How do you treat peroneal tendonitis in runners?
Tendon pain from too much use is a common issue in sports activity. It happens in the event the cumulative load on the tendon is greater than what the tendon can take. There is two parts to this: the first is the cumulative load and that means just how much activity is taken on and how frequently this is done. It is vital that the tendon has time to get used to those loads or the collective load could go beyond that. Which is the second part, just how adapted the tendon would be to those loads. Understanding these principles is important in understanding and dealing with tendonitis.
As an example, peroneal tendonitis which is an overuse injury occurring on the outside of the ankle joint. The collective load in this tendon is greater when activity levels are too high or increased too quickly and not sufficient time is given for the tendon to adjust to those high loads. The cumulative load can also be increased by the biomechanics of the foot. For example, if the supination resistance of the foot is lower then the peroneal muscles on the outside of the leg will have to work harder. That could put an increased force on the peroneal tendons after which combined with training errors that load might possibly go beyond what the tendon can take and it develops tendonitis.
Based on these concepts, peroneal tendonitis is managed by reduction of that cumulative load. That could mean training volumes and frequency need to be reduced somewhat to permit the tendon to adapt to the loads. The strain in this condition can also be decreased with foot orthotics that evert the foot, which means the peroneal muscles will not need to work as hard. Next the tendon should be given an opportunity to get used to the loads. This means that exercising amount and frequency ought to be slowing increased, with lots of rest between training loads to get the tendon to adjust to those loads.