You might be suffering from Peroneal Tendinitis if you have:

• Pain on the outside of your foot (lateral) that can run up to your lower leg.
• Increased pain with activity, less pain when resting.
• Weakness when rotating your foot outward (eversion) or inward (inversion).
• Foot Instability.
• Increased Arch Height.

Peroneal Tendon - Location & Function

There are a number of tendons (fibrous tissue that connect muscle to bone) in the foot which help to control movement while you are walking or running. Two ankle tendons commonly injured are the peroneus longus and the peroneus brevis, and together, these are known as the peroneal tendons.

These 2 long tendons have acquired this name because they harness most, if not all, the strength pertaining to the outside of the leg/ankle. The peroneal tendons are important tendons because they prevent the foot from rolling and causing a lateral (inversion) ankle sprain. The superior peroneal retinaculum and inferior peroneal retinaculum ligaments run over top of the 2 peroneus tendons holding them close to the calcaneus (heel bone). If these 2 tendons were cut, you would have no ability to prevent your foot from turning inward when you walk, effectively causing constant ankle rolling. If these tendons are overstrained and too long, you will find the same thing happening - you will be frequently having ankle inversion sprains.

Peroneal tendons are long, attaching to outer leg muscles then running behind and underneath the bone (fibula) on the outside of the ankle. For some people, injury can cause the natural holding structure to fail and allow these tendons to slip over the bone. In such cases, this is usually called a peroneal tendon dislocation. When they slip into this position the peroneal tendons become slightly weaker than the muscles and tendons on the inside of the ankle. Due to this (you probably guessed it), you are more likely to roll your ankle inward and sprain it on a frequent basis.

Peroneal Tendonitis, Peroneal Tears, and Tenosynovitis

Peroneal Tendon Dislocation (subluxation) or Tearing may occur in one or both of these tendons. This leads to pain, swelling, sensitivity and a sense of instability behind the outside of the ankle. They can also pop out of the supporting ligaments that hold them in place which is called a dislocation. Once this occurs, continuous or recurrent dislocation and tearing may occur without immediate attention and repair. Stitching and at the worst, tendon replacement may be required for patients suffering from torn or dislocated peroneal tendon(s).

Peroneal tendonitis (also spelled tendinitis) is the inflammation and irritation of one or both of the peroneal tendons. Like all forms of tendonitis, peroneal tendonitis is a condition that may flare up and subside over a period of time.

Peroneal tendinitis is usually caused by repetitive use of the tendons, but can also be caused by trauma such as a rolled or sprained ankle. Little tears in the peroneus longus tendon and the peroneus brevis tendon irritate the tendon fibers resulting in pain and inflammation.

Peroneal tenosynovitis is swelling and inflammation of the peroneal tendons' sheaths (or coverings) which prevents the tendons from gliding smoothly within the sheaths causing pain. It can be experienced at the same time of peroneal tendonitis, and has similar symptoms. It often results in trouble moving the ankle and will feel sore to the touch. In rare cases, tenosynovitis can be caused by infection, so it is always recommended to check with your doctor to rule this out as a cause.

Tearing of the peroneus longus tendon and/or the peroneus brevis tendon can occur. This leads to pain, swelling, sensitivity and a sense of instability in the ankle. The tendon(s) can also pop out of the supporting ligaments that hold them in place (superior peroneal retinaculum and inferior peroneal retinaculum ligaments) which is known as dislocation.

Who is Most at Risk of a Peroneal Tendon Injury?

• People who play sports or do activates that involve repetitive ankle movements.
• People who participate in activities such as running on uneven surfaces, racket sports, basketball, hiking, or skiing.
• People with high arches in their foot.
• People in aging populations, because our tendons lose elasticity and become brittle.

Symptoms of Peroneal Tendonitis

Peroneal tendon injuries may happen suddenly through an acute incident / accident / trauma or develop over a period of time from over-use or re-injury (a chronic condition).

If you have peroneal tendonitis you may feel:

• Pain and/or swelling along the tendon and possibly up the leg along the fibularis longus muscle during or after activity.
• Pain occurring from time to time on the outside of the ankle
• Pain that becomes worse with activity and lessens with rest
• Weakness when you try to rotate your ankle outward (eversion) or to the inside (inversion)
• Swelling, inflammation, warmth, or hot to the touch around the outside of your ankle.
• Instability of the foot and/or ankle
• An increase in arch height at the bottom of your foot

It is important to recognize pain in these areas compared to pain over the fibula (your ankle bone) which might indicate a different problem like a stress reaction of the bone or fracture. Pain on the fibula occurs directly over the bone which is easily felt with your fingers. Peroneal tendon injuries are sometimes misdiagnosed and may worsen without proper treatment, prompt opinion by a foot and ankle doctor is advised.

Peroneal Tendonitis Diagnosis

The diagnosis of peroneal tendonitis is usually made by examination of the ankle. A physical check by your doctor will help to determine where the tendons are inflamed, ruptured, or degenerated. The doctor will move your ankle into different positions during a physical examination. The peroneal tendons are checked by holding your foot up and out against the doctor's downward pressure. Stretching the foot up and in can also be used to test whether the tendons hurt. The doctor will also be looking for instability of your ankle joint, swelling, warmth and weakness on the outer side of your ankle.

X-rays may be ordered to make sure there is no fracture or other problem with your fibula or the other bones in your ankle. Your doctor may order a magnetic resonance imaging (MRI) scan of your ankle. These images can show if there is abnormal swelling or scar tissue in the tendons. MRI scans can also show lengthwise tears in the tendons.

Causes of Peroneal Tendonitis

Peroneal tendonitis is the degeneration of the tendon tissue in the ankle. What causes our tendon to start to fall apart?

• Poor footwear encouraging your foot to roll outward stretching the tendons.
• Improper training to an exercise program you have just started
• Repetitive ankle motions in sports, such as running and jumping
• A blow to the outside of the ankle or an ankle sprain
• A high arch puts extra tension on the peroneal tendons
• Incorrect alignment of heel and foot bones causing (hindfoot varus posture)
• A build up of scar tissue on the tendon, the weakened area of the tendon may tear or lead to rupture

These 2 tools are what you need for rapid healing. These are the tools that top professional athletes use to treat their injuries every day. And just like these athletes, you can treat yourself at home. In fact, if you want to heal properly you have to treat yourself because you need to treat your injury every single day.

Nonsurgical Treatment for Peroneal Tendonitis

If you have a lot of pain you may need to have a walking boot or cast for 2 to 4 weeks. If there is no pain or tenderness with walking a stirrup ankle brace, arch support, or lateral heel wedge can help to take tension off of your injured tendons.

In most cases, your Doctor will start with non-surgical treatments options. Some of the options your doctor may recommend include drugs or medications like NSAIDs (non-steroidal anti-inflammatory drugs) to manage pain and inflammation. Steroid injections are advised with caution for any type of tendon condition as there is increased risk of tendon rupture.
(reference: American Academy of Orthopaedic Surgeons)

For acute (new or recent) Achilles tendon tears that have the ability to heal on their own - your doctor may even cast your foot in a toe pointed position (in something called a "hanging enquinus cast") or in a removable brace/splint. A removable splint can be very helpful to prepare you for PT sessions and mobility exercises.

Prolonged use of a cast, removable splint, or long-term rest (restricted movement) without proper exercise or stretching can make your Achilles tendon injury worse. If your Achilles tendon remains completely immobilized and at constant rest, the ends of the Achilles tendon (where it attaches to bone or other muscles) will begin to fill in with scar tissue as part of the healing process. You may also have on-going symptoms of pain, swelling and inflammation, and even poor blood flow circulation.

Lack of proper blood flow and growth of scar tissue will decrease the natural length of the tendon (atrophy) and tighten tissue, reducing the flexibility between your ankle and foot. Your ability to push off with your foot in certain activities such as running, jumping, or going up and down stairs all become compromised. You are also at an increased risk of re-rupture of the tendon, especially if the initial injury was large and required surgery in the first place.

Peroneal Tendon Injury Scar Tissue Growth

The tendon tries to protect itself from this constant irritation by trying to repair the damaged tissue. During the healing process your body will automatically fill in tears in your tendons with dense, brittle tissue called "scar tissue". The human body will use scar tissue as a temporary healing solution and will try to build the scar tissue as fast as possible to heal tears in your peroneal tendons. Scar tissue can form fast to strengthen the damaged tendon, but working fast doesn't mean that the job's done right. When scar tissue forms it doesn't come together as neatly as regular (healthy) tendon tissue would. Scar tissue fibers will lay down over top of your tear in a cluttered, messy and jumbled up way.

This is how scar tissue works. The scar tissue that forms in and around your strained ankle tendons will be unorganized and won't line up properly with the healthy tissue surrounding the tear. This scar tissue will also attach to everything in and around your ankle including the surrounding healthy tissue as well. This can result in a long-term fusing together of your tendon with everything around it; this will definitely freeze up your ankle, severely reducing your mobility.

Scar tissue is a weak form of collagen - hard, inflexible, and tough to get rid of once it begins to take hold. The more scar tissue that develops, the more you lose range of motion. With excess scar tissue build up, the injured soft tissue and the ankle in general will remain weak and prone to re-straining and re-tearing.

While you can go a number of days and even a few weeks without any major setbacks during the injury.. inevitably, a certain movement or motion will happen that causes your injured soft tissue to strain and even tear once again. This is attributed to the scar tissue build up and will result in the buildup of yet more scar tissue and a further reduced range of motion (ROM).

The more scar tissue that develops, the greater the risk of winding up permanently injured with chronic pain or arthritis. Scar tissue means that your joint will not perform as well as it once did and it makes it much more prone to injury later on. The longer the injury remains, the risk of atrophy increases and the risk of more scar tissue increases. This is why it is critical to treat your tendon injury now rather than later.

Nonsurgical Treatment for Peroneal Tendonitis

If you have a lot of pain you may need to have a walking boot or cast for 2 to 4 weeks. If there is no pain or tenderness with walking a stirrup ankle brace, arch support, or lateral heel wedge can help to take tension off of your injured tendons.

In most cases, your Doctor will start with non-surgical treatments options. Some of the options your doctor may recommend include drugs or medications like NSAIDs (non-steroidal anti-inflammatory drugs) to manage pain and inflammation. Steroid injections are advised with caution for any type of tendon condition as there is increased risk of tendon rupture.
(reference: American Academy of Orthopaedic Surgeons)

Step 1 - Reduce Pain and Swelling with Cold Compression

The first step for conservative treatment of your foot tendonitis is to reduce the swelling to "open up" the area for more blood flow. Anyone in the health-care business knows that your blood supplies the oxygen and much needed nutrients required to heal foot tendonitis injuries. This is why for years, doctors, trainers, and other medical professionals have recommended RICE (Rest, Ice, Compression, Elevation) to treat the pain and swelling of fresh injuries, chronic pain, and after any re-injury.

This is important because once blood vessels are blocked or damaged, they can no longer carry oxygenated blood to your damaged tendon and tissues begin to break-down. Without cold compression, tissues break down further because they can't get the oxygen they need to survive. By limiting the amount of damage done to your tendons, you also limit the amount of healing that needs to occur. This is a very important step to heal acute or chronic tendon injuries faster and with less pain!

Step 2 - Improve Circulation, Soften Scar Tissue & Prevent Re-Injury with a TShellz Wrap^®

Once the swelling is gone, moving the tendon and applying a local circulatory stimulation device like the TShellz Wrap^® is really what is needed for completing the recovery cycle. This is critical because tendons are known to receive very little natural blood flow and blood flow is really how your body is able to heal itself. When the tendon tissue is damaged, the already-reduced blood flow is decreased down to a trickle which is why movement is encouraged - it helps get blood flow to where it is needed.

Blood flow (healthy circulation) is an important part of natural tissue healing. Injured tendons take the nutrients available in local blood flow (like oxygen and healing agents) to get rid of any damaged tissue and start growing healthy tissue.

Sometimes Tendons Can't Receive
Enough Natural Blood Flow for Healing

In some cases of acute tendonitis, the micro-tearing is located in an area known as the watershed zone.

The watershed zone is basically a part of the tendon that has the weakest amount of blood supply (even when it's completely healthy with no tears). This area usually gets blood supply from peripheral veins. This reduced blood supply makes the watershed zone an area of your tendon that's prone to injury and a poor healing response.

Many tendons in the body are known to have watershed zones that are prone to tendon tears. Some of the tendons that have a watershed zone include the Achilles tendon, the posterior tibial tendon in the foot / ankle, the rotator cuff (supraspinatus) tendon in your shoulder, the bicep and tricep tendons in your arm and the flexor tendons in your hand.

 

TShellz Wraps^® contain a unique Carbon Fiber Energy Pad which is flexible and will shape to conform to your body. This Energy Pad emits a uniform wave of perfectly safe energy over its entire surface. This energy is absorbed by soft tissue in the treatment area, opening blood vessels, resulting in an increase in blood flow. Increased blood circulation is what your body needs to accelerate the healing of soft tissue and this is why we recommend the TShellz Wrap^®.

The TShellz Wrap^® is an FDA Registered Medical Device and is suitable for use in therapeutic clinics and FROM HOME. It is completely safe for people and patients to use for themselves.

The technology found in a TShellz Wrap^® has been used for decades in the worlds of professional and amateur sports - a contributing factor as to why athletes seem to recover from injuries so quickly.

Have you ever wondered by an athlete can return to activity after 3 or 4 weeks following a tendon injury - while your average person takes much longer to return back to normal? The secret isn't really that much of a secret - it involves consistent treatments (meaning multiple times a day) using a treatment like the TShellz Wrap^® to stimulate blood flow to the injured tissues. Most athletes have the luxury of using in-house facilities many times per day.

How many us can afford the time and money to visit a clinic multiple times a day? Very few indeed. This is how you can gain some of the advantages that athletes enjoy in their injury recovery - by using a device like the TShellz Wrap^® two or three times a day on a consistent basis.

What Else Makes the TShellz Wrap^® So Special?

We believe the TShellz Wrap^® to be one of the most effective home treatments to increase localized blood flow in and around the treatment area.

We can promise that you will receive a product that is designed to be safe and does what it is supposed to do...quickly relieve pain and aid in the recovery from tendon, muscle and other soft tissue injuries.

The unit plugs into a standard wall outlet to get its power. The nice thing about the power supply is that the same unit can be used in North America and overseas as well. It has the capability to operate between 110v and 230v.

The TShellz Wrap^® has a special signal controller that can be set for 3 different power levels of application (3=High, 2=Medium, 1=Low). The cord is long enough that you can sit or lie comfortably and watch TV, read or surf the net while you're using it.

Treatments are max 30 minutes in duration and the device can be worn over clothing. This allows you to use the device at work, at home, or really anywhere you have access to an electrical outlet.

A Recap of the Benefits of the TShellz Wrap^®..

• Targeted applications for most areas of the body
• It can be used before exercise to warm up tissue in the treatment area to reduce the risk of injury
• FDA Registered medical device for use in home or clinics - very high quality
• Increases flexibility of tissues (reducing the re-injury factor)
• It soothes pain and whisks away toxins
• Carbon fiber Energy Pad is strong, lightweight, and flexible - contours very easily
• Enhanced blood flow provides an accelerated healing rate that will save time and money when associated with doctor or physical therapist visits
• A boost in blood flow will maximize the bodys ability to recover quickly. This can be beneficial in post-surgery rehabilitation, getting you back to work faster. Do not use until at least 6 weeks after surgery, and only after approval from your doctor.

The most common question we receive from individuals prior to purchasing is - how many times a day should I be using my wrap and when should I be using them? While treatment plans will differ for each individual and their specific injury, there are general guidelines that should be adhered to.

• Use a Cold Compress or Ice Pack when you are experiencing inflammation (usually after exertion or movement of the injury area).

The TShellz Wrap^® would then be used:

• Right after rising from bed in the morning (as this is when it is most stiff)
• Prior to going to bed at night (to relax the area and allow for better sleep)
• Before you know you will be using your injured joint (going to work, driving, typing, etc).

Step 3 - Stretch Your Foot to Speed Up Recovery

The final step in foot tendonitis recovery is stretching - this is a critical step for complete recovery from your injury! PTs almost always prescribe gentle stretching for to deal with foot tendonitis. Outside of the PT office, your will most likely be assigned a set of stretches and exercise to do at home.

You'll find in most rehabilitation programs stretches combined with other conservative treatments will help to:

• build muscle strength in your lower leg (calf muscle)
• increase mobility and range of motion (ROM)
• speed overall healing of your foot tendonitis
• prevent muscle loss (atrophy) in your lower leg
• improve muscular function and capability
• refine tendon tissue alignment and physical balance
• encourage overall foot and ankle joint flexibility
• facilitate proper warm up for regular exercise
• promote healthy circulation in your foot

It's important to rest the torn tendon because our natural healing process takes time to heal completely. If you don't rest your torn tendon, your acute tendonitis can quickly turn into a chronic tendonitis injury. To repair our damaged tendon tissue quickly, our bodies will use scar tissue to fill in the tears in the tendon. If you need to rest for an extended period of time and avoid certain activities that make your pain worse, you'll be more likely to develop massive amounts of this scar tissue as a temporary healing measure.

Scar tissue may plague you for weeks, months and maybe even years, depending on your level of activity and the amount of conservative treatments you have done during your rehabilitation. Scar tissue is a major problem, especially when it comes to re-injury of your tendon. When dealing with scar tissue it's always important to:

• listen well to your physician, and remember to stick to your conservative treatment plan. Using these treatments every single day will help minimize the amount of scar tissue that will grow in the wound.
• know that frequent use of a Cold Compress or Ice Pack will help reduce the swelling very quickly. Much of the pain you feel will typically be from the swelling, and you'll be surprised how fast pain drops once the swelling is down. Scar tissue growth is further inhibited by a reduction in inflammation (swollen tissue prevents blood flow - tissue dies without blood and scar tissue grows in its place)
• know that the TShellz Wrap will help reduce scar tissue and increase blood flow to the area (thereby accelerating the body's own healing process). Do not use if there is a lot of swelling, use a Cold Compress or Ice Pack instead.
• use the TShellz Wrap before physical activity or stretching. Heat emitted from the TShellz Wrap will help the connective tissue in your joint elongate, and stay elongated for some time after treatment. It will also temporarily increase the flexibility of soft tissue, meaning that it helps improve range of motion while simultaneously reducing your risk of re-injury which is exactly what you want when trying to recover from soft tissue injuries.
• stretching, as assigned by your PT or doctor can not only help get rid of scar tissue, but also promote growth of healthy, flexible tissue.

Prevention

Preventive measures for all types of foot tendinitis include, proper warm up and stretching exercises, wearing the right shoe for the activity, choosing shoes with good arch and heel support and varying your exercise route and routine. (This will help keep one set of muscles from being overstressed).

Gentle stretching is important to help align scar tissue along the normal lines of stress and strength in the healing tendon is enhanced. Scar tissue is fibrous and brittle, without the correct alignment you're left with a weak ankle. You'll have pain and tightness in your ankle for even the smallest daily activities, an this will greatly increase your chance of re-injury.

Product Advisors are available 9:00 am to 5:00 pm Eastern Standard Time Monday to Friday.

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During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort at the location of your soft tissue injury until the pain and inflammation settle. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!