The peroneals are a group of muscles found in the lower leg bone or
fibular, which is why they are also often referred to as the fibular or
fibularis muscles. There are three muscles in this group: the peroneus longus,
brevis and tertius.
Supporting the movement of the foot, these muscles can be subject
to overuse, leading to peroneal tendinopathy – pain and swelling in the
peroneal tendons.
The
origination and insertion of the peroneal muscles
Originating from the fibula, the peroneal muscles become tendons
at the lower part of the leg and insert into the metatarsals, which are located
between the ankle and toe bones.
The peroneus longus originates at the head of the fibula and
inserts into the first metatarsal and the medial cuneiform bone, while the
peroneus brevis originates lower down on the fibula and inserts into the base
of the fifth metatarsal. The peroneus tertius originates at the back of the
third quarter of the fibula and inserts into the shaft and base of the fifth
metatarsal.
The action
and basic functional movement of the peroneals
The muscle group helps the foot to move, in particular around
the ankle joint, and supports us when we stand, whether on both legs or one.
Both the peroneus longus and brevis allow the foot to bend
downwards and twist outwards. Additionally, the peroneus longus supports the
longitudinal and transverse arches of the foot.
The peroneus tertius is a small muscle that can vary in size and
is absent in some people. It lifts the foot upwards and twists it outwards.
What is
peroneal tendinopathy?
This is when the peroneal muscles have been overused, causing
symptoms such as a painful ache or swelling on the outside of the ankle. You
may also feel pain when pointing the foot, moving it inwards or outwards, or
pushing off the ball of the foot while walking or running.
It’s common among athletes and sports professionals, in particular
runners (especially long distance), dancers and basketball players, as well as
any individual who has weak ankles or has suffered an injury to the ankle, such
as a sprain.
How is
peroneal tendinopathy treated?
Early diagnosis is important and the first stage of treatment is
rest. Continuing to walk or run will only make the condition worse. It’s then
advisable to consult a physical therapist.
A physical therapist can help you by:
- Assessing your posture, ankle strength, foot
mobility and footwear
- Asking about your regular activities that involve specific motion (job, hobbies, sports)
- Establishing which movements you should avoid
while the tendons heal
- Recommending treatments such as ice packs or
ultrasound
- Using manual therapy to increase mobility in
the areas around the injury
- Recommending exercises that stretch and strengthen the ankle, foot and leg to improve mobility and stability, including preventative measures
- Advising on the best footwear for you, including
orthotics, eg. shoe inserts, if required
Other treatments that can help include swimming, which will strengthen the ankle without putting weight on it. After a period of time, you can gradually build up to walking and running faster and for longer.
How can
peroneal tendinopathy be prevented?
Wearing the correct supportive footwear for everyday and sporting
use can help to prevent this condition. In some cases you may benefit from
using orthotics.
Specific exercises to strengthen these muscles can also help.
Exercises to strengthen
the peroneals
These include:
- Standing
calf raises – either with feet flat on the floor or standing with the toes on
the edge of a step
- Resistance
bands – loop under the arch of the foot and flex the foot to strengthen the
muscles
- Lunges
on to a half balance ball or wobble balance board
- Heel
walks
If you are suffering from peroneal tendinopathy, it’s advisable
to consult a medical professional and a personal trainer or fitness instructor
before undertaking strengthening exercises.
