Peroneal tendon

Fo the second time in six weeks my ankle got sore and puffy, so I wentfor some advice.

The physio says I have damage to the peroneal tendon(s), and has zapped my right ankle with magnetic and sound waves.

The plan for the next two weeks to repair the damage does not include running, but does include ice, stretching, and cycling/swimming.

Next batch of training to start on softer flat ground than the local streets.

My ultimate goal is to lose weight, and to complete 26.2 miles next April, starting and finishing uninjured.

Advice please - how do I train for a long road race without repeating the damage to date?

Comments

  • Hello helegant,

    I would suggest that thorough identification of underlying cause. Acute injury is possible, with overtraining likely.

    Any issues of poor form and technique should be sorted out.

    Cross training and the old saying 'do not run before you walk' is usefull. You have already suggested altering training surface etc.

    Supportive trainers of the correct variety are also essential.

    kind regards steve d

    P.S i guess others will be along with advice on training regime etc to help you along.
  • Thank you Steve. I'd agree with overtraining as a 'most likely' cause; there was no noticeable 'event' to cause the problem and the pain developed gradually over the last twenty minutes of (mainly) walking. I didn't really notice the damage until I cooled down - mea culpa - but it was a nice day...

    One additional (ignoramus) question. I know bones and muscles get stronger through training. Does the same apply to tendons?

  • No, tendons don't get stonger through training. IMHO.
    I strapped my peroneal tendonitis into place and continued running.
    Probably a bit controversial, but that's what I did and I survived.
  • Limper - how did you work out how to do that?
  • Helegant,
    I strained the Peroneus brevus longus tendons after my first half marathon a few years ago.
    The only way I can describe the pain was feeling like I had shards of glass embedded in my feet...
    Saw a physio, who recommended accupuncture and stretching exercises, within hours of the accupuncture I could walk normally on my foot, within 10 days back to short runs of 1-2 miles. I did the exercises religously and all has been well since.
    If you want to email me I will scan a copy of the exercies that I was given and send them back to you.
    Best of luck!

    T
  • Tb that's very generous of you - would you enable your email please so I can contact you?

    Thank you, H.
  • P.S Have put three pairs of old running shoes in the dustbin today - lest I should ever be tempted to wear them 'one last time'
  • Limper

    yes sure you can strap the peroneal tendons along the distal 1/3 aspect as the run superior to the ankle. If the problem is peroneal snapping disorder of partial peroneal subluxation. But that requires a firm diagnosis and only counts for lower grades of this injury. An orthopaedic referal is typical for mri and intervention.

    As for tendon strength. Tendon and muscle conditioning are possible as part of general physiological adaptation to increased stress, as with most tissue. Connective tissue excepted to a certain degree.

    Helegant

    you need a firm diagnosis from a qualified professional, prior to any form of exercise rehab.

    kind regards

    steven d
    podiatrist
  • Doesn't the physio count as a qualified professional?
  • OK, I've re-read my first post and I think it may be open to misunderstanding.

    I visited a sports phtsiotherapist. The "firm diagnosis" (as I understood it) was "strained peroneal tendons" with several contributing causes:

    1)tight muscles (hence the stretching exercises) which reduced the ability to absorb impact,
    2) running on cambered and uneven pavements,
    3)being overweight - more force going through ankle
    4)trying to do too much too soon
    5) POSSIBLY wearing old shoes (it's faintly possible that I picked up an old pair by mistake as I put retired pairs through the washing machine then keep them for gardening).

    The ultrasound and magnetic pulse was supposed to help healing inside teh ankle, and the advice to ice and stretch, and rest for 2 weeks seems reasonable, as does the suggestion to find soft ground when I restart.

    However, I'm frustrated that it has taken so much effort to achieve so little that I feel like a fraud, and even that has been too much.

    And I'm scared that the same thing will happen again as soon as I restart. I don't know that I trust myself to be able to tell when I'm doing too much, as overuse injuries were a consistent feature of my 2003 FLM preparation. It cost me a fortune in treatment, a lot of lost training time, and left me feeling as my life was one long whinge.

    Is there a better way?
  • Helegant,
    Should be email enabled now, thought it was!!
  • ha ha

    apologies

    mixed a thread up and lost track!

    I would stick to a treatment regime provided for you as an individual, that was the main 'jist' of it;-)
  • As for a better way

    My take on it is to build up very slowly to a firm base and mainatin that base. This is what i have to do, or suffer the consequence.

    But this is not what people typically want to hear, we live in a society that wants everything now with little disruption along the way.

    This is a general observation that applies to most of us at times.

    I continually get people come in and ask for orthotics to cure an injury, literally just like that.

    Taking a history it seems that the person has undertaken little specific walking or general ambulation for 9 months, yet they are surprised at ''shin splints'' when running 20 - 30 miles P/Week within a month.

    As i have said before take it easy and start at the bottom and work up, the results in the end will be worth it and recovery, when you do get injured, won't be such a problem in terms of reducing fitness to pre injury level etc. Start by walking as part of the recovery. And be aware that peroneal injury can increase the chances of lateral ankle inversion injury.

    stevend
  • Thank you SD, your advice has the ring of sense about it, and it's probably what I would say to anyone else in the same situation ;-)
  • More questions I'm afraid...

    Four and a half weeks after the event, the swelling has reduced slightly, and the pain is much reduced / almost absent. However, I had expected to be completely recovered and training again by now.

    Does anyone have any idea how long I can expect recovery to take? Someone really worried me today by telling me that tendon damage can take up to a year to heal. Please tell me that's nonsense!
  • Steven

    we trained together
    see if you can work out who i am

    :-)

    have you been posting on here long?

  • Dear Lurker

    If i play along, does it mean i have to purchase a pair of expensive orthotics from you?

    Steven
  • Helegant

    You need to address the underlying cause. When you do then you will be able to return to training sooner than you think.

    Peroneal tendinitis is caused by repetitive eccentric force on the peroneal tendons, this means the tendons are being forcibly lengthened with each stride. and this usually happens when your natural pronation is being resisted by a strong counter force. Shoes are the most common culprit and peroneal tendonitis is the most common resu;t of someone wearing too stable a shoe for their gait. The second most common cause is fell running or reeptitive sprains on the ankle.

    Gait analysis and correct shoes should be in your near future and then reduce speed and mileage dramatically along with ice and stretch, get back onto tarmac or even smooth gras running, then you will get back into it ... good luck
  • Helegant
    Tendons are what is known as "fibrous tissue," they do not have a blood supply of their own thus the necessary material needed to effect repair are not directly supplied to them at all.

    They are able to pinch from surrounding soft tissue as blood passes by, therefore it is important to warm the area and mobilise regularly thus, attracting more blood to the area. (n.b. avoid warming the area if there is any sharp pain present, no problem if the discomfort is of the stiff, achy type).

    Tendons can take well over a year to completely heal but can, with care, be "match-fit" within a couple of months.

    Persevere with your rehabilitation, patience now will significantly improve the likelihood that you will line up, fighting fit next April.

    Impatience may well ruin your plans

    Good luck

  • Cabletow and Ajax, thank you very much for your advice.
  • Update today.

    MRI scan shows peroneal tendonitis which has not healed after 3 months of conservative treatment, with no running.

    Surgeon has suggested a cortisone injection into the tendon in preference to an operation, with the op as a back-up plan. Downside seems to be that the injection will ultimately weaken the tendon.

    I've agreed to go ahead on Saturday, but would appreciate some considered views from any experts out there.
  • Injection done this morning. Fingers crossed.
  • Some misinformation regarding tendon strength posted previously.

    You CAN improve tendons through training. Plyometric training will improve the musculotendinous stiffness of the tendon.

    A stiff tendon accepts biomechanical loading more efficiently, is more fatigue-resistent and therefore less prone to injury / rupture.

  • Thank you for that very encouraging information - hope is the best medicine.

    Will you post again please and advise what plyometric means, as I know I'm not the only one with tendon problems?
  • Hi Helegant..
    Plyometrics is a form of exercise that uses explosive movements to develop muscular power. Power = strength converted into speed. Jumping and bounding are examples of plyometric activity..they are fun, easy to learn but see last para!

    For a muscle to cause movement, it contracts (concentric contraction). There's a maximum amount of power with which a muscle can contract. However, if the muscle is lengthened (eccentric contraction) just before the contraction, it will produce more power. Magic!

    However the mechanism requires that the time between eccentric and concentric contraction phases is very short (only a few secs). The theory is this extra power comes from the muscle gaining potential (stored) energy much like a stretched rubber band. This stored energy dissipates fast, so the action must be quick.

    The process is also known as the "stretch shortening cycle", if you want to google it, and is the underlying mechanism of plyometric training.

    It's not for the faint-hearted / untrained. After my first plyo session I took to my bed with ibuprofen. My legs were seriously mashed.. Never experienced DOMS like it! Once a week is all I'd recommend for plyos - followed by an ice bath ;o)
  • Siance, Thanks for the words about plyometrics - I noted the bit about "not for the untrained"!

    11 days after the steroid injection, and with a determined attempt not to use the joint for the first 7 days, I can see an improvment. The swelling has much reduced and is almost back to the day after the injury, and my ankle doesn't feel at all 'mushy'.

    Ever hopeful that this improvement will continue, I am now wondering whether it is OK to start doing some gentle exercise (nothing explosive just yet!).

    I'm seeing the surgeon again next week, and plan some gentle walking between now and then - maybe even a bike ride at the weekend.

  • Well here we are again :-(

    Lost all motivation after 4 months of 'malingering' with peroneal tendonitis last year.

    10 weeks ago I went to my favourite specialist running shoes and kitted out in new shoes started walking for an hour a day, every day. All went well so I decided to build up to running gradually again. (I do mean gradually - I must have run all of half a mile in total over two weeks)

    No probs at jog pace. Then 10 days ago I found an old running track and just couldn't resist 200 meters of reaonable pace - just to see what happened... my brain remembered, and it felt great :-)

    However, my peroneal tendon rebelled overnight, and although the swelling above the ankle has now reduced, I still have puffy mushy ankle and foot with associated discomfort.

    AAAAARRRGGGGHHHHH!!!

    I'm hoping to get to the physio for some treatment next week.

    Obviously I won't run for a while, but is it OK to keep on walking while this is sorted?
  • Thanks to everyone for their advice. I'm running again, and now need to get some neutral shoes with lots of cushioning (advice requested on the gear thread).

    Cabletow's comment about over-stable shoes has been confirmed by physios, and after treatment and a new set of orthoses I'm moving again and starting to train.

    Yippeee!!!
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