Peroneal Tendonitis and Tendonopathy

  • Kevin A. Schafer
  • Samuel B. Adams
  • Jeremy J. McCormickEmail author


Tendinopathy is a broad encompassing term that is often used to describe both inflammatory and noninflammatory disorders. The cellular processes involved in the most common tendinopathies are poorly understood, but injury is thought to occur secondary to altered cellular signaling that directly changes tendon microstructure. Clinically, the causes of these alterations can be classified into intrinsic and extrinsic factors specific to each patient. Therefore, practitioners should consider these factors when developing patient treatment strategies, with a particular emphasis on risk factors that are modifiable.


Tendinopathy Tendonitis Tendinosis Neurogenic inflammation Intrinsic and extrinsic risk factors 


  1. 1.
    Andarawis-Puri N, Flatow EL, Soslowsky LJ. Tendon basic science: development, repair, regeneration, and healing. J Orthop Res. 2015;33(6):780–4.CrossRefGoogle Scholar
  2. 2.
    Bass E. Tendinopathy: why the difference between tendinitis and tendinosis matters. Int J Ther Massage Bodywork. 2012;5(1):14–7.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Federer AE, Steele JR, Dekker TJ, Liles JL, Adams SB. Tendonitis and tendinopathy: what are they and how do they evolve? Foot Ankle Clin. 2017;22(4):665–76.CrossRefGoogle Scholar
  4. 4.
    Boyer MI, Hastings H 2nd. Lateral tennis elbow: “is there any science out there?”. J Shoulder Elb Surg. 1999;8(5):481–91.CrossRefGoogle Scholar
  5. 5.
    Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF. Time to abandon the “tendinitis” myth. BMJ. 2002;324(7338):626–7.CrossRefGoogle Scholar
  6. 6.
    Abate M, Silbernagel KG, Siljeholm C, Di Iorio A, De Amicis D, Salini V, et al. Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Res Ther. 2009;11(3):235.CrossRefGoogle Scholar
  7. 7.
    Millar NL, Murrell GA, McInnes IB. Inflammatory mechanisms in tendinopathy – towards translation. Nat Rev Rheumatol. 2017;13(2):110–22.CrossRefGoogle Scholar
  8. 8.
    Thorpe CT, Screen HR. Tendon structure and composition. Adv Exp Med Biol. 2016;920:3–10.CrossRefGoogle Scholar
  9. 9.
    Xu Y, Murrell GA. The basic science of tendinopathy. Clin Orthop Relat Res. 2008;466(7):1528–38.CrossRefGoogle Scholar
  10. 10.
    Chiodo CP. Understanding the anatomy and biomechanics of ankle tendons. Foot Ankle Clin. 2017;22(4):657–64.CrossRefGoogle Scholar
  11. 11.
    Riley G. The pathogenesis of tendinopathy. A molecular perspective. Rheumatology (Oxford). 2004;43(2):131–42.CrossRefGoogle Scholar
  12. 12.
    Ackermann PW. Neuronal regulation of tendon homoeostasis. Int J Exp Pathol. 2013;94(4):271–86.CrossRefGoogle Scholar
  13. 13.
    Ljung BO, Forsgren S, Friden J. Substance P and calcitonin gene-related peptide expression at the extensor carpi radialis brevis muscle origin: implications for the etiology of tennis elbow. J Orthop Res. 1999;17(4):554–9.CrossRefGoogle Scholar
  14. 14.
    Han SH, Choi W, Song J, Kim J, Lee S, Choi Y, et al. The implication of substance P in the development of tendinopathy: a case control study. Int J Mol Sci. 2017;18(6).Google Scholar
  15. 15.
    Almekinders LC. Tendinitis and other chronic tendinopathies. J Am Acad Orthop Surg. 1998;6(3):157–64.CrossRefGoogle Scholar
  16. 16.
    Heckman DS, Reddy S, Pedowitz D, Wapner KL, Parekh SG. Operative treatment for peroneal tendon disorders. J Bone Joint Surg Am. 2008;90(2):404–18.CrossRefGoogle Scholar
  17. 17.
    Bruce WD, Christofersen MR, Phillips DL. Stenosing tenosynovitis and impingement of the peroneal tendons associated with hypertrophy of the peroneal tubercle. Foot Ankle Int. 1999;20(7):464–7.CrossRefGoogle Scholar
  18. 18.
    Lui TH. Tendoscopic resection of low-lying muscle belly of peroneus brevis or quartus. Foot Ankle Int. 2012;33(10):912–4.CrossRefGoogle Scholar
  19. 19.
    Mirmiran R, Squire C, Wassell D. Prevalence and role of a low-lying peroneus brevis muscle belly in patients with peroneal tendon pathologic features: a potential source of tendon subluxation. J Foot Ankle Surg. 2015;54(5):872–5.CrossRefGoogle Scholar
  20. 20.
    van Dijk PA, Madirolas FX, Carrera A, Kerkhoffs GM, Reina F. Peroneal tendons well vascularized: results from a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1140–7.CrossRefGoogle Scholar
  21. 21.
    McCarthy MM, Hannafin JA. The mature athlete: aging tendon and ligament. Sports Health. 2014;6(1):41–8.CrossRefGoogle Scholar
  22. 22.
    Petersen W, Bobka T, Stein V, Tillmann B. Blood supply of the peroneal tendons: injection and immunohistochemical studies of cadaver tendons. Acta Orthop Scand. 2000;71(2):168–74.CrossRefGoogle Scholar
  23. 23.
    Funakoshi T, Iwasaki N, Kamishima T, Nishida M, Ito Y, Kondo M, et al. In vivo visualization of vascular patterns of rotator cuff tears using contrast-enhanced ultrasound. Am J Sports Med. 2010;38(12):2464–71.CrossRefGoogle Scholar
  24. 24.
    Ippolito E, Natali PG, Postacchini F, Accinni L, De Martino C. Morphological, immunochemical, and biochemical study of rabbit achilles tendon at various ages. J Bone Joint Surg Am. 1980;62(4):583–98.CrossRefGoogle Scholar
  25. 25.
    Zhou Z, Akinbiyi T, Xu L, Ramcharan M, Leong DJ, Ros SJ, et al. Tendon-derived stem/progenitor cell aging: defective self-renewal and altered fate. Aging Cell. 2010;9(5):911–5.CrossRefGoogle Scholar
  26. 26.
    Birk DE, Fitch JM, Babiarz JP, Doane KJ, Linsenmayer TF. Collagen fibrillogenesis in vitro: interaction of types I and V collagen regulates fibril diameter. J Cell Sci. 1990;95(Pt 4):649–57.PubMedGoogle Scholar
  27. 27.
    Pabalan N, Tharabenjasin P, Phababpha S, Jarjanazi H. Association of COL5A1 gene polymorphisms and risk of tendon-ligament injuries among Caucasians: a meta-analysis. Sports Med Open. 2018;4(1):46.CrossRefGoogle Scholar
  28. 28.
    Altinisik J, Meric G, Erduran M, Ates O, Ulusal AE, Akseki D. The BstUI and DpnII variants of the COL5A1 gene are associated with tennis elbow. Am J Sports Med. 2015;43(7):1784–9.CrossRefGoogle Scholar
  29. 29.
    Ranger TA, Wong AM, Cook JL, Gaida JE. Is there an association between tendinopathy and diabetes mellitus? A systematic review with meta-analysis. Br J Sports Med. 2016;50(16):982–9.CrossRefGoogle Scholar
  30. 30.
    Oliveira RR, Medina de Mattos R, Magalhaes Rebelo L, Guimaraes Meireles Ferreira F, Tovar-Moll F, Eurico Nasciutti L, et al. Experimental diabetes alters the morphology and nano-structure of the achilles tendon. PLoS One. 2017;12(1):e0169513.CrossRefGoogle Scholar
  31. 31.
    Lundgreen K, Lian OB, Scott A, Nassab P, Fearon A, Engebretsen L. Rotator cuff tear degeneration and cell apoptosis in smokers versus nonsmokers. Arthroscopy. 2014;30(8):936–41.CrossRefGoogle Scholar
  32. 32.
    Chang SA. Smoking and type 2 diabetes mellitus. Diabetes Metab J. 2012;36(6):399–403.CrossRefGoogle Scholar
  33. 33.
    Castro AD, Skare TL, Nassif PA, Sakuma AK, Barros WH. Tendinopathy and obesity. Arq Bras Cir Dig. 2016;29 Suppl 1(Suppl 1):107–10.CrossRefGoogle Scholar
  34. 34.
    Scott A, Zwerver J, Grewal N, de Sa A, Alktebi T, Granville DJ, et al. Lipids, adiposity and tendinopathy: is there a mechanistic link? Critical review Br J Sports Med. 2015;49(15):984–8.CrossRefGoogle Scholar
  35. 35.
    O’Neill S, Watson PJ, Barry S. A Delphi study of risk factors for achilles tendinopathy- opinions of world tendon experts. Int J Sports Phys Ther. 2016;11(5):684–97.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Mears AC, Osei-Owusu P, Harland AR, Owen A, Roberts JR. Perceived links between playing surfaces and injury: a worldwide study of elite association football players. Sports Med Open. 2018;4(1):40.CrossRefGoogle Scholar
  37. 37.
    Rowson S, McNally C, Duma SM. Can footwear affect achilles tendon loading? Clin J Sport Med. 2010;20(5):344–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Kevin A. Schafer
    • 1
  • Samuel B. Adams
    • 2
  • Jeremy J. McCormick
    • 1
    Email author
  1. 1.Department of Orthopedic SurgeryWashington University School of MedicineSt LouisUSA
  2. 2.Foot and Ankle Division, Department of Orthopedic SurgeryDuke University Medical CenterDurhamUSA

Personalised recommendations