury has a different treatment plan associated with it, so an individual experiencing ankle pain must be honest with their doctor about where the pain is located and the severity of it.

Diagnosing Peroneal Tendon Injury

Experiencing pain in the foot or ankle may not need immediate attention – many injuries and causes of pain can heal on their own with some rest and anti-inflammatory medication. If the pain persists for longer than 3 weeks and begins to interfere with daily activities, it might be necessary to consult a doctor.

The diagnosis process for tendon injuries begins with a simple evaluation in the doctor’s office. This evaluation may include an examination of foot structure, observation of a range of motion in the foot, and a conversation about activity level, family history, and history of traumatic injury.

Doctors will often ask where the pain is felt, check for swelling, and try out several exercises that may exacerbate pain to pinpoint the source of it. If they are unable to determine the cause of pain with a simple evaluation, other diagnostic methods may be ordered to further specify the source of pain. These include:

• MRI: Magnetic resonance imaging, or MRI, is used to develop an image of the soft tissue in the body. These can be used to determine if there is damage to the soft tissue of a tendon. They may also be used to determine if the tendons are dislocated.
• X-ray: these may be used to determine the general structure of the foot. They are used to look at bone structure and can be useful in determining abnormalities that may result in subluxation or sprains.
• CT scan: this diagnostic technique can create an image of some soft tissue as well as bone and is therefore useful in determining the attachment of tendons to bone or muscle.
• Ultrasound: this technology is the most cost-effective and generally more common than the others for this reason. It allows doctors to look at an image of soft tissue structures, therefore allowing them to witness tears to the tendons. Ultrasound technology is also often used for certain treatments so that doctors can be certain of where they are placing injections.

Each diagnostic method comes with a list of pros and cons, so doctors will suggest what they think is best for each patient. Some diagnostic methods may not be necessary or possible due to financial constraints or the availability of equipment.

Many of these methods are effective in diagnosing the injury of the peroneal tendon. Once the injury is properly diagnosed, doctors will move on to devising a treatment plan.

Treating Peroneal Tendon Injuries

Each treatment that a doctor may recommend will be tailored to each patient. Factors that may influence treatment include a history of injury, physical activity level before injury, and lifestyle. Though treatment for each condition is different, doctors will often use the following tools to help a patient recover:

• Rest and anti-inflammatory measures: the first item in most doctors’ toolboxes is to suggest that a patient rest and use over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs) such as Motrin or ibuprofen to manage pain. These drugs work by delivering a small dose of anti-inflammatory properties throughout the body. Rest can help the body heal as well as prevent further injury, which can occur if the affected area is under continuous stress.
• Physical therapy: a goal of physical therapy for the ankle is to increase blood flow which promotes the body’s natural healing processes. Physical therapy also seeks to restrengthen muscles surrounding the ankle joint to provide support. Some injuries to the ankle can cause a feeling of instability which physical therapy can ameliorate.
• Wearing a brace: while physical therapy can help to provide stability internally, wearing a brace on the ankle can help provide external support while the tendons heal. It may be recommended for a patient to wear a brace all of the time, or only during certain activities such as sleep or exercise.
• Corticosteroid injections: this type of injection delivers a high dose of cortisol to the injury site. Cortisol has anti-inflammatory properties and can help with the sensation of pain. These injections are becoming less common as they have been proven to damage soft tissue over time. Factors that may influence a doctor’s decision to recommend these injections include the patient’s age, cause, and location of deterioration.
• Surgery: when the solutions above fail to relieve a patient’s pain, doctors may choose to discuss surgery with a patient. There are many forms of surgery that may work for different types of injury. Surgical options can vary from minimally invasive to highly invasive procedures. Every surgery comes with a set of risks that should be discussed with a surgeon and/or anesthesiologist before deciding to undergo surgery. The recovery time for each surgery will vary based on the invasiveness of the surgery and the patient’s commitment to recovering. Some of the surgical procedures include:
  • Reattaching tendons: if the tendons have become dislocated or completely removed from the bone, they may become reattached using a special type of screw.
  • Repairing tendons: surgeons may choose to sew tendons together that have become split or damaged.
  • Removing inflamed tissue: some tissue surrounding the tendon can be removed, especially when it is no longer serving its intended function.
  • Joint replacement: in extreme cases, the entire joint may be replaced with synthetic parts. This is seen as a last resort and a major procedure. It is often only recommended when the extent of damage to the joint is beyond repair.

There is an alternative form of treatment that should also be considered. When dealing with an injury of the peroneal tendon, patients should weigh all of the possible options for treatment. The field of regenerative medicine offers a promising method for treating this kind of injury.

Orthobiologic Methods for Treating Peroneal Tendon Injuries

Patients who undergo orthobiologic treatments have a high satisfaction rate, especially for soft tissue injuries such as those to the peroneal tendon. Regenerative medicine is particularly effective in treating soft tissue injuries like the peroneal tendon. These treatments could also help treat other degeneration in the areas in which they are injected.

CELLAXYS offers two types of orthobiologic treatments:

Platelet-Rich Plasma (PRP) Therapy

PRP therapy includes isolating platelets from your blood plasma, processing it, and then reinjecting it into the affected areas. Platelets are healing components in your body that release 10 Growth Factors to accelerate the new tissue growth. They also send chemical signals to attract healing cells from the blood and form a scaffolding for developing new tissues.

This scaffolding is called fibrin, which is a web-like sticky structure. An increased amount of growth factors and platelets in the injured area can shorten the recovery time and repair the damaged tendons faster.

Cell-Based Therapies

Cell-based therapies are also known as stem-cell therapies that focus on your own tissues or autologous tissues. These tissues are extracted from your adipose cells or bone marrow. Then, they are processed and reinjected into the injury site.

Depending on your condition, your doctor will go for one of the two types of cell-based therapies:

• Minimally Manipulated Adipose Tissue Transplant (MMAT). It involves extracting healthy stem cells from the adipose tissues and inserting them into the peroneal tendons. The doctor can perform MMAT in different areas of your body in one procedure.
• Bone Marrow Concentrate (BMAC). This procedure replaces the damaged cells of your peroneal tendons with highly concentrated cells from your bone marrow.

Cell-based therapies are performed under anesthesia, which is why they cause zero to no pain. These procedures are completed in 1.5-2 hours.

These therapy forms are performed by experts as outpatient procedures, meaning that they typically don’t take longer than two hours. Some patients have experienced pain at the injection site after the procedure, but this typically goes away in a matter of days and is replaced by a decrease in chronic pain.

Doctors will often use imaging technology such as an ultrasound to ensure that the injection is in the correct place. These treatments can be coupled with other treatments such as physical therapy to allow the recovery process to go even more smoothly.