Peroneal Tendinitis: General Mechanical Treatment Thoughts

Hi, Dr. Blake--

I saw you in October 2014 for peroneal tendonitis incurred during tennis play.  You recommended bracing (I bought the ASO ankle brace; like you said, very good brace), activity modification (I'm back on the tennis court, but conservative with my movement), ice (I ice after tennis/cycling), thera band exercises (I'm doing) and stretching (I'm doing with a PT).  I am clearly doing better than when I saw you.  However, today is 3 months post-injury, and I am not yet 100% (am I expecting too much for a 66-year old guy?) and I feel some occasional soreness in my ankle. 

First question:  Do you feel my progress is reasonable?

Second question:  You watched me walk, and you said I walked on the outsides of my feet, perhaps contributing to my risk for this injury.  I wear an over-the-counter Birkenstock orthotic.  Do you feel that an orthotic that addressed my walking on the outsides of my feet would help me?

Thanks for your feedback!

Dr Blake's response:

     Thanks for the followup. Yes, everything sounds reasonable, even if you were 33!! The goal is to gradually increase your activity while keeping the pain level between 0-2, with an occasional twinge. The real good mechanical things you can do are:

1. gradually get stronger and stronger with the peroneal tendons

2. every evening do your balancing exercises (first goal 2 minutes with eyes closed)

3. continue wearing the protective brace for 2 months longer than you think you need to.

4. Make sure that your shoes are not broken down to the outside (due a monthly check by standing them on a flat surface and looking at the back of the heel).

5. Get orthotics adjusted/made to center you. I would be happy to revisit that area. 

Hope this helps. Rich