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PERONEAL BREVIS AND LONGUS TENDONITIS

The peroneal brevis and peroneal longus muscles work with the fibula, running down the lateral (outside) of the lower leg to the planter (underside) of the foot at the base of the 5th metatarsal (little toe). These muscles are principally evertors of the foot, balancing against excessive inversion. The pain is often located in the lateral transverse arch area, following the pathway of the muscles and tendons.

This is often misdiagnosed as a lateral ankle sprain because isolated injury to the peroneal tendons is rare. Injury can occur in conjunction with an ankle strain also. Function can be severely compromised by any tendon disruption; conversely, complete rupture can be asymptomatic. The reason for this variation is not known.

This is a disorder primarily of those with a pes cavus (high arch) foot. Arch support and proper shoe selection is essential in curing and relieving this disorder..

Other names or similar foot conditions:

• Leg tendonitis
• Weak ankles

Symptoms:

• Pain and instability on the lateral side of the lower leg, ankle and foot that follows the peroneal muscle path

Signs to look for:

• Pes cavus (high arch) foot
• Pain and instability on the lateral side of the lower leg, ankle and foot that follows the peroneal muscle path

Possible Causes:

• Acute injury
• Repetitive injury cause by lack of arch support and non-supportive footwear
• Found in those with arthritic, systemic and/or neurologic conditions where the foot becomes pes cavus

Goals:

• Control motion in the foot and leg
• Align feet, ankles, knees and hips
• Move foot forward with as little lateral movement as possible
• Footwear that support legs, ankles and feet

Solutions:

Arch Supports:

• Bio-Orthotics Winstep or Sundance exercising support with metatarsal lift

• Lower and thinner arch support with longitudinal and metatarsal support, such as the Bio-Orthotics Journey or Silhouette, for use when shoes cannot accommodate the Winstep or Sundance exercising support

• Extra depth shoes with firm heel counter, connecting shanks, high toe box and stiff rocker soles
• For exercise, wear shoes with titanium springs
• MBT physiological shoe
• Negative heel shoe
• Go barefoot on a minimal basis only

Other:

• If the arch support and shoes do not provide enough stability, add wedging from the hind foot to the forefoot
• For a flexible foot, use a lateral wedge
• For a rigid foot, use a medial wedge
• Go barefoot on a minimal basis only

Activities:

• Medical assessment and/or RICE (rest, ice, compression and elevation
• No weight bearing exercising until symptoms recede and correct arch supports and shoes are in place
• Regular stretching of gastrocnemius and soleus muscles, Achilles tendon and arch structure
• Rotate weight bearing exercises, such as walking or jogging, with non-weight bearing exercising, such as swimming or bicycling