Conservative Treatment of Peroneal Tendon Injuries: Rehabilitation

  • Eric FolmarEmail author
  • Michael Gans


Rehabilitation professionals are often charged with front line management of ankle sprains, tendonitis, and other various pain issues associated with the foot and the ankle. Critical to the management of peroneal tendon injuries is a detailed evaluation and differential diagnosis to ensure that the patient is being managed in the proper setting. This chapter systemically identifies the normal and pathological function of the peroneal tendons, with an emphasis on the evaluation and differential diagnosis of peroneal tendon injuries. Particular attention will be placed on the identification and treatment of the associated normal and abnormal biomechanics.


Peroneal tendon injuries Conservative treatment Nonoperative management Peroneal disorders 


  1. 1.
    Selmani E, Gjata V, Gjika E. Current concepts review: peroneal tendon disorders. Foot Ankle Int. 2006;27(3):221–8.PubMedGoogle Scholar
  2. 2.
    Perry J, Burnfield J. Gait analysis: normal and pathological function. Thorofare: Slack, Inc; 2010.Google Scholar
  3. 3.
    Kokubo T, Hashimoto T, Nagura T, et al. Effect of the posterior tibial and peroneal longus on the mechanical properties of the foot arch. Foot Ankle Int. 2012;33(4):320–5.PubMedGoogle Scholar
  4. 4.
    Baumhauer JF, Alosa DM, Renstrom AF, Trevino S, Beynnon B. A prospective study of ankle injury risk factors. Am J Sports Med. 1995;23(5):564–70.PubMedGoogle Scholar
  5. 5.
    Arnason A, Sigurdsson SB, Gudmundsson A, Holme I, Engebretsen L, Bahr R. Risk factors for injuries in football. Am J Sports Med. 2004;32(1_suppl):5–16.Google Scholar
  6. 6.
    Bahr R, Bahr IA. Incidence of acute volleyball injuries: a prospective cohort study of injury mechanisms and risk factors. Scand J Med Sci Sports. 1997;7(3):166–71.PubMedGoogle Scholar
  7. 7.
    Noronha M, França LC, Haupenthal A, Nunes GS. Intrinsic predictive factors for ankle sprain in active university students: a prospective study. Scand J Med Sci Sports. 2013;23(5):541–7.PubMedGoogle Scholar
  8. 8.
    Emery CA, Meeuwisse WH. The effectiveness of a neuromuscular prevention strategy to reduce injuries in youth soccer: a cluster-randomised controlled trial. Br J Sports Med. 2010;44(8):555.PubMedGoogle Scholar
  9. 9.
    Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic risk factors for acute ankle injuries among male soccer players: a prospective cohort study. Scand J Med Sci Sports. 2010;20(3):403–10.PubMedGoogle Scholar
  10. 10.
    Hiller CE, Refshauge KM, Herbert RD, Kilbreath SL. Intrinsic predictors of lateral ankle sprain in adolescent dancers: a prospective cohort study. Clin J Sport Med. 2008;18(1):44–8.PubMedGoogle Scholar
  11. 11.
    Kofotolis ND, Kellis E, Vlachopoulos SP. Ankle sprain injuries and risk factors in amateur soccer players during a 2-year period. Am J Sports Med. 2007;35(3):458–66.PubMedGoogle Scholar
  12. 12.
    McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med. 2001;35(2):103–8.PubMedPubMedCentralGoogle Scholar
  13. 13.
    McGuine TA, Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med. 2006;34(7):1103–11.PubMedGoogle Scholar
  14. 14.
    Shell IG, Greenberg GH, McKnight R, et al. Decision rules for the use of radiography in acute ankle injuries: refinement and prospective validation. JAMA. 1993;269(9):1127–32.Google Scholar
  15. 15.
    Jonckheer P, Willems T, De Ridder R, et al. Evaluating fracture risk in acute ankle sprains: any news since the Ottawa ankle rules? A systematic review. Eur J Gen Pract. 2016;22(1):31–41.PubMedGoogle Scholar
  16. 16.
    Roth JA, Taylor WC, Whalen J, Roth JA, Taylor WC, Whalen J. Peroneal tendon subluxation: the other lateral ankle injury. Br J Sports Med. 2010;44(14):1047–53.PubMedGoogle Scholar
  17. 17.
    Martin RL, Davenport TE, Paulseth S, Wukich DK, Godges JJ. Ankle stability and movement coordination impairments: ankle ligament sprains. J Orthop Sports Phys Ther. 2013;43(9):A1–40.PubMedGoogle Scholar
  18. 18.
    de Noronha M, Refshauge KM, Herbert RD, Kilbreath SL. Do voluntary strength, proprioception, range of motion, or postural sway predict occurrence of lateral ankle sprain? Br J Sports Med. 2006;40(10):824–8.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Pope R, Herbert R, Kirwan J. Effects of ankle dorsiflexion range and pre-exercise calf muscle stretching on injury risk in Army recruits. Aust J Physiother. 1998;44(3):165–72.PubMedGoogle Scholar
  20. 20.
    Andres BM, Murrell GA. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466(7):1539–54.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Karlsson J, Wiger P. Longitudinal split of the peroneus brevis tendon and lateral ankle instability: treatment of concomitant lesions. J Athl Train. 2002;37(4):463–6.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Sobel M, DiCarlo EF, Bohne WH, Collins L. Longitudinal splitting of the peroneus brevis tendon: an anatomic and histologic study of cadaveric material. Foot Ankle. 1991;12(3):165–70.PubMedGoogle Scholar
  23. 23.
    Sobel M, Pavlov H, Geppert MJ, Thompson FM, DiCarlo EF, Davis WH. Painful os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot Ankle Int. 1994;15(3):112–24.PubMedGoogle Scholar
  24. 24.
    Martin RL, Irrgang JJ. A survey of self-reported outcome instruments for the foot and ankle. J Orthop Sports Phys Ther. 2007;37(2):72–84.PubMedGoogle Scholar
  25. 25.
    Martin RL, Irrgang JJ, Burdett RG, Conti SF, Van Swearingen JM. Evidence of validity for the Foot and Ankle Ability Measure (FAAM). Foot Ankle Int. 2005;26(11):968–83.PubMedGoogle Scholar
  26. 26.
    Binkley JM, Stratford PW, Lott SA, Riddle DL. The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther. 1999;79(4):371–83.PubMedGoogle Scholar
  27. 27.
    Redmond AC, Crane YZ, Menz HB. Normative values for the foot posture index. J Foot Ankle Res. 2008;1(1):6.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: the foot posture index. Clin Biomech (Bristol, Avon). 2006;21(1):89–98.Google Scholar
  29. 29.
    Cornwall MW, McPoil TG, Lebec M, Vicenzino B, Wilson J. Reliability of the modified foot posture index. J Am Podiatr Med Assoc. 2008;98(1):7–13.PubMedGoogle Scholar
  30. 30.
    Keenan AM, Redmond AC, Horton M, Conaghan PG, Tennant A. The foot posture index: Rasch analysis of a novel, foot-specific outcome measure. Arch Phys Med Rehabil. 2007;88(1):88–93.PubMedGoogle Scholar
  31. 31.
    McLaughlin P, Vaughan B, Shanahan J, Martin J, Linger G. Inexperienced examiners and the foot posture index: a reliability study. Man Ther. 2016;26:238–40.PubMedGoogle Scholar
  32. 32.
    Delahunt E, Monaghan K, Caulfield B. Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint. Am J Sports Med. 2006;34(12):1970–6.PubMedGoogle Scholar
  33. 33.
    Monaghan K, Delahunt E, Caulfield B. Ankle function during gait in patients with chronic ankle instability compared to controls. Clin Biomech (Bristol, Avon). 2006;21(2):168–74.Google Scholar
  34. 34.
    Martin RL, McPoil TG. Reliability of ankle goniometric measurements: a literature review. J Am Podiatr Med Assoc. 2005;95(6):564–72.PubMedGoogle Scholar
  35. 35.
    Elveru RA, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting. Subtalar and ankle joint measurements. Phys Ther. 1988;68(5):672–7.PubMedGoogle Scholar
  36. 36.
    Aydog E, Aydog ST, Cakci A, Doral MN. Reliability of isokinetic ankle inversion- and eversion-strength measurement in neutral foot position, using the Biodex dynamometer. Knee Surg Sports Traumatol Arthrosc. 2004;12(5):478–81.PubMedGoogle Scholar
  37. 37.
    Fraser JJ, Koldenhoven RM, Saliba SA, Hertel J. Reliability of ankle-foot morphology, mobility, strength, and motor performance measures. Int J Sports Phys Ther. 2017;12(7):1134–49.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Kelln BM, McKeon PO, Gontkof LM, Hertel J. Hand-held dynamometry: reliability of lower extremity muscle testing in healthy, physically active, young adults. J Sport Rehabil. 2008;17(2):160–70.PubMedGoogle Scholar
  39. 39.
    Ancillao A, Palermo E, Rossi S. Validation of ankle strength measurements by means of a hand-held dynamometer in adult healthy subjects. J Sens. 2017;2017:8.Google Scholar
  40. 40.
    Alfuth M, Hahm MM. Reliability, comparability, and validity of foot inversion and eversion strength measurements using a hand-held dynamometer. Int J Sports Phys Ther. 2016;11(1):72–84.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Chrintz H, Falster O, Roed J. Single-leg postural equilibrium test. Scand J Med Sci Sports. 1991;1(4):244–6.Google Scholar
  42. 42.
    Forkin DM, Koczur C, Battle R, Newton RA. Evaluation of kinesthetic deficits indicative of balance control in gymnasts with unilateral chronic ankle sprains. J Orthop Sports Phys Ther. 1996;23(4):245–50.PubMedGoogle Scholar
  43. 43.
    Jerosch J, Prymka M. Proprioception and joint stability. Knee Surg Sports Traumatol Arthrosc. 1996;4(3):171–9.PubMedGoogle Scholar
  44. 44.
    Lentell G, Katzman LL, Walters MR. The relationship between muscle function and ankle stability. J Orthop Sports Phys Ther. 1990;11(12):605–11.PubMedGoogle Scholar
  45. 45.
    Bohannon RW, Larkin PA, Cook AC, Gear J, Singer J. Decrease in timed balance test scores with aging. Phys Ther. 1984;64(7):1067–70.PubMedGoogle Scholar
  46. 46.
    Iverson GL, Kaarto ML, Koehle MS. Normative data for the balance error scoring system: implications for brain injury evaluations. Brain Inj. 2008;22(2):147–52.PubMedGoogle Scholar
  47. 47.
    Finnoff JT, Peterson VJ, Hollman JH, Smith J. Intrarater and interrater reliability of the Balance Error Scoring System (BESS). PM R. 2009;1(1):50–4.PubMedGoogle Scholar
  48. 48.
    Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star excursion balance test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006;36(12):911–9.PubMedGoogle Scholar
  49. 49.
    Gribble PA, Kelly SE, Refshauge KM, Hiller CE. Interrater reliability of the star excursion balance test. J Athl Train. 2013;48(5):621–6.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Hertel JMS, Denegar CR. Intratester and intertester reliability during the star excursion balance tests. J Sport Rehabil. 2000;9:104–16.Google Scholar
  51. 51.
    Gribble PA, Hertel J, Denegar CR, Buckley WE. The effects of fatigue and chronic ankle instability on dynamic postural control. J Athl Train. 2004;39:321–9.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Hertel J, Braham RA, Hale SA, Olmsted-Kramer LC. Simplifying the star excursion balance test: analyses of subjects with and without chronic ankle instability. J Orthop Sports Phys Ther. 2006;36(3):131–7.PubMedGoogle Scholar
  53. 53.
    Olmsted LC, Carcia CR, Hertel J, Shultz SJ. Efficacy of the star excursion balance tests in detecting reach deficits in subjects with chronic ankle instability. J Athl Train. 2002;37(4):501–6.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Hubbard TJ, Kramer LC, Denegar CR, Hertel J. Contributing factors to chronic ankle instability. Foot Ankle Int. 2007;28(3):343–54.PubMedGoogle Scholar
  55. 55.
    Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med. 2016;50(19):1187–91.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409–16.PubMedGoogle Scholar
  57. 57.
    Galloway MT, Lalley AL, Shearn JT. The role of mechanical loading in tendon development, maintenance, injury, and repair. J Bone Joint Surg Am. 2013;95(17):1620–8.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Heckman DS, Gluck GS, Parekh SG. Tendon disorders of the foot and ankle, part 1: peroneal tendon disorders. Am J Sports Med. 2009;37(3):614–25.PubMedGoogle Scholar
  59. 59.
    Krause JO, Brodsky JW. Peroneus brevis tendon tears: pathophysiology, surgical reconstruction, and clinical results. Foot Ankle Int. 1998;19(5):271–9.PubMedGoogle Scholar
  60. 60.
    Redfern D, Myerson M. The management of concomitant tears of the peroneus longus and brevis tendons. Foot Ankle Int. 2004;25(10):695–707.PubMedGoogle Scholar
  61. 61.
    Whitman JM, Cleland JA, Mintken P, et al. Predicting short-term response to thrust and nonthrust manipulation and exercise in patients post inversion ankle sprain. J Orthop Sports Phys Ther. 2009;39(3):188–200.PubMedGoogle Scholar
  62. 62.
    Pellow JE, Brantingham JW. The efficacy of adjusting the ankle in the treatment of subacute and chronic grade I and grade II ankle inversion sprains. J Manipulative Physiol Ther. 2001;24(1):17–24.PubMedGoogle Scholar
  63. 63.
    Vicenzino B, Branjerdporn M, Teys P, Jordan K. Initial changes in posterior talar glide and dorsiflexion of the ankle after mobilization with movement in individuals with recurrent ankle sprain. J Orthop Sports Phys Ther. 2006;36(7):464–71.PubMedGoogle Scholar
  64. 64.
    Cleland JA, Mintken PE, McDevitt A, et al. Manual physical therapy and exercise versus supervised home exercise in the management of patients with inversion ankle sprain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther. 2013;43(7):443–55.PubMedGoogle Scholar
  65. 65.
    Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc. 2016;60(3):200–11.PubMedPubMedCentralGoogle Scholar
  66. 66.
    Loghmani MT, Warden SJ. Instrument-assisted cross-fiber massage accelerates knee ligament healing. J Orthop Sports Phys Ther. 2009;39(7):506–14.PubMedGoogle Scholar
  67. 67.
    Salom-Moreno J, Ayuso-Casado B, Tamaral-Costa B, Sánchez-Milá Z, Fernández-de-Las-Peñas C, Alburquerque-Sendín F. Trigger point dry needling and proprioceptive exercises for the management of chronic ankle instability: a randomized clinical trial. Evid Based Complement Alternat Med. 2015;2015:790209.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Hiller CE, Nightingale EJ, Lin CW, Coughlan GF, Caulfield B, Delahunt E. Characteristics of people with recurrent ankle sprains: a systematic review with meta-analysis. Br J Sports Med. 2011;45(8):660–72.PubMedGoogle Scholar
  69. 69.
    Morrison KE, Kaminski TW. Foot characteristics in association with inversion ankle injury. J Athl Train. 2007;42(1):135–42.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Verhagen EA, Bay K. Optimising ankle sprain prevention: a critical review and practical appraisal of the literature. Br J Sports Med. 2010;44(15):1082–8.PubMedGoogle Scholar
  71. 71.
    Verhagen EA, van Mechelen W, de Vente W. The effect of preventive measures on the incidence of ankle sprains. Clin J Sport Med. 2000;10(4):291–6.PubMedGoogle Scholar
  72. 72.
    Janssen KW, Kamper SJ. Ankle taping and bracing for proprioception. Br J Sports Med. 2013;47(8):527–8.PubMedGoogle Scholar
  73. 73.
    Olmsted LC, Vela LI, Denegar CR, Hertel J. Prophylactic ankle taping and bracing: a numbers-needed-to-treat and cost-benefit analysis. J Athl Train. 2004;39(1):95–100.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Rovere GD, Clarke TJ, Yates CS, Burley K. Retrospective comparison of taping and ankle stabilizers in preventing ankle injuries. Am J Sports Med. 1988;16(3):228–33.PubMedGoogle Scholar
  75. 75.
    Simoneau G. Changes in ankle joint proprioception resulting from strips of athletic tape applied over the skin. J Athl Train. 1997;32:141–7.PubMedPubMedCentralGoogle Scholar
  76. 76.
    Beam JW. Orthopedic taping, wrapping, bracing, and padding. 2nd ed. Philadelphia: F. A. Davis Company; 2012.Google Scholar
  77. 77.
    Best R, Mauch F, Bohle C, Huth J, Bruggemann P. Residual mechanical effectiveness of external ankle tape before and after competitive professional soccer performance. Clin J Sport Med. 2014;24(1):51–7.PubMedGoogle Scholar
  78. 78.
    Simoneau GG, Degner RM, Kramper CA, Kittleson KH. Changes in ankle joint proprioception resulting from strips of athletic tape applied over the skin. J Athl Train. 1997;32(2):141–7.PubMedPubMedCentralGoogle Scholar
  79. 79.
    Purcell SB, Schuckman BE, Docherty CL, Schrader J, Poppy W. Differences in ankle range of motion before and after exercise in 2 tape conditions. Am J Sports Med. 2009;37(2):383–9.PubMedGoogle Scholar
  80. 80.
    Cordova ML, Takahashi Y, Kress GM, Brucker JB, Finch AE. Influence of external ankle support on lower extremity joint mechanics during drop landings. J Sport Rehabil. 2010;19(2):136–48.PubMedGoogle Scholar
  81. 81.
    Bicici S, Karatas N, Baltaci G. Effect of athletic taping and kinesiotaping(R) on measurements of functional performance in basketball players with chronic inversion ankle sprains. Int J Sports Phys Ther. 2012;7(2):154–66.PubMedPubMedCentralGoogle Scholar
  82. 82.
    Briem K, Eythorsdottir H, Magnusdottir RG, Palmarsson R, Runarsdottir T, Sveinsson T. Effects of kinesio tape compared with nonelastic sports tape and the untaped ankle during a sudden inversion perturbation in male athletes. J Orthop Sports Phys Ther. 2011;41(5):328–35.PubMedGoogle Scholar
  83. 83.
    Halseth T, McChesney JW, Debeliso M, Vaughn R, Lien J. The effects of kinesio taping on proprioception at the ankle. J Sports Sci Med. 2004;3(1):1–7.PubMedPubMedCentralGoogle Scholar
  84. 84.
    Yen SC, Folmar E, Friend KA, Wang YC, Chui KK. Effects of kinesiotaping and athletic taping on ankle kinematics during walking in individuals with chronic ankle instability: a pilot study. Gait Posture. 2018;66:118–23.PubMedGoogle Scholar
  85. 85.
    Janssen KW, van Mechelen W, Verhagen EA. Bracing superior to neuromuscular training for the prevention of self-reported recurrent ankle sprains: a three-arm randomised controlled trial. Br J Sports Med. 2014;48(16):1235–9.PubMedPubMedCentralGoogle Scholar
  86. 86.
    Cordova ML, Ingersoll CD, LeBlanc MJ. Influence of ankle support on joint range of motion before and after exercise: a meta-analysis. J Orthop Sports Phys Ther. 2000;30(4):170–7; discussion 178–182.PubMedGoogle Scholar
  87. 87.
    Chagas-Neto FA, de Souza BN, Nogueira-Barbosa MH. Painful os peroneum syndrome: underdiagnosed condition in the lateral midfoot pain. Case Rep Radiol. 2016;2016:8739362.PubMedPubMedCentralGoogle Scholar
  88. 88.
    Oliva F, Frate D, Ferran NA. Peroneal tendons subluxation. Sports Med Arthrosc Rev. 2009;17(2):105–11.PubMedGoogle Scholar
  89. 89.
    Lee JS, Kim KB, Jeong JO, Kwon NY, Jeong SM. Correlation of foot posture index with plantar pressure and radiographic measurements in pediatric flatfoot. Ann Rehabil Med. 2015;39(1):10–7.PubMedPubMedCentralGoogle Scholar
  90. 90.
    Kang MH, Lee DK, Park KH, Oh JS. Association of ankle kinematics and performance on the y-balance test with inclinometer measurements on the weight-bearing-lunge test. J Sport Rehabil. 2015;24(1):62–7.PubMedGoogle Scholar
  91. 91.
    Lee DK, Kang MH, Lee TS, Oh JS. Relationships among the Y balance test, berg balance scale, and lower limb strength in middle-aged and older females. Braz J Phys Ther. 2015;19(3):227–34.PubMedPubMedCentralGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Physical Therapy, Movement & Rehabilitation SciencesNortheastern UniversityBostonUSA
  2. 2.American Academy of Orthopaedic Manual Physical TherapistsBaton RougeUSA
  3. 3.Physical Therapy and Sports Medicine CentersGuilfordUSA
  4. 4.PTSMC Orthopedic Physical Therapy Residency ProgramWest HartfordUSA

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