After a peroneal tendon injury, it is important to perform ankle strengthening and range of motion exercises, including a peroneus brevis stretch, for proper healing. Lateral ankle injuries are very common in those who are active, but they often respond well to exercise.
Peroneus Brevis Injuries
Whether you are an athlete or someone that loves to run and hike for exercise, ankle injuries must be properly treated to prevent complications.
There are two peroneal tendons, namely the peroneus brevis and peroneus longus. These can be found on the outside of your ankle and run behind the fibula bone, explains the American Orthopaedic Foot & Ankle Society (AOFAS). Tendons attach muscle to the bone and therefore, these tendons attach to the muscles with the same name.
The peroneus brevis and peroneus longus muscles both work to stabilize the ankle, as well as turn the ankle outward. The difference between the two is that the peroneus brevis starts lower down in the leg, while the peroneus longus starts higher up in the leg.
The peroneal tendons are prone to repetitive or overuse injuries that may lead to inflammation (tendonitis), says the AOFAS. These types of injuries cause thickening and swelling of those tendons, resulting in pain in the back and outside of the ankle. Those with peroneal tendonitis are often marathon runners or people who have recently increased their activity levels.
A peroneal tendon strain is another common ankle injury. Generally, strains occur when a muscle or tendon is overstretched. For example, you can accidentally twist or roll your ankle inward when running, jumping off a high surface or excessive running on inclined surfaces, according to Connecticut Children's Medical Center.
Those with peroneal tendon strains may report hearing a pop or snap during the injury, as well as pain on the outside of the ankle. There is also frequently swelling on the outside of the ankle, as well as pain with turning the toes outward.
You may also notice snapping or popping while walking after a peroneal tendon injury. This is called "subluxing" of the peroneal tendons and occurs when the injured tendons slide away from the fibula during movement.
Peroneus Brevis Injuries Initial Treatment
Before beginning an exercise program, make sure you have your ankle checked by a doctor. Most peroneus injuries respond well to conservative treatment, but surgery is needed in some cases, states the AOFAS.
In the early stages of your injury, you may require a splint or boot to protect your ankle and allow it to heal. Your doctor may prescribe anti-inflammatory medications as well. After the acute phase and most of the pain has subsided, he or she will clear you for exercises.
Early treatment involves exercises to improve range of motion and flexibility. Whereas gentle movement is allowed, avoid doing a peroneal stretch (by turning your foot inward) at this stage as the tendon is still healing.
Perform the following exercises when you can comfortably stand on your injured foot with your heel resting on the floor, recommends Tufts Medical Center.
Move 1: Towel Stretch
- Sit with your injured leg straight in front of you.
- Loop a towel around your toes and the ball of your foot.
- Pull the towel toward your body as you keep your legs straight.
- You will feel a stretch in your ankle joint, as well as the back of your calf.
- Hold for 15 to 30 seconds. Repeat three times.
Once you can easily do the above exercise without feeling much of a stretch, Tufts recommends moving on to the following exercises.
Move 2: Standing Calf Stretch
- Stand facing a wall with your hands on the wall.
- Place your injured leg back with your heel on the floor. Place your other leg forward with your knee bent.
- Turn your back foot slightly inward, in a pigeon-toed position.
- Lean forward into the wall, until you feel a stretch in the back of your calf.
- Hold for 15 to 30 seconds. Repeat three times. Perform several times a day.
Move 3: Standing Soleus Stretch
- Stand facing a wall, with the injured leg behind you and your other leg bent in front (same position as the above exercise).
- Turn your back foot slightly in.
- Instead of keeping your back leg straight, bend your back knee slightly and lean into the wall as you feel a stretch in your calf.
- Hold for 15 to 30 seconds. Repeat three times.
Peroneus Brevis Strengthening Exercises
In addition to improving flexibility and range of motion, it's essential to strengthen the muscles that support your ankle. This may lower your risk of injuries in the future.
According to a January 2016 review in Knee Surgery, Sports Traumatology, Arthroscopy, the following exercise is safe after a peroneal tendon injury.
Move 1: Resisted Ankle Eversion
- Sit with both legs in front of you. Tie a loop in one end of elastic tubing.
- Place your injured foot though the loop, placing the band around the arch of your foot.
- Step on the band with your uninjured leg and hold on to the band with your hand to provide the tension.
- Push your ankle outward against the resistance of the band to strengthen your peroneal muscles.
- Keep your other foot still and don't turn your knee. Keep your leg still, allowing only your ankle to move.
- Do 2 sets of 15 reps.
Tufts Medical Center also recommends the following exercises for muscle strengthening, balance and flexibility:
Move 2: Heel Raise
- Stand behind a chair or counter with both feet on the floor.
- Holding on for support, rise on your toes for five seconds.
- Perform 2 sets of 15 reps.
- Progress to doing this exercise only on the injured leg.
Move 3: Step-Ups
- Stand with your injured leg on a step 3 to 5 inches high and uninjured leg on the floor.
- Step up, lifting the uninjured leg off the floor.
- Complete 3 sets of 15 reps.
Move 4: Balance and Reach
- Holding onto a chair for support, stand on the foot of your injured leg and bend your knee slightly.
- Reach forward in front of you by bending at the waist and then come back up straight. Try to reach out further each time to challenge yourself.
- Repeat 15 times.
Move 5: Peroneal Stretch
The following is a peroneus longus and peroneus brevis stretch. Don't perform this exercise more often than necessary and stop if you have pain.
- Sit with your legs crossed with your injured foot on top.
- Turn your foot inward so the sole of your foot is facing up.
- Gently use your hands to apply more pressure for more of a stretch.
- Hold for 10 seconds. Repeat three times.
Read more: Ankle-Friendly Cardio
Peroneal Tendonitis Massage
In addition to ankle strengthening and flexibility exercises, peroneal tendonitis massage may facilitate healing too. A small study published in the Biomedical and Pharmacology Journal in December 2015 suggests that friction massage combined with a calf massage on a sprained ankle may improve range of motion, muscle strength and balance. Therapeutic massage may reduce tissue adhesion while increasing blood flow to the muscles and other tissues.
Wait to do the cross fiction massage at least seven days after your injury when most of the pain has subsided. To perform a peroneal tendonitis massage, gently turn your ankle inward and apply direct pressure with one finger across the ligament, behind your fibula bone. Apply pressure backward and forward across the ligament for five minutes. It may be uncomfortable at first, but your pain should decrease as the massage continues.
Perform ankle strengthening and flexibility exercises several times a week to prevent complications. The AOFAS also recommends wearing arch support, which may help facilitate healing, as those with high arches are more susceptible to peroneus brevis injuries.
- American Orthopaedic Foot & Ankle Society: "Peroneal Tendinosis"
- Connecticut Children's Medical Center: "What Is a Peroneal Tendon Injury?"
- Tufts Medical Center: "Peroneal Tendon Injury Exercises"
- Knee Surgery, Sports Traumatology, Arthroscopy: "Rehabilitation After Surgical Treatment of Peroneal Tendon Tears and Ruptures"
- Sports Injury Clinic: "Peroneus Brevis Injury Rehabilitation"
- Biomedical and Pharmacology Journal: "Effect of Friction Technique on Ankle Sprain Grade II Treatment"
- Sports Injury Clinic: "Sprained Ankle Massage"