Ankle > Peroneal Tendon Disorders > Treatments

   Immobilization

Treatment Introduction

If your peroneal tendons have dislocated and are popping in and out of their natural groove behind your small lower leg bone, immobilizing your ankle may help your tendons heal back in the proper position. Ankle movement causes the peroneal tendons to pop out of position, and immobilization can give your tendons a chance to remain in the correct position while your body produces a sort of scar tissue that will hold them down in place. Immobilization also may be prescribed when you peroneal tendinitis causes a large amount of pain and interferes with ankle movement. If you have a small tear, your physician may consider immobilization for a period of four to six weeks to see if your tendon can heal on its own without surgery. You typically have your ankle immobilized in either a short leg walking cast or a removable cam walker for four to six weeks.

   A short leg walking cast wraps around your foot, ankle, and lower leg. Made of layers of fiberglass, it starts below your knee and is open around your toes to allow toe movement. A stockinette covers your skin and padding is placed around your foot, ankle, and lower leg. Your physician usually rolls the first dry layer of fiberglass around your leg and foot. Extra fiberglass strips are wrapped around the sole of your foot. Additional fiberglass layers are applied wet over the first layer.

   When the short leg walking cast dries, it should immobilize your ankle but allow you to move your toes. It should be snug but not tight. Your cast will have a sturdy bottom so you eventually can walk while wearing it. Report any loss of sensation to your physician.

   A cam walker is a removable boot, made of nylon straps that fasten around your calf and foot. Most cam walkers have an adjustable hinge at the ankle that can be set to allow the range of motion your physician prescribes. The sturdy bottom of the cam walker is rocker shaped, which enables you to walk.

Most patients are instructed to use crutches for the first few weeks in a cast or cam walker, but you usually can bear weight right away. Weight bearing increases as you can tolerate the pain.

Depending on the pain caused by your peroneal tendon disorder, crutches are usually prescribed to help you get around. Try to rest as much as possible. In a short leg walking cast or cam walker, many patients are pain-free and can bear weight right away. However, household tasks that require you to be on your feet may be difficult for four to six weeks. It can be helpful to have someone around the house to assist with any physical chores. In general, you should wear your cast or cam walker as instructed by your doctor until symptoms subside. Your physician usually schedules regular follow-up visits to check your progress. You typically begin weight bearing without crutches in the cast or cam walker before going back to normal shoe wear. Your physician typically prescribes range of motion exercises for you to perform at home after your cast is removed. You can begin range of motion exercises earlier if you are wearing a cam walker. You generally are instructed to remove it for a brief period, and to move your ankle up, down, and side-to-side. Start with slow movements and do not move your ankle too far in any direction. You will likely know early on if the immobilization helped or not. If your previous level of pain returns within a week or two of your cast coming off, it is likely that you will need some sort of surgical intervention. Your physician usually evaluates your ankle after four to six weeks, talks with you about your physical and athletic goals, and determines whether regular cardiovascular exercise and everyday weight bearing can sufficiently strengthen your ankle.

Rehabilitation

Though formal physical therapy rarely is prescribed, athletes who want to return to sports as quickly as possible may choose to visit a physical therapist. Formal physical therapy also may be prescribed for patients who do not make good progress strengthening their ankles on their own. Have your physician examine your ankle if you experience episodes of pain or discomfort while exercising. Most patients can return to sports and activities within six months. Physical therapy usually involves learning an ankle stretching routine and performing ankle and lower leg strengthening exercises.

   Ankle stretching exercises

   Ankle strengthening exercises

To prevent reinjury to your ankle, you should strengthen your peroneal tendons. Physicians often recommend proprioceptive training, which includes training with a special balance board (BAPS board) that rolls on top of a ball. Increasing your ankle strength and balance can help you better withstand strain on your ankle during activities. The peroneal tendons prevent inward turning of your ankle (inversion) and are responsible for the stability of your ankle. It is difficult to know which patients are prone to future peroneal tendon injuries, but certainly people with weak tendons have a tendency to invert their ankle and suffer an ankle sprain or reinjure their peroneal tendons. Though you usually do not have any restrictions on your activities after peroneal tendinitis, you should be cautious when running on uneven surfaces or engaging in high-velocity sports that may cause twists or falls.