Peroneal tendinopathy, also referred to as peroneal tendonitis is a common condition in athletes, particularly runners. It causes pain and swelling to the back of the foot or the outside of the lower leg, particularly when running.
Each leg has two peroneal tendons which run parallel down the lower leg bone (fibula) and behind the bony part of the ankle (lateral malleolus).
One peroneal tendon attaches to the outside of the foot at the base of the small toe. The second peroneal tendon runs underneath the foot and attaches to the inside of the foot arch.
Peroneal tendinopathy or peroneal tendonitis occurs when the peroneal tendon rubs on the bone causing inflammation.
Our renowned medical team provides a range of treatments, from the traditional to the innovative:
This is an effective and well-researched procedure that’s a potential alternative to surgery. It takes advantage of the blood’s natural healing properties to reduce pain and improve joint function. It uses a specially concentrated dosage of platelets prepared from your own blood to repair damaged cartilage, tendons, ligaments, muscle and bone. Patients usually see their symptoms improve in one to two weeks of having the injections. Read more clinical evidence supporting PRP here.
AMPP® Activated Mesenchymal Pericyte Plasma (using Lipogems® technology)
A pioneering new treatment using your body’s own stem cells from a combination of Lipogems® and Platelet Rich Plasma Therapy to treat pain and inflammation. It harnesses natural repair cells removed from your body fat to target problems affecting discs, joints, tendons, ligaments and muscles.
The procedure takes around an hour and early results suggest an improvement for 75% of suitable patients. The minimally invasive procedure is a possible alternative to having an operation or can be used after surgery to help healing.
Are sometimes recommended if you’ve not had much success with the first-step approaches of painkillers, rest, stretching and physiotherapy.
Peroneal tendinopathy is an overuse injury that results in pain to the back of the foot or the outside of the lower leg. It’s common in athletes and runners and can be caused by a sudden increase in training or physical activity such as walking, running or jumping.
Improper training can also cause peroneal tendinopathy and so can wearing unsupportive footwear.
Peroneal tendinopathy may also be found in people who have muscle imbalance. This is where one muscle is stronger than the others and it pulls on the peroneal tendon causing tendonitis. It can also occur in people who have high foot arches.
Peroneal tendinopathy can either be acute meaning symptoms come on suddenly or chronic where symptoms build up over time. With both forms of peroneal tendinopathy, you may experience:
• Pain at the back of the ankle which worsens during activity
• Pain and discomfort when turning the foot in or out
• A warm feeling around the back or outside of the foot
• Swelling at the back or on the outside of the foot
• Instability of the ankle when bearing weight on the foot
If left untreated, over time scar tissue will form to protect the damaged peroneal tendon. This weakens the tendon and makes it more prone to tearing.
If you are experiencing pain to the back of your foot or lower leg, a doctor will examine your foot applying pressure to different areas to see where it hurts. In some cases, the doctor may refer you to have an:
• X-ray – to see if there any other bone problems which could be causing the pain
• MRI – using a magnetic field and radio waves a detailed image of the foot is created which can reveal subtle changes in the patellar tendon
• Ultrasound – sound waves are used to create an image of your foot which can reveal any abnormal swelling or scar tissue in the peroneal tendon
Treatment for peroneal tendinopathy aims to relieve symptoms and improve the function of the foot and ankle.
Initial treatment may include medications such as analgesics which help reduce the pain, non-steroidal anti-inflammatory drugs – NSAIDS – which reduce the pain and inflammation and steroid injections which reduce inflammation and provide short-term relief.
Lifestyle modifications, such as restricting the amount of exercise you do and getting plenty of rest can help in the treatment of peroneal tendinopathy.
Applying ice to the area can help relieve the pain, particularly after exercise. If you do this, it’s important to place a cloth between the ice and your skin to prevent you getting an ice-burn.
It may be recommended that you wear a brace during activities that involve repetitive ankle motion. Your doctor may also advise you to carry out a range of exercises and stretches (once the pain has decreased) to strengthen the foot and ankle and to improve flexibility.
Our expert team specialises in treating peroneal tendinopathy using advanced non-surgical techniques including stem cell therapy, AMPP® Activated Mesenchymal Pericyte Plasma (using Lipogems® technology) and Platelet Rich Plasma (PRP) therapy.
Surgery is rarely recommended as a treatment for peroneal tendinopathy, but it may be an option if your symptoms don’t improve with other non-surgical treatments.
If the tissue around the peroneal tendon is causing irritation and discomfort, your surgeon may remove it by performing a tendon release or tenotomy. A tendon release is where the surgeon cuts severely tight tendons from the muscle to allow for more flexibility of the ankle.
If the peroneal tendonitis has caused a tear in the peroneal tendon your surgeon may look to repair the tendon.
While the surgery is a routine procedure, it will involve a period of rehabilitation afterward.
Our innovative range of treatments goes beyond what’s available on the NHS. As well as providing a full opinion on your condition that includes all the traditional non-surgical and surgical options, our experienced consultants will also assess your suitability for our alternative biological therapies, Platelet Rich Plasma (PRP) and Activated Mesenchymal Pericyte Plasma (AMPP)..
Your consultation will be with one of our foot specialists, Mr. Nima Heidari or Mr. Nicholas Savva and will last approximately 30 minutes. On the day, or the day before you will be asked to attend for an MRI scan.
As well as undertaking an examination, our specialists will take details of your medical history and discuss your symptoms. They will also detail all your treatment options and cover their potential benefits and risks.
Our expert team comprises of highly experienced surgeons, sports medicine doctors and physiotherapists who are committed to delivering a high level of care and the correct treatment option so you can quickly get back to moving around.
Autologous means ‘from the same person’ rather than from a donor. Essentially, your own cells are used to encourage healing. With this type of treatment, there’s a dramatic reduction in the risks of the rejection, infection or contamination that come with using material from someone else. The innovative therapies we offer are based on this idea. If you’ve found traditional treatments aren’t helping your pain, of if you’re looking for a possible alternative to surgery, then this approach is one to consider.
Biological treatments are pioneering procedures and we’re continuously monitoring and recording its effectiveness. Patients undertaking these treatments are asked to complete pre-operative and post-operative questionnaires.
The information obtained from these questionnaires allows us to monitor your progress and it also contributes to our evidence-based database and other global studies on biological treatments. All information gathered is anonymised.