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Peroneal tendinosis and ankle sprains

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Mar 22, 2015.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Peroneal tendinosis as a predisposing factor for the acute lateral ankle sprain in runners
    Pejman Zia, Emir Benca, Florian Wenzel, Reinhard Schuh, Christoph Krall, Alexander Auffahrt, Martin Hofstetter, Reinhard Windhager, Tomas Buchhorn
    Knee Surgery, Sports Traumatology, Arthroscopy; 18 Mar 2015
  2. Craig Payne

    Craig Payne Moderator

  3. drhunt1

    drhunt1 Well-Known Member

    This appears to be a "chicken or the egg" argument...which comes first? I submit that it's the lateral instability of the osseous structures in the foot that predisposes the runner to inversion type sprains. (The fact that the peroneus brevis tendon is involved to a greater degree than the longus is no big surprise). Merton Root discussed this in his second volume...lateral instability secondary to a rear foot varus deformity, although this situation may be more involved than just one deformity. It is the osseous and joint relationships that create the peroneal tendinosis...not the other way around. Further, one cannot necessarily "change" the way a runner runs...nor should we try. Orthotics are the answer...and in more extreme cases, (admittedly those that are more extreme in this regard, IMO, do not find running as a long term aerobic answer), surgical intervention might be necessary.
  4. efuller

    efuller MVP

    I agree that lateral instability from osseous structures could be cause of the peroneal tendonitis. I also agree the instability and tendonitis can be treated using orthotics and surgery.

    However, I disagree with the notion that a rearfoot varus causes supination. I agree that there are other osseous relationships that could also cause supination. These other relationships can all be combined together by looking at the concept of center of pressure relative to the STJ axis. It is much easier to explain how an orthotic works in preventing peroneal tendonitis by using center of pressure in relation to the STJ axis than trying to explain how balancing out a "deformity" treats lateral ankle instability and peroneal tendonitis. The deformity correcting paradigm would cast the foot in neutral position with the hope of moving the foot toward neutral position. The vast majority of the time neutral position is more inverted than resting position. You don't want to push the laterally usnstable foot toward inversion. You do want to increase pronation moment from ground reaction force.

  5. drhunt1

    drhunt1 Well-Known Member

    While a rear foot varus doesn't "cause" supination, (in fact, quite the opposite), it predisposes the patient to inversion type sprains to a greater degree. If the rear foot varus position is extreme enough, the STJ functions at it's end of ROM in eversion to compensate. There is no further eversion available for the patient to therefore compensate for closed kinetic chain forces arising from above or below. The peroneal complex then is either subject to acute injury and/or is over-utilized by the patient to stabilize the foot, resulting in chronic inflammation. Perhaps no other joint in the foot is more subject to GRF's than the STJ.
  6. Dananberg

    Dananberg Active Member

    Once an acute sprain has occurred, neural signaling to the peroneals becomes altered, most commonly inhibited. While the general sense is that the tendons were injured in the original sprain, I have found that the common denominator is the peroneal inhibition which is a direct result of the sprain. When the effects of the inhibition continue for a long enough period of time, repeated sprains and peroneal strain including tendonitis become evident. Its the arthrogenic impact on the neural signaliing which ultimately produces the signs and symptoms. This is also why hallux limitus type symptoms can also arise following ankle injury. The same PL muscles are required for normal 1st MTP joint dorsiflexion. Without this stabilizing effect, the 1st met head dorsiflexes via ground reaction force, jamming the joint in the process. Mobilizing the fibula head and base via ankle manipulation technique can resolve all these simultaneously.


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