“What is the best treatment for peroneal tendonitis?”

The best initial treatment for peroneal tendinits is bracing with a medical grade brace such as the ASO brace (can order online), at least a couple visits with a physical therapist to be taught exercises to do at home on your own for 6-8 weeks, avoidance of activities that make it hurt worse such as running, sports, etc., and a short course of an anti-inflammatory medication such as ibuprofen or aleve for 3-4 weeks (check with your regular doctor if you have questions about whether or not you can take these medications).

If, after about 8 weeks or so your pain persists despite this then you should see a sports medicine trained doctor or orthopedic surgeon for further evaluation like an MRI to look for a tear or other problems.

Assuming the diagnosis is correct, a short period of immobilization in an ankle brace or fracture boot depending on severity as well as anti-inflammatory medications usually resolve the issue. Formal physical therapy can play a role in treatment if necessary. Surgical intervention is seldom necessary for isolated peroneal tendonitis.

Good luck,

Dr. Louden

An injection into the sheath of the tendon

The first step is to avoid what caused it and a brief period of rest for the tendon so the inflammation calms down. The quickest way to do this sometimes is in a walking cast boot that you see football players often wearing on the sidelines. Physical therapy can help as well. If there is acute inflammation and pain, using ice appropriately can help a lot quicker than oral anti-inflammation medications, which if there are no contra-indications can also be helpful. If symptoms persist it can indicate that there is a tear, degeneration, subluxation and/or dislocation of the tendon, or perhaps the wrong diagnosis. Further work up may then include an mri scan, emg/nerve conduction study and other tests. A cortisone injection into the tendon sheath may also be necessary but should be done by a specialist to avoid iatrogenic injury. Lastly, surgical options are sometimes necessary.

Relative rest is helpful. So for example, if you play basketball you may want to cut down the hours that you play or play more intermittently. Bracing often helps and you can purchase ankle braces and sporting good stores are online. Over-the-counter anti-inflammatories help such as Advil. Topical medication such as Biofreeze is helpful. If these measures are not helpful to you should consult an orthopedic surgeon, family practitioner familiar with sports medicine or podiatrist for further recommendations

Physical therapy and stretching exercise.