Member Question: Peroneal Tendon Pain

author : AMSSM
comments : 1

Member Question

"I have peroneal tendon problems on my left. The brevis is a complete rupture after two repairs. I think the longus is having to compensate. I am having pain lateral & below the knee. I am fairly certain it is the muscle that attaches to one of the tendons. I seem to have the pain more after cycling. Any ideas on a fix? Also, I have pain on the right iliac crest - right on the bone - doesn't go anywhere else. Is there any chance this is related?"

Answer by Marco Valencia, MD and Grant Morrison, MD
Members AMSSM

First of, I just wanted to clarify the location of the pain. You were talking about peroneal tendon problems which would be around the lateral aspect of the ankle. On the other hand, you described pain lateral and below the knee. Were you referring to the same location?

If your ankle feels fine but the pain is limited to your knee area, then your instincts are good; the peroneal muscles do originate from that region. These muscles may be struggling to regain the strength and endurance they need to keep you running. Given that the tendons that arise from these muscle and descend into your ankle gave out and required surgery, we suspect they may not have been in peak condition prior to the surgery. Try this: stand on your injured leg with a bare foot on a flat floor, and check your balance. How many times do you have to touch your toes to the floor to keep your balance? Compare this to standing in the same fashion on your right foot. How much are you struggling to keep your balance? Are you gyrating wildly to keep upright? I would not be surprised if you have a significant muscle imbalance that will take significant effort to retrain. You could try simple balancing exercises, standing for a full minute on your left foot and alternating with your right. Try a minute each time, alternating sides, for three total minutes each. Increase the challenge by standing on a pillow. You will find your balance gradually improving, and this may well help you gain the stability you need. Alternatively you might consider seeing a good physical therapist who is experienced in treating runners and has a good awareness of biomechanics.

On the other hand, the way you have described your symptoms and the history of your peroneus brevis tendon, you might be referring to your lateral ankle. This might be due to a condition called peroneal tenosynovitis. It is a common cause of chronic lateral ankle pain. This is usually due to a tear or subluxation (or dislocation) of one of the peroneal tendons. With your history of recurrent peroneus brevis tears, this is the most likely cause as the brevis tendon is the most commonly affected tendon leading to this condition. Symptoms can include pain and swelling on the lateral ankle. An MRI is an appropriate imaging test to evaluate this condition. This may also reveal if you have torn your brevis tendon again. Depending on what is found, treatment options may include casting, a tendon sheath cortisone injection, more physical therapy, bracing or even another surgery.

With regards to your right iliac pain, this could be related to your left side if your mechanics are so thrown off that you must overcompensate with your right leg. Ask your running partners to run behind you and look for any abnormalities in your gait, such as your heel swinging outward, your knees angling inward, or even your arms swinging in wildly different patters.  Again, a visit with a good physical therapist experienced in biomechanics and runners could be very helpful.  A running video gait analysis could be very interesting also.

Sincerely,
Marco Valencia, MD
Grant Morrison, MD

Rating

Click on star to vote
17468 Total Views  |  131 Views last 30 days  |  31 Views last 7 days
date: April 27, 2012

Author


AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

Author

avatarAMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

View all 352 articles