Hi, I was recently diagnosed with Peroneal Tendonitis in my right foot. The podiatrist told me to take some time off and that the tendon should heal up in about a month. I have now taken 3-4 weeks off of running and my condition has not improved. I am beginning to think running was never the actual cause of my injury. I ran two half marathons on the injury along with weeks of training and only experienced mild discomfort (I’ve had the pain for about 1.5-2 months). It only really hurt when I ran on uneven terrain which is the reason why I saw the doctor.
The cycling shoes are Mountain Bike shoes made by SIDI with SPD cleats. The reason why I think that the cycling shoes are causing the problem is because I always experience pain on the lateral part of my right foot after about an hour of cycling. The pain is tolerable but has always been there since the day I got the cycling shoes. The pain is also only in my right foot. The left foot feels perfectly fine. The left shoe is also looser than the right shoe because my left foot is about half an inch smaller than the right foot. This is the reason why I couldn’t go with the next size up.
Anyways, I think it’s time for some new cycling shoes. Even if the shoes didn’t cause the injury they are certainly aggravating it. It would also probably be a good idea to get some triathlon cycling shoes because that is what I am training for. Does anyone have any suggestions on cycling shoes/cleats that could help take stress off the peroneal tendon? Is there anything I could do in the mean-time with regards to cleat position that could reduce stress on the tendon?
Funny I just had someone in my studio this morning with SPD related foot issues…
I think the pedals are just as likely to be your culprit as the shoes. The platform on the SPD is very small, and the lateral stability is not great. I would bet your foot wants to roll to the outside off the pedal and this is straining the tendon, making it work too hard. The worst thing you can do is get a road shoe and use it with those SPDs - you wont have any tread on the shoe to (maybe) contact the pedal and stabilize your foot. I think this is what you meant to do (you asked about new “cleats” but not pedals…), but JIC, make sure you switch to a proper road pedal system (Look and Speedplay are the best IME) and get the cleats set up by a fitter who knows what they are doing. A road system will constrain your foot more, which is good, except for when its constrained to the wrong position, then its bad.
I often find insoles to be helpful, I sell quite a few of the Sole here in my studio and have only had 1 unhappy customer in 2 years. Most folks rave about them.
Jam your cleats back as far as they will go for now as that puts less strain on all parts of the foot and may provide a little relief.
Shoes and cleats can stay - first thing to address this common issue are some varus wedges under the cleats for your likely forefoot varus. A good fitter can do (even measure) this, or you can go online - search for LeMond Lewedges.
Thanks for the quick responses. I’ve been icing it occasionally but haven’t been taking any NSAIDs because of the possibility that they might slow healing.
Yeah, when I said “cleats” I meant pedals. I talked to my LBS and had them order some of the LeMond wedges. We’ll see if that fixes the problem. If not I’ll look into the Look and Speedplay systems.
I have had the exact same experience and was never diagnosed as having peroneal tendonitis, although after reading about it more on the internet, I think that is an accurate diagnosis. I was told I had a partial tear in the peroneal brevis tendon. Unlike your situation, however, I have road shoes and Ultegra pedals.
Brief background to serve as a warning for you. I did Florida 70.3 in May, 2006 with no problems and then after completing the 70.3 in Clearwater in Nov 06, my ankle was bothering me. I assumed I twisted it during the run somehow and, because my season was over, took time off to let it heal. In 07, I started biking again because I thought running was the culprit. Eventually, I went to the doctor, had Xrays, MRIs, prescription NSAIDs, etc. I kept taking time off to let it heal (getting fatter in the process), and whenever I got back into any regular activity, it would come back.
Fast forward to now. After laying off everything for a long time, I started back training this summer. No problems until this weekend after a 40 mile ride. I’m not doing much, mind you, ~ 2-3 bike rides a week in the 25-40 mile range, and about 4-5 runs per week in the 4-7 mile range. Now, my stupid ankle is slightly swollen again at the peroneal tendons.
I tell you all this more for a warning to get proper treatment and not drag it out like I’ve done. Also, I was hoping some experts in the ST crowd could offer some advice as to what I should do. I’ve considered switching my shoes/cleats/pedals to a Speedplay system, but I saw that there is a 185 pound limit and I’m tipping the scale at a robust 195 right now. Is this a real concern with Speedplays? Also, I was “professionally” fitted and they placed two wedges under my right shoe (which is the only one that hurts). Should I try removing the wedges to see if that helps any? Finally, my fear is that scar tissue has invaded the area and it may not ever heal properly given the time involved with my injury. Any suggestions on the best course of treatment?
Went to a new podiatrist today (see post above) and was diagnosed with peroneal tendonitis and got a shot of Cortisone and a prescription for Naproxin. He thought it was much more likely to be a result of running as opposed to biking (more of a weight-bearing activity). We decided the best way to find out is let the area heal for a week or two with no activity, and then ease back into only a single discipline, in my case, biking, in an attempt to rule out one or the other.
Unfortunately, I didn’t get a warm and fuzzy feeling that this injury will simply heal and never come back. The doctor hinted that I should just know my limitations and exercise accordingly in the future once its healed. Anyone out there ever been diagnosed with peroneal tendonitis and recover to do HIM or IMs? I’m also still hoping someone will chime in on their opinion regarding switching to Speedplay pedals.
To the OP, sorry to hijack your thread and rant on my personal injury. Hope you’re doing better.
Haha, no problem. Your story is just more motivation for me to try and get this worked out now.
I’m planning on getting some orthotics within the next week and hopefully a bike fit once I go home (I had a bike fit when I bought the bike but they never looked at my cleats/pedals/shoes). I also started icing the injury four times a day. Hopefully that will do something… waiting around sucks.
Part of my problem is also the fact that I can’t really stay off my feet. Walking too and from class is pretty unavoidable time on my feet. That’s probably why my condition hasn’t really improved.
Best of luck with your injury. Hopefully things heal up.
Did you feel the pain in the middle part of your peroneal or just the foot? I have pain in the middle of my peroneal. It’s been there since August. Same thing I feel it more running, but I took 6 weeks off from running, biked a bit and it’s still there. How is yours doing? What did you do to heal it?
It has gotten better since my last post but it still hasn’t gone away.
Refering to “pain in the middle part of your peroneal or just the foot”: My pain is usually on the edge of my foot under the fifth metatarsal and under the bottom of my foot where the peroneus longus tendon inserts into the first metatarsal. So it does extent from where the tendon first goes under the foot at the base of the fifth metatarsal all the way to the anchor point at the first metatarsal.
I do think that rest, ice, and massage is definitely helping it though. I’ve spent less time walking (because it finals week and I have no class) and have started to ice the bottom of my foot and massage it at least three times a day. What I do is take a soda can and freeze it until it’s solid (not too much or it will explode >.<) I then place a yoga/pilates mat on the floor and ice my foot by rolling my foot over the can. I usually do this for about 10 minutes with no socks until my foot is nice and cold. I then let it rest for about a minute and then take a golf ball and roll it under whatever part of my foot hurts. I massage side to side, up-down, and in circles. I then usually repeat this process once more (ice then massage). The yoga/pilates mat is helpful because it pads the soda can (that way it doesn’t explode from metal fatigue) and it holds the golf ball in place so it doesn’t go flying off it some direction.
I’ve also been stretching and massages my calves with a foam roller. A marathon stick would probably work better to hit all of the peroneal tendon triggerpoints.
Pretty much hitting all the bases and hoping something works. IDK what specifically is working, but that’s what I am doing. I should also have some orthotics on the way which will also hopefully help.
Hopefully this helps
-Adam
Random thoughts: Thick carpet could probably replace the yoga/pilates mat (except your carpet will get wet because of the condensation on the can) and a can of soup with the label removed could probably replace the soda can. I haven’t had any explosions since i started using the yoga/pilates mat.
I have suffered peroneal tendonitis in both feet and it doesn’t start after 40 miles more like 4, after considerable experimenting I found it is being caused by the cycling shoes which aren’t wide enough. No cycling shoe I have found is wide enough and I’ve found that I can successfully cycle in my vibram five fingers for many miles with no troubles using Ergon PC2 pedals. This is my solution it’s a give an take I can give up riding or I can ride in my five fingers. I prefer to ride.
I have suffered peroneal tendonitis in both feet and it doesn’t start after 40 miles more like 4, after considerable experimenting I found it is being caused by the cycling shoes which aren’t wide enough. No cycling shoe I have found is wide enough and I’ve found that I can successfully cycle in my vibram five fingers for many miles with no troubles using Ergon PC2 pedals. This is my solution it’s a give an take I can give up riding or I can ride in my five fingers. I prefer to ride.
At that point I’d spring for some custom Rocket 7 shoes. They’ve gotta beat 5-fingers and platform pedals. Don’t know if you tried Bonts, but they are also mega wide.
I’ve had the same problem and was curious if you have tight IT bands? If so, you need to fix the problem (tight IT band) versus just fixing the symptoms. Stretch your IT band post workout and lots of foam roller.
Having a tight IT band can cause a whole lot of problems because they can throw the tension off on the other tendons in the leg to include the peroneal and adductors.
Now that time (a long time) has passed- can anyone give any updates on their peroneal tendonitis? Especially interested to hear if Adam NL or Sake every completely got rid of the pain and got back to running. I have just passed a year since original injury, probably have run only 30 mi in the past year total. Biking on the roads seems to be ok but being on the trainer aggravates it. MRI diagnosed peroneal brevis tear right where it inserts into the 5th metatarsal, but I have pain all the way up the lateral part of my leg almost up to my knee. Have custom orthotics (I’m desperate at this point), which are ok, but certainly no miraculous healing. On the other hand, I’m probably twice as fast a swimmer as I used to be, so, that’s cool, I guess.
I believe I have the same problems as most in this thread. Fortunately for me, it only hurts after exercising not during which may be a bad thing. I took a lot of time off from my last IM and the pain went away, got back on the bike, pain came back. Looks like thats the culprit now. I’ve had this problem before, went to the Drs, said if I want it gone, I’d have to cast it for x number of weeks. I can’t (I mean I’m sure I could) I am very active as a PE teacher and with 3 little kids and my weight would sky rocket. Sucks getting old.
Nice blast from the past. I read my previous posts and remember this all too well. I eventually switched to Speedplay pedals, and while I would love to report that all is better, I sadly can’t say that. After taking substantial periods of time completely off, I’m back to swimming, running, biking, etc. I currently am working up the base and hoping to do a HIM next year, but I’m concerned that this injury may prevent it. I currently do long rides of 60 miles and run up to 8 miles, but I definitely still “feel it” after doing a big week. The swelling has not returned, so that is good. I am constantly afraid that each time I extend my training, it will reoccur like before and knock me out for a long time again. I am therefore slow to increase my distances and only move up about 10% each month on my long bike/runs. I certainly have not found a remedy yet. Wish I had found some great cure, but I think this will be something I live with for the rest of my life. Best of luck to you and your recovery. Take it slow…
I have this pain , but only when I use Keen bike shoes. I get it on the right side of my foot when I wear my keen bike sandals or keen bike shoes. I use frog pedals with these shoes. I normally wear sidi genius and speedplay and don’t have a problem with this set up. I wish I knew why the problem occurs with the keen shoes and frog pedals. I would like to be able to wear these for times when touring or when i know i will be getting of the bike and walking around. The last time i wore the shoes , i rode ~25 miles. The pain got pretty bad and when i got home , there was a swollen pad on the right side of my foot and it hurt to walk on it. I am worries that I will develop a chronic problem if i continue to try and wear them. Why would this occur only with this set up and I wonder if there is a solution … like some kind of support , etc. Thanks for any input on this.
Just guessing wildly here, but have any one of you with peroneal tendonitis done excentric calf raises with foot eversion for PT? I’m thinking standing on a stair or book or something, but sideways with only first metatarsal on the stair and bent knee.
Tendinitis (well, once it goes on for more than like a week it’s not an -itis, but rather tendinopathy/tendinosis) in the achilles tendon is treated with excentric calf raises and lot of them.
Since the Peroneal tendons are much thinner and smaller I would start very lightly with them, maybe 3*5 negative and work from there.
I went through a few weeks of pain, broke down and went to the doc. He wanted to cast it for a month, that wasn’t going to happen. I took a couple easy weeks, wore an ankle brace. Big helps were, new shoes, both running and riding, find ones that are looser in the heal cup. An alternate to that is to not tie the shoe all the way to the top lace or not as tight across the top. Massage the bottom of your foot with a golf ball. Also used a Nalgene was water frozen in it to massage the foot. Stretch the shiz out of your IT band and keep a golf ball at hand. I keep one under my desk at work, when I feel my foot creeping in with pain, 20 minutes and the pain is gone. Driving also aggravates my heal, haven’t figured out the correction for that one yet.