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Running Injuries - Persistent and Degenerative Peroneal Tendinopathy
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18 months ago, I went for a regular 5 mile run and came home with a swollen and painful ankle. I rested for 3 weeks doing other activities and then tried to run again with the same result. I rested for a month before having an x-ray -- no broken bones and prescribed elliptical. It didn't get better so I went to an ortho about two months after that. I was diagnosed with peroneal tendonitis got a lace up brace and did PT for 8 weeks. No real improvement and after several follow up appts, I was sent for an MRI almost a year after the onset of this and was diagnosed with peroneal longus tendiopathy. I did another round of PT, tried a cortisone injection, and needling. Instead, my ipsolateral hip flexor and adductor started hurting, I was majorly overpronating, and started having plantar fascia pain. So, 3 months after the first MRI, I had a second MRI which found moderate peroneal tenosynovitis and small partial thickness 1.5cm split tears of the peroneous longus and brevis. Also, chronic ATL ligament sprain without rupture (old sprains that never fully healed). I don't really display outward symptoms except every morning my ankle is super stiff and I absolutely cannot run on it or it gets really painful; I can't wear normal shoes because that hurts it too so I'm stuck in sneakers; and now I can't even bike because of the related hip pain. One doctor told me to do nothing; one wants to do surgery; and another said put my foot/leg in a cast. I opted for the cast last week as a middle ground but now I am afraid I am wasting another 4 weeks on something that will not work. Any advice?
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Re: Running Injuries - Persistent and Degenerative Peroneal Tendinopathy [OX123010] [ In reply to ]
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What is the current theory for your peroneal overload or is it theorized from the lateral sprain traumas and instabilty? Have you been to a good podiatrist or CPed? There are subtle ways to offload this muscle group with custom orthotics, but you will still need to address tissue. It will require finding a very good clinician.
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Re: Running Injuries - Persistent and Degenerative Peroneal Tendinopathy [OX123010] [ In reply to ]
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I lack knowledge to offer any advice -- only hopes that your situation improves. I'm curious of your age and training background?

________
It doesn't really matter what Phil is saying, the music of his voice is the appropriate soundtrack for a bicycle race. HTupolev
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Re: Running Injuries - Persistent and Degenerative Peroneal Tendinopathy [OX123010] [ In reply to ]
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 small partial thickness 1.5cm split tears of the peroneous longus and brevis.



I had a small tear of the peroneous tendon a few years ago. Wore a walking boot for almost 8 weeks. Then allowed walking "distance" without a boot for another eight weeks with a gradual introduction of stationary bicycle riding towards the last few weeks. An home exercise program via the local therapy clinic was also introduced at this time. Then a gradual introduction of a walk-run treadmill routine. No problems today as I let the thing heal correctly.
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Re: Running Injuries - Persistent and Degenerative Peroneal Tendinopathy [Billyk24] [ In reply to ]
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OP: I am in my early 30s (female) and did a variety of activities, making sure not to do the same activity two days in a row. Activities prior to injury included cycling, running, barre classes, yoga, and some light free weight training.

Thanks, Billyk24, as your response gives me more hope that this cast might actually help me. How long were you injured before you realized you had the tear/sought treatment?

One of the biggest issues I have experienced is that I am not outwardly symptomatic unless I try to go running in which case I have pain/tenderness. I typically have no swelling and despite many pokes and prods by doctors, typically there are no sharp pains. This has resulted in a couple of different physicians who simply believe there is nothing wrong with me even with the MRI results to show them there is. Has anyone dealt with an injury/doctor like that?
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Re: Running Injuries - Persistent and Degenerative Peroneal Tendinopathy [OX123010] [ In reply to ]
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OX123010 wrote:
OP: I am in my early 30s (female) and did a variety of activities, making sure not to do the same activity two days in a row. Activities prior to injury included cycling, running, barre classes, yoga, and some light free weight training.

Thanks, Billyk24, as your response gives me more hope that this cast might actually help me. How long were you injured before you realized you had the tear/sought treatment?

One of the biggest issues I have experienced is that I am not outwardly symptomatic unless I try to go running in which case I have pain/tenderness. I typically have no swelling and despite many pokes and prods by doctors, typically there are no sharp pains. This has resulted in a couple of different physicians who simply believe there is nothing wrong with me even with the MRI results to show them there is. Has anyone dealt with an injury/doctor like that?


To me, I find that a bit unusual that you have no pain with poking and prodding at the area of the peroneal tendons. For many people, when these tendons are truly diseased, there is definite tenderness as you poke around on the back or very lower edge of your outside ankle bone (lateral malleolus). If there is no tenderness or pain when doing this, it would definitely make you think of something else (even though peroneal tendonopathy must be kept as part of the differential diagnosis). I am not a radiologist, or Ortho doc, but I bet many of us runners would show a little inflammation (or damage) to our tendons and/or ligaments with MRI scanning. I had osteitis pubis, which is an inflammation where the pelvic bones come together, and had "bone edema" on MRI. Considering I was symptomatic, this went along with my diagnosis of OP. But, I was also told (and read) that a lot of runners (and other athletes) probably have pelvic "bone edema"(inflammation) but different people respond in different ways.

Have you seen a sports med doc???
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