Peroneal tendinosis pertains to the enlargement, thickening, and swelling of the peroneal tendons located on the outer aspect of the ankle, just behind the fibula bone. Typically stemming from overuse, such as repetitive activities that strain the tendons over prolonged durations, peroneal tendinosis commonly emerges without a specific injury history.

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Symptoms

Individuals with peroneal tendinosis often engage in new or intensified exercises, like marathon running, leading to pain around the back and outside of the ankle. Notably, there's usually no direct injury preceding the discomfort.

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Causes

Peroneal tendinosis can arise from improper training, rapid training escalation, or ill-fitting footwear. Those with high arches might be more susceptible due to increased tendon workload necessitated by the inward heel orientation.

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Anatomy

The peroneus brevis and peroneus longus are responsible for outward ankle rotation. These tendons traverse the back of the fibula, enclosed within a protective retinaculum.

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Diagnosis

Dr. Kamel diagnoses peroneal tendinosis based on patient history, clinical examination, and imaging studies like ultrasound or MRI. Pain on palpating the peroneal tendons, coupled with specific movements, aids in diagnosis.

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Treatment

Non-surgical management typically suffices for most cases, involving rest, immobilization with a CAM walker boot or ankle brace, gradual return to activity, orthotics for varus alignment correction, and physical therapy. Platelet-rich plasma (PRP) injections might facilitate healing, while steroid injections are avoided due to rupture risk. Surgical intervention becomes an option if conservative measures fail, with options ranging from tendon repair to deeper fibula groove creation or tendon resection, depending on the tendon's condition.

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Recovery

Complete recovery may take time, with surgery potentially requiring a prolonged period of non-weightbearing and subsequent physical therapy.

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Risks and Complications

Surgical risks include infection, wound complications, and nerve damage, particularly to the sural nerve.

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Considerations

Neglected peroneal tendinosis can progress to tendon tear or ankle sprain, potentially leading to chronic ankle instability and cartilage damage. Unlike tendinitis, characterized by acute inflammation post-injury, tendinosis entails chronic tendon pain, resulting in enlargement and thickening without acute inflammation.