What are the Peroneal Tendons?

The peroneal tendon runs behind the lateral malleolus or the bony bit on the outside of the ankle (video). The peroneus longus tendon runs around the back of the lateral malleolus and under the foot to attach at the outside of the first metatarsal and cuniform bones. The peroneus brevis passes around the back of the lateral malleolus and attaches to the outside of the foot on the base of the 5th metatarsal. The muscles act to dorsi flex the foot (point foot upwards) and evert the foot.
Symptoms of peroneal tendinopathy

• Pain and swellilng on the outside of the ankle or heel.
• Pain is worse during activity and gets better with rest.
• Pain when pressing in on the peroneal tendons.
• Pain when the foot is passively inverted (stretching the peroneal muscles) and with resisted eversion.
• Calf muscles may be tight.

Causes of peroneal tendinitis

• Running along slopes causing excessive eversion (rolling out) of the foot.
• Tight calf muscles
• Overuse, particularly in dancers or basketball players.
• Overpronation of the foot or excess eversion of the foot.

Treatment of peroneal tendinopathy

• Rest
• NSAID’s (non steroidal anti inflammatory drugs) may be prescribed to reduce pain and inflammation.
• Stretching the calf muscles (and peroneal muscles).
• Deep tissue sports massage to the peroneal muscles to reduce tension and help lengthen the muscles.
• In severe cases surgery may be required.

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What is the midtarsal joint?

The midtarsal joint is also known as Chopart’s joint and consists of the talonavicular joint (between the talus and navicular bones) and calcaneocuboid joint (between the calcaeus or heel bone and the cuboid bone).

Injury to the midtarsal joint is rare but is more likely seen in gymnasts, footballers and sports involving jumping.
Symptoms of calcaneocuboid injury include

• Pain in the outside middle of the foot which may come on after an ankle sprain or similar injury.
• Pain and swelling on the outside top of the joint.
• Placing the foot into inversion may cause pain.
• An MRI scan may be done to confirm the diagnosis.
• An X-ray can be done to rule out a fracture.

Treatment of calcaneocuboid injury

• Taping the foot might help support the joint.
• Doctor may prescribe NSAID‘s (such as ibuprofen) to reduce pain and inflammation.
• Orthotic inserts may be fitted.
• A cotricosteroid injection may be done if symptoms persist.

Symptoms of bifurcate ligament injuries include

Treatment

• Treatment is similar to that of the calcaneocuboid injury with immobilization for 4 weeks.
• Surgery may be considered.

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What is Lateral Plantar Nerve Entrapment?

The lateral plantar nerve passes through the tarsal tunnel between the abductor hallusis muscle and the quadratus planus muscle. This nerve can become trapped causing pain in under the heel on the inside (medial aspect) and up into the inside of the ankle.
Treatment of lateral plantar nerve entrapment

• Rest
• NSAID‘s (e.g. ibuprofen)
• The arch of the foot can be supported with tape.
• Orthotics may be prescribed to correct overpronation

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