Peroneal Tendonitis – A Do-It-Yourself Rehab Plan for Runners and Other Athletes

Happy Friday Everyone!! As you may have seen from my instagram or facebook pics, I’ve managed to over-train myself into injury…. And yes, once again it was due to too much training in footwear not ideal for my gait. When will I ever learn?

I’ve managed to give myself a nice case of peroneal tendonitis. The pain started just behind/below my lateral malleolous on my right ankle:

This injury came on slowly over the last few weeks of training prior to Ragnar. It only hurt while I was running, with the pain subsiding slowly after a run. As it wasn’t THAT painful, I didn’t think too much about it. In hindsight I’ve realised that I did this to myself. Not only did I switch to a minimalist shoe, I also did not put my orthotics in the shoes. I also drastically increased my training in order to be prepared for the endurance demands of my legs at Ragnar.  I am my own worst enemy.

What is Peroneal Tendonitis?

Basically it’s inflammation of the peroneal tendon, caused by repetitive friction under the retinaculum (a fibrous band of tissue) behind the malleolous (ankle bone). The inflammation causes TONS of pain, and a moderate amount of swelling (This tendon is within the joint capsule so the swelling is contained within it). Unfortunately the swelling in the capsule pushes on other ligaments and structures in the joint causing tremendous pain when weight bearing). This article explains it FAR better than I ever could without copying and pasting it, so I suggest you read up on it. Unfortunately is very technical in it’s description, yet it is very thorough. It also has awesome pictures.

I earned my certificate in Athletic Therapy from York University, so I put together a rehab plan to get myself better for my next half marathon (3 weeks from now), and I thought that I’d share my plan with you, so that if you ever find yourself dealing with killer pain on the outside of your ankle that comes on slowly you could follow it too.

First off – you MUST stop doing whatever activity caused the onset of your ankle pain, and assess your footwear and training plan to determine if they contributed to the injury. 9 times out of 10 your shoes (minimalist?) or training caused the injury. I also suggest that you see a pedorthist if you suspect that you require orthotics for pronation.

Here’s the peroneal tendonitis rehab plan:

1. Warm-up: 10 min on a recumbent bike, pain-free.
2. Stretching – Hold each stretch for at least 30 sec, and repeat 3 times: achilles, soleus, peroneals, quads, hamstrings, piriformis.
3. Strengthening – 3 x 10-15 reps of each: dorsiflexion, plantarflexion, inversion, eversion, calf raises. With these exercises use pain as your guide – if it hurts like a son of a b-tch, stop, and move to the next step: massage.
4. Massage: Find a friend to gently massage the bottom of your foot, calf and peroneal muscles, starting from the foot up to the calf, pushing gently towards the heart to help loosen muscles and flush out swelling. Start with a light, general touch, then work more specifically on each muscle.

(You may owe your friend a nice cold beer after doing this for you.)

OR AN ALTERNATIVE TO MASSAGE:

Roll your calves, and peroneal muscles (muscles on the outside of your lower leg) on a foam roller OR TENNIS BALL. The soles of your feet can be rolled on a tennis ball.

5. Ice: 10 min on, 10 min off x3 (You should also do this periodically throughout the day until your injury heals)

6. Protect your injured ankle: Use KT Tape or KB Tape (Medical grade tape) to help support and protect the injured tendon – here’s a video on how to apply the tape:

I call this the miracle tape – it wasn’t a product that had been invented when I completed my degree and athletic therapy certificate program, so it’s relatively new to me. I’ve been using it for this injury, and it has REALLY helped to speed up the healing process. Visit their website and order yourself a couple of rolls to have on hand. Trust me – you’ll love it too!

Repeat the above 3 times/week for 2-3 weeks.

NOTE: If you do not see a gradual improvement over the 2-3 weeks, visit your Athletic Therapist (you’ll be looking for someone who is NATA certified in the US, or CATA certified in Canada), or your Sports Physiotherapist as they may be able to identify other contributing factors, or your injury may be more severe requiring more intense rehab modalities such as ultrasound, or IFC.

Hugs! I hope your injury heals fast!