Have seen lots of helpful threads on peroneal tendon injuries so I thought I’d share my story and see if anyone has any advice or insight.
Right before Thanksgiving I was doing a speed workout on the treadmill when I noticed some lateral pain on my right foot. Didn’t think much of it, re-tied my shoe and started the next set. Had to stop completely as I had a great deal of pain and couldn’t even walk properly. I suspected subluxed cuboid, which has happened to me before. Saw two different chiros for adjustments. The adjustments didn’t provide relief like when I had had this before. Went to a podiatrist, who x-rayed and said I had a sfx in the 4th metatarsal. That has now healed, but I still had pain under the cuboid. Podiatrist said it might be ligament damage, but that I could try some easy running. Last Saturday went out for an easy run, about three miles in I could feel pain under my foot so I decided to play it safe and walk the rest of the way home. As I walked, I could feel something slipping down my ankle. I actually thought there was a little pebble in my shoe, there was nothing there so I am convinced something tore in my ankle. The next few days the pain wasn’t bad, I even did a long ride on the trainer the next day, but now I am having constant pain and can’t even walk normally. I am getting an MRI next week. Although I have pain and a little swelling, I don’t seem to have ankle weakness or instability. There is no popping or clicking either. I’m icing and taking naproxen, but it’s hard to know if that’s helping.
So my question is, it is a tendon tear? Something with the sheath? The reticulanum (sp?). At this point I’m basically assuming the worst, that I’ll need surgery and do no racing this year.
Any advice or similar stories would be appreciated. Thanks in advance!
2 weeks before the Marine Corps marathon I went from feeling great one day to not being able to walk the next day. MRI diagnosed tibial peroneal tendonitis and a stress reaction. I was in a boot for a month, a lace up ankle brace for 3 weeks and I went to PT. I am slowly beginning to run again - ran my first mile last week. Hopefully you won’t need surgery, but I was cautioned to heed the dr’s advice. I have high arches to begin with and I was terrified that my arches were going to fall. I found a podiatrist was more helpful than an orthopedic dr.
I also assumed the worst when I started having peroneal pain and googled the surgery stuff. Last year I started having foot pain in my left foot and tried to work through it for a few weeks. I guess I I was compensating and injured my other foot (right). woke up and could barely walk on it. Pain in the peroneal area and under the side of my foot. I got a cortisone shot , bad idea. Podiatrist thought it was tendinitis since most peroneal injuries come from trauma. I did have a history of severe ankle sprains so I was still worried. Finally got to an ART guy aftnow trying to let it heal with no improvement who helped in only a few sessions. Changed my shoes at a great running store to help with my high arches and supination foot strike. Good luck.
Hi Ironmom1, I think I read your story on this forum when I was researching the peroneal tendons. Glad to hear that you are back running again. I actually have very low arches and nearly flat feet, which probobaly contributed to my initial cuboid problem. I am also seeing a podiatrist.
A question, have you been able to bike or swim at all during this time? Right now I don’t feel that I can do either, since it is painful to point or flex (and even painful just sitting here on the sofa). But if I don’t need surgery I hope to at least be able to return to swim/bike soon…or I might go crazy
Thanks rroof for responding; I admit after reading your responses to other posters I was hoping I’d hear from you!
I did look up os peroneum. I feel some discomfort along the lateral side of my foot just behind the fifth metatarsal, but mostly I feel a painful burning around the outside of the malleolus. But as you say, the MRI should hopefully tell what’s going on. I’ll update once I hear the results for anyone who’s curious or might be going through something similar.
Hi tallvinny,
Thanks for the reassuring story. I have noticed some tightness in peroneal muscle, so I tried rolling with the foam roller and even a rolling pin. It might have helped a little, hard to tell. I am hoping they prescribe PT for me if I don’t need surgery.
My PT told me to stay away from weight bearing exercise for a while so I have been erging (rowing) and lifting weights. I don’t usually swim in the winter because an indoor pool is far, but the PT did suggest water running as an option.
Update- I had an MRI and just spoke with my podiatrist. He says that the fourth metatarsal is still fractured, and that I need to go back in the boot for another month. Unfortunately the MRI did not include the ankle area (grrr) so he can’t say what might be going on with the peroneal tendons. He did suspect that other areas of the foot have been compensating for the fracture, and that when it heals everything should be ok. Hopefully.
In the meantime, I have been rolling my calves and peroneal muscles like crazy and I’ve noticed a definite improvment. I even tried to push the tendon back over the malleolus, thinking that it might be subluxed. I have no idea if I actually accomplished anything (or if it was subluxed in the first place), but it does feel better.
Guess I’ll be heading to the pool soon! Thanks for your input, everyone. Tallvinny, thanks for the message- I tried to respond but I can’t PM since I am a newb
I have an ongoing and very similar problem. I have had several years of very severe left lateral ankle and lower leg pain (posterior to and immediately above the lateral malleolus) upon fast walking or running and numerous visits to general practitioners and podiatrists with differing diagnoses of strained ankle, shin splints, runners strain, etc.
In October 2011, debilitating pain just above the lateral malleolus brought on by anything more than a stroll, caused me to revisit a podiatrist. The MRI indicated nothing and the doctor recommended I restrict activity. I stopped walking except as necessary, no running, biked very little, used NSAIDs, ice and waited. There was a little improvement, but four months later, while standing, sudden and sharp pain at the cuboid which did not go away caused me to find another podiatrist who ordered another MRI. This MRI showed peroneal tendonitis (inflammation just below the *lateral malleolus) *with no apparent tear. The pain at the cuboid was constant and severe and I was barely able to walk even short distances. The podiatrist suspected a subluxated cuboid, performed some adjustments and put my foot in a short walking boot.
After about 4 weeks with the boot, I saw an orthopedic surgeon who ordered an oblique x-ray which clearly showed a fractured os peroneum, two pieces about 2 mm apart with jagged edges. He recommended that I continue the boot and diagnosed the pain above the lateral malleolus as compartment syndrome and unrelated to the os peroneum injury. The cuboid area pain did subside after 8 weeks in the boot, but is now recurring (with much less intensity) and the ankle and leg pain is very severe again if I walk fast or run, though I can bike.
I am beginning to doubt that I really have compartment syndrome at all and think that the peroneal tendon inflammation and the os peroneum fracture are related, and maybe one (or both) of the peroneal tendons has a longitudinal tear which has long gone undiagnosed (I have read these can be hard to see) causing the constant pain upon motion, and the resultant scar tissue and tendon dysfunction stressed the os peroneum to the point of fracture. Does my theory seem plausible? If so, maybe surgery to repair the tendon might relieve the pain at both sites.
It is possible, though your theory isn’t quite right - the os peroneus (coupled with other “dysfunctions” like a tight posterior calf group, increased activity too fast, etc.) causes the tendinosis/tendinitis, note the other way around.
I don’t remove an os peroneum very often since they usually are not symptomatic, but it appears that yours might be a chronic issue. I doubt you have compartment syndrome as well (as this would likely show on the bike as well), but this can be tested with a pressure test after activity pretty easily.
Thank you for the quick reply. So, the os peroneus could be the root of the problem. Do you think a longitudinal split is likely or another MRI might be in order to look for a split? Is there an experienced trick for spotting an obscure split?
Thank you for the quick reply. So, the os peroneus could be the root of the problem. Do you think a longitudinal split is likely or another MRI might be in order to look for a split? Is there an experienced trick for spotting an obscure split?
You want your (new) MRI read by a good musculoskeletal radiologist (not all are). I read my own as well, but rely on just 2 in my area that I trust. But, the MRI needs to be correlated with your symptoms clinically to give a full picture of what is going on and how to proceed. Obviously if you have a long longitudinal tear, fractured os peroneum and chronic pain not responsive to conservative therapy, taking out the os peroneum while repairing the tear would be reasonable recommendation. You apparently did not have a tear in Oct of 2011, but that was quite a while ago with ongoing symptoms. You certainly appear to have cuboid syndrome as well.
Hey all,
OP here- wanted to post an update and see how other people’s peroneal tendonitis issues are progressing (hopefully resolving). I have had a very frustrating time of progress and regression. During Feb and March I went to Physical Therapy and learned a few interesting things: that I have the “flattest and most flexible feet has ever seen;” that I have a gait pattern called “uncompensated forefoot varus,” and that orthotics are for sure in my future. They did the usual ultrasound, various ankle exercises, electrical stim, icing, a bit a deep tissue work (that was only once when I didn’t see my regular guy- the woman who worked on my leg worked all the way from my ankle almost up to my knee. She also told me that ART is no longer considered a good treatment because it can cause long-term damage to the muscle. I do have a bit of soreness in my left quad where I had ART done last summer…And when I asked her if I had os peroneum problems she laughed at me and told me I’d be in a lot more pain. So good to rule that out, anyway). Anyway things were a bit up and down but mostly trending toward getting better. I even ran one slow, shuffling mile on the treadmill a few weeks ago.
However, I’ve been done with PT for two weeks now and things are rapidly getting worse. I have pain on the lateral portion of my foot right where the peroneal tendon brevis inserts into the cuboid. I also have dull burning pain around the lateral malleolus extending up my calf a few inches. Driving is painful (right foot), and I spend 1-2 hrs in the car per day. I’ve been wearing PowerStep inserts in my shoes most days. I’m stretching and rolling with the foam roller. I even bought Brooks Addiction, which are serious motion control, and wear them around the house. I feel like I’m doing everything right and its only getting worse. I am still biking and swimming…the PT told me that biking wouldn’t be an issue but I’m wondering if the shoes/pedals could be an issue. They are a bit narrow for my feet (I have bunions, thanks to my super flat feet). I suppose I could stop biking but between the no-running, no-racing, and inability to lose winter weight (running is the only thing that really takes the weight off for me), I might have a nervous breakdown if I also can’t bike.
I know there are no easy answers but it would be great to hear from anyone who has gone through this- did you experience set-backs? What kind of timeline are we talking here, another 2, 6, 12 months? What stuff did you do at home that helped?
TIA. I hope you all are having better luck than I am.
I have been through the peroneal nightmare and still have some slight irritation at times. I initially injured it about 1 year ago while running, a slight longitudinal tear was the diagnosis. It was 4 months before I could run again. Initially, one of my doctors put a pad under the lateral side of my shoe to help offload while walking (this was helpful since it was very painful). The pad was probably 3mm and cut so that it mimicked half of the insole and we placed this under the insole on the lateral side.
Something I find interesting about your post is that I also have an uncompensated varus forefoot with a short, hypermobile first ray. Three years ago I was prescribed custom orthotics without taking this into account and I think this has lead to some of the problems. Nowadays, I am running without orthotics but have done a ton of foot strengthening and also made sure that my big toe functioned as it should. It may seem trivial but having the foot in good working order is crucial.
I still have some pain in the area at times and try to roll out the knot that appears with a golf ball. I have had ART and Graston and have found both to be helpful. I have noticed that if I wear a high medial arch shoe my peroneal hurts more. I think I need additional lateral support to offset the high medial.
I NEED YOUR HELP! I thought I’d ask the forum for some advice. Here’s my situation, I believe it’s peroneal tendonitis, though could be a stress fracture - though I don’t think so. Last year I took a long break from triathlon. Not much training due to work & other things going on. I did an Ironman without training (Canada). I came away so but uninjured, which was the goal. After that I was working 80 hour weeks and no time for triathlon. I decided to get back into it around Dec-January, a few months ago. I was dealing with a heel spur and IT syndrome, and decided to try something crazy and give Newtons a try. 3 weeks into getting back into it, I got a pain on the outside of my right foot while on the treadmill. I was only running 3-5 miles per run, 3 days a week or so…easing back into things.
I have since tried about 5 different pairs of shoes, gotten dry needling done, ART, etc. I still cannot run and have not run much in a few months. Pain was not getting any better. It is also very sore after cycling, especially low cadence work. Yesterday I moved my cleat position so less pressure is on the outside of the foot, and after today’s ride I was actually encouraged since I had less pain walking around afterwords.
For those who have had peroneal tendonitis, is this where it hurts? I was told by the PT it’s not cuboid syndrome since it hurts at a different place than usual cuboid. Thanks! See photo: http://i1138.photobucket.com/albums/n537/rborger/photo_zps64b5438c.jpg
borgerendurance - That is in the general area. My worst pain was underneath and directly on the side of the foot. I have had all types of running injuries and this one had me the most worried. At 3 months of no running and working with a rehab guy it still felt like it was no better. I could not push off at all off of my forefoot without significant pain. I honestly thought I might never get it healed up without some type of surgery nonsense. Then finally I made it over the hump and was able to walk/run at 4 months.
I was able to ride a bike about 10 days after the initial injury (water running before that). I stayed away from my road bike since it hurt to unclip and used my mountain bike with my flat pedals with no problems. You might want to try either a slight lateral heel wedge or as I talked about above, the pad under the lateral mid and forefoot to see if that takes some of the load off. I always try to do my best to limit the amount of ibuprofen that I take but I did find it made a huge difference.
Hey-I have the exact same problem for the last year! Can barely walk and i’m only 25. Please tell me you figured it out or have had improvements? my peroneal tendons are killing me and all MRI’s and xrays are normal I’m so worried I won’t get my life back!
I’m so worried I won’t get my life back!