Tendon Disorders >
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.
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.
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.
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.
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.
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.