by As a podiatrist, I see many patients who experience foot and ankle pain. One common culprit is the peroneus longus muscle. This muscle plays a crucial role in ankle stability and foot movement, and if it becomes injured or inflamed, it can lead to pain and discomfort. Let’s delve into peroneus longus pain in more detail.
What is the Peroneus Longus?
The peroneus longus (also known as the fibularis longus) is a long, powerful muscle located on the outer side of your lower leg. It originates at the head of the fibula and sometimes from the lateral condyle of the tibia bones. It runs down the leg, behind the outer ankle bone (lateral malleolus). The muscle then turns into a tendon, travelling under the foot and attaching to the bones on the inside of your arch (The first metatarsal and medial cuneiform bones).
Functions of the Peroneus Longus
The peroneus longus performs two main actions:
- Eversion: It helps turn your foot outward, away from the midline of your body.
- Plantarflexion: It assists in pointing your foot downward.
In addition, the peroneus longus is a vital stabilizer of your ankle and arch, helping to prevent the ankle from rolling inward too much.
Causes of Peroneus Longus Pain
Several factors can cause or contribute to peroneus longus pain:
- Overuse and Repetitive Stress: Activities that involve repetitive ankle movements, such as running, dancing, or sports, can overwork the peroneus longus, leading to inflammation and pain (tendinitis).
- Ankle Sprains: A sudden twist or awkward landing can injure the peroneus longus tendon, causing it to become inflamed or even tear.
- High Arches: People with high arches place additional stress on their peroneus longus tendons, increasing the risk of injury.
- Inverted Foot: Individuals with inverted foot types are more prone to developing peroneus longus pain due to the strain on the muscle caused by the biomechanical abnormality.
- Other Conditions: Arthritis, nerve compression, and certain systemic diseases can affect the peroneus longus, leading to pain and dysfunction.
Symptoms of Peroneus Longus Pain
The most common symptoms of peroneus longus pain include:
- Pain on the outside of the ankle: This is typically felt behind the outer ankle bone or along the outside of the foot.
- Swelling: There may be swelling around the ankle or foot.
- Weakness: The ankle may feel unstable, or you may have difficulty turning your foot outward.
- Snapping or Popping Sensation: In some cases, you may feel a snapping or popping sensation around the ankle as the tendon moves.
Diagnosis
To properly diagnose peroneus longus pain, your podiatrist will perform a thorough examination of your foot and ankle. They will ask you about your symptoms and medical history, as well as any activities that may have contributed to your pain. Your podiatrist will also perform physical tests to assess your ankle strength, range of motion, and stability.
Imaging studies, such as X-rays, ultrasounds, or MRIs, may be ordered to rule out other causes of foot pain and to evaluate the condition of the peroneus longus tendon.
Treatment
The treatment for peroneus longus pain typically involves a combination of the following (It is mainly treated conservatively):
- Rest, Ice, Compression, and Elevation (RICE): This involves resting your ankle, applying ice packs (15-20 minutes for the first 72 hours), wrapping it in a compression bandage, and keeping it elevated.
- Physical Therapy: Stretching and strengthening exercises can improve the flexibility and strength of your ankle and foot. Ankle eversion exercise with a resistance band is good, especially when done slowly on the eccentric phase. Please do not do this without the advice of your podiatrist, as you could make things worse.
- Orthotics: Custom-made shoe inserts can support your arches, reduce stress on the peroneus longus tendon, and prevent future problems. I often prescribe insole with a lateral valgus posting (The outer part of the insole is built up more than the inside). My patients often find relief from this approach.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce pain and inflammation.
- Immobilization: Wearing a brace or walking boot may be recommended in severe cases to protect the tendon and allow it to heal.
- Surgery: In rare cases of severe tendon tears or chronic pain unresponsive to other treatments, surgery may be necessary to repair the tendon.
Prevention
To reduce the risk of peroneus longus pain:
- Warm up and cool down before and after exercise.
- Gradually build up the exercise intensity level.
- Wear supportive shoes.
- Maintain a healthy weight.
- Use proper form and technique during sports and exercise.
Prognosis
If the treatment regime is successful (it generally is), most people with this condition can expect to return to their normal activities without any issues.
Living With
Managing Peroneus Longus pain involves adhering to treatment plans, practising preventive measures, and maintaining open communication with healthcare providers to address concerns and adjust treatment as necessary.
Conclusion
Peroneus longus pain, while often misdiagnosed or dismissed as a simple ankle issue, can have a significant impact on your mobility and quality of life. Understanding the causes, symptoms, and treatment options is crucial for finding lasting relief. If you experience persistent ankle or foot pain, don’t hesitate to seek professional evaluation for a proper diagnosis and a tailored treatment plan. See pain in the back of the ankle above the heel for more. Good luck!
FAQs
How long does it take for it to heal?
Recovery time varies depending on the severity of the injury. Mild cases may improve within a few weeks, while more severe tendonitis or tears can take several months of dedicated treatment.
Can I still exercise with it?
Listen to your body. Rest is important in the initial stages, but modifying activity and choosing low-impact exercises under the guidance of a podiatrist or physical therapist helps maintain strength and flexibility during recovery.
Will I need surgery?
Surgery is a last resort. The vast majority of cases respond well to conservative treatment.
What’s the difference between peroneus longus pain and plantar fasciitis?
While both cause foot pain, peroneus longus pain is primarily on the outside of the foot and ankle, while plantar fasciitis is felt under the heel.
Can I prevent future occurrences?
Yes! Strengthening exercises, proper footwear, gradual increases in activity, and addressing any underlying foot or gait issues can reduce your risk.
Should I be worried?
While Peroneus Longus pain can be uncomfortable, the prognosis is generally favourable with appropriate treatment and management. Most individuals can return to their normal activities without lasting isues.
References
- Brukner, P. & Khan, K., 2017. Clinical Sports Medicine. 5th ed. Sydney: McGraw Hill Education.
- Izraelski, J. (2013). Human Locomotion: The Conservative Management of Gait-Related Disorders [Review of the book Human Locomotion: The Conservative Management of Gait-Related Disorders, by T. C. Michaud]. Journal of the Canadian Chiropractic Association, 57(4), 366. PMCID: PMC3845474.
Note From Us: This article provides general information and is not a substitute for professional medical advice. Always consult a healthcare professional for proper diagnosis and treatment of any foot or ankle pain.
