Diagnosis
In order to be able to make the correct diagnosis, many doctors only need to talk to the doctor-patient relationship, also known as anamnesis. It is important that the patient describes when the pain occurs. For example, there are patients in whom the pain, triggered by the peroneal tendon syndrome, only occurs under stress, whereas others experience it when they have not done any sport for too long.
Based on the conversation, the physician can already collect first important diagnoses and then carry out additional examinations. The next step is the inspection, during which the doctor looks at the patient and can thus determine whether anatomical malpositions, such as a bowleg (varus), are present and thus explain the peroneal tendon syndrome. In addition, the physician may notice a broad-legged gait, a hollow foot or an incorrect foot position.
One of the most important methods to determine peroneal tendon inflammation is duplex sonography. This is a special ultrasound examination in which the vessels are examined. An inflamed tendon has many vascular insertions, whereas a healthy tendon is vascular-free.
This can be clearly seen with the help of duplex ultrasound and thus the degree of inflammation can be determined. An X-ray examination can also help to make a diagnosis, but it mainly shows bony irregularities and is therefore less suitable for assessing the tendons or the degree of inflammation. There are several ways to treat peroneal tendon syndrome.
First, the patient should try to keep the strain on the tendon as low as possible. On the one hand, this means that the patient should not do any sports, and on the other hand, he or she should wear suitable footwear. Only in rare cases a splinting of the lower leg and the ankle is necessary in order to avoid stressing the tendons at all.
In most cases, however, it is not sufficient to reduce the strain on the tendon, but an additional anti-inflammatory therapy is required. Anti-inflammatory medications are used which often have an additional pain-relieving effect. These include, among others, the non-steroidal anti-inflammatory drugs, NSA for short.
Often it helps the patient additionally if he can work out exercises with the help of a physiotherapist, which strengthen the tendon but at the same time do not put too much strain on it. In addition, the physiotherapist can correct any incorrect posture or gait and thus prevent a recurrence of peroneal tendon syndrome. Nevertheless, it is possible that patients may not be able to perform various movements over a longer period of time, especially if they jerk the lower leg muscles.
If a patient suffers from a particularly high arch of the foot, which in turn causes the peroneal tendon syndrome, specially made medical insoles can help. In addition, there are some home remedies that can improve the pain and also the swelling caused by inflammation. On the one hand, it does most patients good if they apply cool compresses to the affected area.
Cool curd cheese compresses can also help, as they also have a pain-relieving effect. Potato wraps are only perceived as pain-relieving by a few patients because they become very warm and are therefore better suited for back pain than for pain relief in peroneal tendon syndrome. In rare cases, an additional surgical therapy must be performed to improve the symptoms of peroneal syndrome.
If the tendon tears, it is important to remove the resulting effusions (debridement) and repair the tendon. In some cases, the canal in which the tendon runs must also be smoothed to prevent the tendon from being worn down again in this canal. In most cases, however, such a surgical procedure is not necessary.
If an inflammation of the peroneal tendon does not result in pronounced damage to the tendon itself, the disease is primarily treated conservatively, i.e. without surgery. Conservative therapy includes the use of anti-inflammatory and pain-relieving medication, support bandages and cold compresses. Above all, however, the affected extremity should be spared.
Although adequate immobilization of the ankle joint is essential to prevent the progression of the disease, it must be remembered that prolonged immobilization can in turn delay the healing process and even lead to further damage to muscles and bones.Physiotherapy can help to reduce inflammation processes more quickly by moderately activating the diseased leg. It also helps to counteract the loss of muscle and bone substance that inevitably occurs during prolonged immobilization. Exercising the affected ankle joint should only be done under the supervision of an experienced physiotherapist.
Jerky and sudden movements, especially slipping and sudden changes of direction must be avoided at all costs. These would worsen the symptoms and could cause lasting damage to the tendon. If structural damage to the tendon itself occurs during inflammation of the peroneal tendon, surgery may be necessary.
As a rule, the patient should not be seen for six weeks after surgery. The doctor may also prescribe physiotherapy during this phase and beyond to support the healing process. The so-called Kinesio-Taping is a therapy that can be applied additionally within the scope of conservative measures.
The treatment concept is based on the application of self-adhesive, elastic adhesive strips to the skin. The water- and air-permeable adhesive plasters are used in many orthopedic diseases and can help to relieve the muscles by lowering the resting tone in case of inflammation of the peroneal tendon. Some techniques are intended to relieve swelling and pain caused by swelling by irritating skin receptors.
Kinesiotapes can be applied by orthopedic surgeons or physiotherapists with special training and are becoming increasingly popular among patients and therapists. The benefits of the colorful tapes have not yet been sufficiently scientifically proven. This is due on the one hand to the novelty of the method and on the other hand to the difficulty of conducting suitable studies on the topic.
