Do you also have pain on the outside of your ankle? It could be a Peroneal Tendon Tear!

Have you ever suddenly felt pain on the outside of your ankle while walking, running, or playing a sport? Or has the outside of your ankle just been feeling strange and sore for a while? Maybe you feel like your leg is out of control, like it's "out of joint" when you walk. One reason for this could be damage to two special tissues in your leg. Let's talk about this in detail today.

What is a Peroneal Tendon Tear?

Simply put, a peroneal tendon tear is when one or both of the peroneal tendons in your foot become damaged. There are two tendons in your foot, called the peroneal brevis and the peroneal longus. These are like strong bands. These are the muscles in your lower leg that connect to the bones in your foot. They also help to stabilize your foot and ankle. They are located along the back of your ankle bone and on the side of your foot.

Think of this tendon as a rubber band. If it's stretched too much, or if a sudden force is applied, it can tear, right? That's what happens here too.

Why is this a little difficult to recognize?

Often, a peroneal tendon tear occurs in conjunction with other ankle injuries. For example, if your leg suddenly turns inward (we call this an inversion injury), the ligaments in your ankle can tear, resulting in a sprained ankle. In both cases, you may think that the pain is just from the sprained ankle. Therefore, a peroneal tendon tear can be hidden behind other injuries, which is why it can sometimes be difficult to diagnose.

That's why, if you have persistent ankle pain, it's very important to see a doctor who has special training in foot and ankle problems.

You can see a podiatrist, a sports medicine physician, or an orthopaedist . They will examine your foot thoroughly, find out what's wrong, and prescribe the right treatment for you.

Types of Peroneal Tendon Tears

These tendon tears can be divided into two main types:

Acute Tears

These happen suddenly. Imagine that you are running, going down stairs, or playing sports and your leg suddenly bends inward. At that moment, your ankle has to put a lot of force on these `(Peroneal Tendons)` to straighten itself out. When that happens, the tendon can be overstretched and torn. Usually, in the case of an `(Acute Tear)` like this, you remember exactly when and how it happened.

Chronic Tears

These are the most common types of injuries. You may not even remember that you sprained your ankle or injured it. These tears occur slowly, over time, due to constant pressure and strain on the tendon (overuse). For example, in some sports (think long-distance running or dancing), this can happen when you keep doing the same movements. The pain in your ankle may go away for a while, then come back. You may not even know what caused it.

Classification according to the nature of the tear (Severity)

Doctors also classify these tendon tears according to their severity:

• Grade 1 (Mild): This is when the tendon is slightly more stretched than normal, but it is still able to hold your foot and ankle in place. You may feel some pain and swelling.
• Grade 2 - Moderate: This is a partial tear of the tendon. There is some pain and swelling. There may be some to moderate loss of ankle stability.
• Grade 3 - Severe: This is when the tendon is completely torn. Doctors also call this a ``Rupture''. This means the tendon is separated into two pieces. A complete tear like this usually requires surgery.

You can tear one or both of your `(Peroneal Tendon)`. Most often, people tear the `(Peroneal Brevis Tendon)`.

What do you feel when you have a peroneal tendon tear? (Symptoms)

In this case, you may experience symptoms like:

• Pain on the outside of the ankle. In the case of a gradual tear (Chronic Tear), this pain may last for a few days, then go away, and then come back again.
• A feeling of instability or weakness in the ankle. The ankle may feel like it "pops" or "buckles" when walking. This is especially noticeable when walking on a bumpy road.
• Swelling. The back of the ankle may swell.
• Sometimes you can feel pain even when you touch that area.
• Rarely, a "clicking" sound may be heard over the tendon.

What causes this? (Causes)

There are two main causes of a peroneal tendon tear:

• A sudden injury to the ankle. For example, an inversion ankle sprain.
• Overuse: This occurs when you continue to perform the same movements over and over, or when you put too much pressure and strain on the tendon for too long .

What are the risk factors?

Certain factors may increase the risk of this type of tendon tear:

• Playing sports that require rapid side-to-side rotation of the ankle, such as basketball, netball, soccer, and tennis.
• For people with high arch feet, the way the weight of the foot is distributed can put more pressure on the tendons.
• Tight muscles in the groin area and lower legs.
• Wearing ill-fitting shoes. Such as shoes that lack support, are tight on the foot, or are not suitable for the activity being performed.
• Poor Training Form: Not using correct form when exercising or playing sports.
• The decrease in tendon strength with age may also have some impact.

Complications that may occur if left untreated

If you don't treat this properly, problems like these can occur:

• Repeated Ankle Sprains.
• Continued Ankle/Foot Pain.
• Ongoing ankle instability.
• Tendon Snapping or Subluxation: This is when the tendon slips over the bone on the outside of the ankle . You may hear or feel a "clicking" sound.

How do doctors diagnose this?

Diagnosing this condition begins with a physical examination.

Physical examination

The doctor will ask you and do the following:

• Things like your symptoms, how long they've been present, and how they're progressing.
• Your foot and ankle will be carefully examined and checked for signs of injury (swelling, redness, pain when touched).
• Your foot and ankle will be turned and flexed in different directions.
• They will gently apply pressure to your foot and ask you to exert force against it (this is called `resistance tests`).
• Gently press on different areas of the ankle to find out exactly where the pain is coming from.

These methods can help your doctor get an idea of ​​what is causing your symptoms. However, some imaging tests may be needed to confirm the diagnosis and rule out other problems.

Imaging tests that may be needed

Your doctor may order one or more of these tests:

• Foot X-rays: Check for any broken bones.
• Ankle X-rays: Also see bone-related problems.
• Ultrasound scan: This can provide a good look at the condition of soft tissues such as tendons and muscles. This can help determine if there is a tendon tear and how far it has stretched.
• MRI Scan (Magnetic Resonance Imaging - MRI): This is the best way to see things like tendon tears very clearly. It can show a lot of details, such as the condition of the tendon, the size of the tear, and the damage to the surrounding tissues.

How is this treated? (Treatment)

A peroneal tendon tear is treated with conservative measures, surgery, or a combination of both. If your tear is mild, your doctor may try nonsurgical treatments for a few months to see if they help. However, if the tear is severe, or if it is completely torn, surgery is more likely to be recommended first.

Conservative Measures

This belongs to:

• Taking anti-inflammatory medications: These can help reduce pain and swelling (e.g., things like `Ibuprofen`, `Naproxen`, but take them as directed by your doctor).
• Rest the foot and reduce physical activity: The tendon needs time to heal. Therefore, you may need to stop running, jumping, or playing sports for a while.
• Immobilizing the foot: This involves putting on a brace or boot. This stops the ankle from moving and helps the tendon heal.
• Working with a physical therapist: A physical therapist will teach you specific exercises that will help you regain strength, flexibility, and range of motion in your legs.
• Regenerative Therapies: Sometimes treatments such as `(Prolotherapy)`, `(PRP Injections)` (Platelet-Rich Plasma), `(Dry Needling)` and `(Deep Massage)` may also be suggested. These stimulate the tissue healing process.

Surgery

If these nonsurgical treatments don't help, or if your tear is severe, you may need surgery. Surgeons use a variety of surgical techniques to restore the function of your peroneal tendon. The best method depends on the type of tear you have (whether it's a partial tear or a complete tear).

Here are some surgical methods:

• Removing the damaged part of the tendon and repairing the remaining healthy part.
• Removing the damaged part of one peroneal tendon and attaching the remaining part to the other healthy peroneal tendon. Doctors also call this ``Side-to-side Tenodesis``.
• Tendon transfer involves taking a healthy tendon from another part of your own foot and transplanting it to replace the damaged peroneal tendon.
• Reconstruction of the peroneal tendon using tissue obtained from a tissue donor (allograft).

Complications that may occur after surgery

As with any surgery, some complications can occur, but these are uncommon.

• Ankle pain (may occur frequently).
• Persistent swelling.
• Numbness of the skin near the surgical incision (due to nerve damage).
• Incision Infection.
• Deep Vein Thrombosis (DVT) (this is very rare).

Your doctor will tell you more about these risks.

Will this heal without surgery?

It depends on the severity of the tear. Mild tears may heal without surgery. However, severe tears, especially if the tendon has completely ruptured, may require surgery.

How long does it take to recover?

This varies from person to person. There are many factors that affect it: the type of treatment you received, the severity of your tear, your age, and your overall health. So, it's best to ask your doctor how long it will take to heal based on your condition.

Generally speaking:

• It can take about one to three months to recover from non-surgical treatments.
• If you have surgery, it can take several months to return to normal activities (like going to work or playing sports).

During your recovery after surgery, you can expect the following:

• You will be able to gradually begin weight-bearing on your leg. Perhaps after about four weeks, you will be able to partially weight-bear on your leg.
• Physical therapy can begin after about six weeks. You will work with a physical therapist to rebuild the strength and range of motion in your leg. These sessions will help you safely return to your normal activities.

Ask your doctor about your long-term recovery and what you can do to avoid similar injuries in the future.

How to prevent such disorders? (Prevention)

While peroneal tendon tears cannot always be prevented, there are several things you can do to help prevent these types of soft tissue injuries in the feet and other injuries throughout the body:

• Wear the right shoes: Choose shoes that fit your foot shape (for example, if you have high arch feet), are comfortable, and provide good support. When your shoes wear out or your foot becomes uncomfortable, replace them. Also, wear shoes that are suitable for the job you are doing. Think about how dangerous it is to play sports like tennis, badminton, and netball that require you to run from side to side while wearing sneakers.
• Maintain a balanced exercise routine: We've all been taught to eat a balanced diet. But we forget that a balanced exercise routine is just as important. It helps prevent injuries. Create a plan that includes aerobics like walking, flexibility exercises like yoga, and strength training like using resistance bands. It's a good idea to talk to your doctor before starting a new exercise routine to make sure it's safe for you.
• Warm up before you start exercising: Don't jump into running, jumping, or lifting weights right away. Do something like jogging in place for a few minutes or walking around for a few laps. These ``warmups`` prepare the moving parts of your legs (and other parts of your body) for the intense activity that follows.
• Cool down after exercise: Don't stop exercising immediately. If you're running, switch to jogging and then walk. Cool down for at least 10 minutes with low-intensity, slow movements.
• Stay Flexible: Stretching is one of the most important things you can do to prevent injury. Learn how to stretch properly and make it a daily habit.

When should you see a doctor?

If you have symptoms of a peroneal tendon tear, see a doctor as soon as possible. The sooner you get treatment, the sooner you can start to recover. If possible, see a doctor who specializes in foot and ankle injuries (such as a sports medicine specialist, orthopedic surgeon, or podiatrist).

Your doctor will tell you how often you need to come back for follow-ups.

Questions to ask your doctor

These questions will help you learn more about your condition:

• What kind of foot/ankle injury do I have?
• How serious are these disorders?
• What can I do at home to reduce symptoms?
• What changes should I make to my activity level?
• How long do I have to wait to return to my normal activities?
• What kind of treatment do you recommend?
• What are the advantages and disadvantages/risks of that treatment?
• How long will it take to recover?
• Can you recommend shoes or inserts that will provide comfort and support for my feet?
• When can I start playing sports or exercising again?

What is the difference between a tendon "tear" and a "rupture"?

Many people use these two words interchangeably. However, doctors use the word ``Rupture`` when the tendon is completely torn and separated into two pieces (that is, a ``Grade 3`` tear). This is the most severe case of a tendon tear.

Words like "tear" or "rupture" can be scary. But remember, doctors recognize and treat injuries like peroneal tendon tears all the time. They're ready to help you get back on your feet and get you back on your feet.

The most important thing is to follow your doctor's instructions carefully during your recovery. Whether you have surgery or not, your foot needs time to heal and get stronger again. Don't rush to get back to normal all at once. Patience is the key here. Your doctor will tell you when it's safe for you to resume your normal activities, exercise, and sports.

Finally, remember (Take-Home Message)

Pain on the outside of the ankle is not a simple thing. It could be a ``Peroneal Tendon Tear``. In such cases:

• Seek medical advice immediately. The sooner you recognize it, the quicker the treatment and the quicker the recovery.
• Follow your doctor's instructions exactly. Be sure to follow the instructions regarding rest, exercise, and medication.
• Don't rush it. Give it time to heal.
• Think about prevention too. Things like wearing the right shoes, warming up and cooling down before and after exercise, and maintaining flexibility can help protect against future injuries.

Your health is in your hands!

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