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Saturday, October 17, 2015

Peroneal Tendinitis: Email Correspondance

 I have been suffering from peroneal tendonitis for four years now and I'm hoping you can shed some insight on how I can kick this thing for good! Originally, my podiatrist recommended motion control shoes to control the torque in my ankle: that was a complete failure. I rolled both my good and bad ankle twice in a matter of hours.
Dr Blake's comment: Wow, that was bad luck. Peroneal tendonitis stands be more from over supination (aka under pronation) than over pronation, so I am not sure why the motion control. Neutral, and some stability shoes, are great for this problem. My favorites are the Saucony Triumph and Brooks Ghost right now. 

After this my local running store recommended a support shoe instead. These shoes are usually fine for a few weeks, but as soon as they start to break in the underpronation gets worse and worse. It's a weird combination of feelings: like the arch support is so heavy that my feet aren't touching the ground on the inside, but also that the heel has worn out so quickly that I feels like it isn't touching the ground either. 
Dr Blake's comment: Look at the posts on lateral shoe wedging (which may be crucial), and common modifications of supination control. You can even power lace for supination protection.

I recently switched to a neutral shoe after the owner at another local running store was horrified that I was literally walking on the edges of my feet (and I have the ugly calluses along the entire edge to prove it). The neutral shoe has helped greatly. I feel significantly less later calf pain, but I can feel the tendonitis creep back in. It almost feels as though my feet slide from one side of the shoe to the other while I'm underpronating, and no amount of lacing can keep them in place. When I strike the ground evenly I have no pain, but when the edge of my foot hits the ground I can feel it right up the tendon.
Dr Blake's comment: This is why are supinators fall in love with shoe wedging and inserts that correct. Over supination is the most unstable and dangerous biomechanical problem I treat on a regular basis. You can even purchase some Red Sole Inserts from REI and other stores, and use masking tape and/or duct tape along the lateral under surface border, to straighten your foot until you get some professional help. When dealing with injuries, finding the mechanics that are causing or aggravating the problem, is vital. Or the problem is a repeating issue. 

I've also tried a lateral heel wedge to no avail, and a full over the counter lateral insole. Are there any other options or am I doomed to pain? I can't understand how one ankle sprain 4 years ago has led to such significant change in my mechanics, I always just grabbed any old shoe and had no problems before. 
Dr Blake's comment: Ankle sprains, where there is loss of ligament stability, can cause subtle and not so subtle instabilities that the body has to deal with. Besides the info above, start doing your Single Leg Balancing nightly (for it will take 1-2 years to get super strong in the protection of your ankle and probably now is a good enough time to start).

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.