How do you treat peroneal tendonitis?

Tendon pain from excessive use is a very common issue in sports activity. It happens if the cumulative load on the tendon is higher than what the tendon can take. There is two parts to this: the first will be the collective load which means simply how much exercise is carried out and how frequently this is done. It is crucial that the tendon has time to get accustomed to those loads or the collective load can exceed that. Which is the second aspect, just how adapted the tendon would be to those loads. Understanding these concepts is extremely important in being familiar with and managing tendonitis.

As an example, peroneal tendonitis  which is an overuse injury that occurs on the outside of the ankle joint. The cumulative load in this tendon is increased when exercise amounts are too high or increased too quickly and not sufficient time is given for the tendon to adjust to those higher loads. The cumulative load can also be increased by the biomechanics of the feet. For instance, if the supination resistance of the foot is reduced then the peroneal muscles on the outside of the leg will likely need to work harder. That will put an increased force on the peroneal tendons after which put together with training errors that load could very well go beyond what the tendon can take and it develops tendonitis.

Based upon these principles, peroneal tendonitis is managed by reduction of that collective load. That can mean training amounts and frequency needs to be decreased somewhat to allow the tendon to adapt to the loads. The load in this disorder can also be reduced with foot orthotics that evert the foot, which means the peroneal muscles does not need to work so hard. Next the tendon should be given an opportunity to adapt to the loads. This means that training volume and frequency ought to be slowing increased, with plenty of rest between training loads to give the tendon to adjust to those loads.

Should runners be concerned about overpronation?

Overpronation is a expression that triggers plenty of angst among podiatrists and running shoe shops because it brings about a huge amount of confusion and controversy. Pronation is actually a movement of the foot where the ankle rolls inwards and the mid-foot (arch) of the foot collapses. This is the normal healthy movement that is important for normal foot biomechanics and impact moderation. Overpronation is said to be the phrase helpful to identify should there be too much of this normal pronation. The first aspect of the discussion is exactly what is normal what is actually abnormal and just where will be the threshold of the split between normal pronation and overpronation. You can find formidable views on every side of this controversy and there doesn't seem to be any resolution in the debate on the horizon.

The reason why the subject creates a great deal of debate is that overpronation continues to be thought to be a key aspect in overuse injuries in runners. Podiatric doctors commonly use foot supports to manage the condition and running shoe producers design running shoes to help athletes which have the condition. This implies there is lots of vested interest in this. The issue arises is that the research evidence demonstrates that, yes, overpronation is often a risk factor for a running injury, however it is not a large risk factor. It can be further complicated by a lot of athletes that have pretty severe overpronation and never develop any problems and don't need foot orthoses or running shoes with the motion control design characteristics. That doesn't help solve the controversy nor help clinicians make judgements re foot orthotics and for running shoe sellers on advice as to what needs to be the proper running shoe. It really comes down to clinicians and running shoe retailer’s individual expertise and experience and making decisions in the framework of precisely what is suitable for the individual athlete.

Running Shoes and Running Injury

Running is a common sport, recreational activity and way to achieve health and fitness goals. Big money is involved at the elite end of the sport, and at the other end of the spectrum, there is a boom in the numbers of people taking up running and doing things like running marathons. Running has so many health benefits and is easy to do, not requiring expensive equipment or gym memberships. The only cost involved is a good pair of running shoes. Despite that ease, running is not without its problems. During any one year period anywhere from a third to a half of runners get an injury that might stop them from running. At the elite end of the spectrum this interferes with training; at the other end, it can affect motivation to continue running. 

Most running injuries are what are called an overuse injury and comes from the repetitive stress on the body from the activity, rather than the acute type injury that can occurs in other sports. The main cause of running injury is there is too much load applied to the tissues than what the tissues can take. Too much load could just be a matter of doing too much running too quickly for the tissues to get used to that load. This is why any increases in activity have to be done slowly and surely to give the body a chance to get used to it. The other reason for too much load is a biomechanical problem. This may be due to an inherent muscle weakness, a tight muscle, or a bony deviation, or from a poor running technique, or from not having the right running shoe to match the individual foot and type of running done. Most treatment options for running injuries are aimed at reducing the stress or load by addressing all of those factors.