Peroneal tendon injuries fall into three categories: tendonitis, tears, and subluxation. They are more common in active, athletic patients and can be acute (sudden) or chronic (lingering) in nature.

Tendonitis is inflammation, acute tears are caused by an injury and tendonosis (chronic tears) are usually caused by overuse and repetitive stress or chronic tendonitis. Subluxation usually occurs in an acute injury, like an ankle sprain, where the tendons actually dislocate onto the outer ankle bone and snap back and forth with activity.

The symptoms of a peroneal tendon injury can include swelling, pain, warmth, weakness and instability of the foot and ankle. Subluxation can also include a snapping feeling and sporadic pain with activity.

 Treatment of peroneal tendon injuries is often delayed by misdiagnosis. If you are experiencing any of the symptoms of a peroneal injury, seek medical attention from a foot and ankle surgeon urgently. The longer the tendons go untreated, the more damage occurs. X-rays and physical examination usually lead to an MRI to solidify the diagnosis. My patient’s MRI showed a severe rupture of peroneus brevis with a bulbous scar tissue formation which you can see in the below picture. Peroneus longus was normal.

Treatment include rest, casting, functional orthotics, anti-inflammatory medication or injection therapy, physical therapy, bracing, and in some cases surgery. Obviously, my patient needed a repair. We excised the torn and hypertrophied part of the tendon, then repaired the rest and fixed her ligaments so she would stop being so unstable and finally lose her “cankle”. Here is the piece of abnormal tendon we excised. Wow! Big chunk!!

Your disability from a peroneal tendon injury can be significantly reduced by early intervention, so if you are experiencing any of these symptoms, call or contact the office and be evaluated. The sooner you have a proper diagnosis, the faster you will return to normal activity levels pain-free. If my patient had come in earlier to have her “ankle sprain” evaluated, conservative therapy might have healed her tendon injury!

Winter has decided to visit North Texas today. Two inches of ice covered by snow, and just in time for the Super Bowl. Time to think about trying to prevent slip and fall injuries. Lots of people fall on ice and snow every year-without serious injury. Not so fortunate were some 16,000 Americans who die each year from falls, according to the National Safety Council (NSC).

I wonder how many of them were runners? I watched from my window this morning as one of my crazy neighbors fell running on the sidewalk in front of my house. The snow had not even stopped coming down yet! Crazy! Even I ran on the treadmill this morning, and most of my peeps will tell you: I Hate Treadmill Running! Better the treadmill than the emergency room!

Falls rival poisoning as the number one home accident in the U.S. The number of injuries or deaths from falls due to winter conditions is not recorded by the NSC. But, safety experts agree that many injuries result from falls on ice-covered surfaces.

Safety Tips

It's important that individuals recognize the hazards of slippery surfaces. Here are helpful hints from winter-safety experts that will reduce the risk of falling when slippery conditions exist:

Wear boots or overshoes with soles. Avoid walking in shoes that have smooth surfaces, which increase the risk of slipping. Trail running shoes are better than your regular road shoes.

Run or walk consciously. Be alert to the possibility that you could quickly slip on an unseen patch of ice. Avoid the temptation to run quickly. Run in high alert!

Run or walk cautiously. Your arms help keep you balanced, so keep hands out of pockets and avoid carrying anything that may cause you to become off balance. This even means leaving your precious water bottle at home.

Run or walk "small." Practice your "Chi" running and throw your center of gravity forward. Avoid an erect, marching posture. Look to see ahead of where you step.

When you step on icy areas, take short, shuffling steps, curl your toes under and run or walk as flatfooted as possible.

Run where the path has been cleared. Even in your own yard, remove snow immediately before it becomes packed or turns to ice. Keep your porch stoops, steps, walks and driveways free of ice by frequently applying ice melter granules. This is the best way to prevent formation of dangerous ice patches. Don't be stupid like my neighbor and try to run while snow is still flying!

Falling Safely

Even when you practice safe running and walking habits, slipping on ice is sometimes unavoidable. It takes, on average, less than two seconds from the moment you slip until you hit the ground. That's precious little time to react. In that instant, the risk is an injury to your head, a wrist, hip, ankle or shoulder.

When falling, it is best to use a tuck-and-roll principle. It's important to tuck your body, lift your head and avoid trying to break the fall with a hand, which can cause a wrist injury. Ask Dr Karpati about her broken wrist from skiing the next time you are in the office. The idea is to make yourself as small as possible by rolling up into a ball.

People in North Texas hardly ever think about falling on ice and snow, but serious injuries can occur. If you are a klutz or are planning to spend a lot of time in the cold; following these guidelines may help protect you from serious injury this winter. If it is not a choice to hit the treadmill, practice caution while running in the snow and ice. If you do happen to fall and sprain your ankle or foot, call the office. Help is just a phone call away! And remember, just because you can walk on it doesn’t mean it is not broken.

Run Happy and Be Careful! Don't Be a Statistic!

I normally do not comment on football in my blog, but I have been asked this question so many times this week that it is comment worthy. For the record, even though I have allegiance to the New England Patriots and the Cowboys, I have always been a Brett Farve fan. He is the epitome of the endurance athlete as a football player, just like Cal Ripken was an example of the ever present endurance baseball player. (Yes, I love Cal too!) That aside, I think Brett is crazy to play tomorrow!

Why? First, he has two fractures in his foot and ankle. A stress fracture in his ankle and an avulsion fracture of his calcaneus (the heel bone). His ankle is already a disaster in which he has had at least 5 surgeries that we know of and has significant degenerative arthritis! Why make it worse? The season is a disaster and the Vikings are losing confidence in him. If he can’t move tomorrow, he is either going to get seriously hurt or get pulled by the coach. Why not sit voluntarily?

On the flip side, he probably needs an ankle replacement already. He could numb up his ankle, play, then risk crushing whatever cartilage was left. Stupid! And a bad example to younger football players. Face it: the season should be over and he should call it a career. (Which he should’ve done at the end of last season anyway!

Brett, don’t play. You risk hurting yourself more or at the very least looking more stupid that your antics have been in the last two years!

I was almost apoplectic! Injected his tendon or even around his tendon?! In my world, that’s almost borderline malpractice; but I can’t fault the physician, she obviously didn’t know any better and was trying to treat the patient. Bottom line: Go to a sports medicine physician. We would all tell you the same thing: injecting the Achilles tendon can lead to spontaneous rupture which would basically end his running days. Look at poor Dan Marino…a ruptured Achilles tendon ended his Hall of Fame career!

Let’s talk about Achilles tendon injuries. They are very common especially in runners with high arched feet or very flat feet. Both of these foot types put way too much torque on the tendon and will cause a wear and tear tendonitis that eventually becomes tendonosis without proper treatment.

Tendonitis results from overuse. Long-standing tendonitis becomes tendonosis (degeneration of the tendon) which is much harder to treat. This overuse can happen over a period of time or can happen over a weekend.  Those of you who exercise regularly or are in training for an athletic event, as strong as the Achilles tendon is, this work horse could use a break every once in a while!  With chronic, long term, sustained use, this tendon becomes strained.  It also can become just as strained with whom we fondly refer to as the “weekend warriors”.  You know who you are!  You are the ones who think it perfectly o.k. to hike the Appalachian Trail or take the steep way down the Grand Canyon over a three day weekend because “it was there”! Marathon runners who decide they can run the Western States 100 without the proper training….you can't hide for long....I will find you....

The simplest form of treatment can involve rest, heel lifts, icing, inserts, night splints, custom orthotics and anti-inflammatories.  More complex forms Achilles tendonitis can include immobilization through a boot or cast, physical therapy, and in the most resistant cases, surgery. Active release myofascial release is very helpful. Thank God for David Bloom at Restoration Physical Therapy and Dr. Darryl Laney at Laney Chiropractic in Keller! Most of my long-standing Achilles tendon injuries are successfully treated with aggressive PT and manipulation on top of orthotic control. The longer you have it, the worse it gets.  Do not let it get that far. Tendonosis is a chronic degeneration that can lead to splitting of the tendon and long term disability!

Thinking of waiting to see if it works itself out or are trying to work through the pain?  Let us help you reconsider. Chronic Achilles tendonitis (tendonosis) results in degeneration and breakdown within the tendon and this, in turn, can lead to a partial tear or full rupture.  Now that will put you out for more than a couple months!    If you are experiencing a nagging pain or swelling to the Achilles tendon or the back of the heel, call or contact the office to have it evaluated.  It is that simple!

Spring is in the air in North Texas. The brief snows are gone and recreational sports are starting their schedules. The soccer, baseball and lacrosse leagues are having their first games; the high-school track team is gearing up for competition, and The Leukemia Society’s Team-in-Training groups are just starting to increase their mileage aiming for an early summer marathon finish. Spring is in the air, and our old friend the ankle sprain is starting to show up more frequently in the office. Basketball and volleyball seasons are always the main producer of this injury; but you would probably be surprised how many ankle sprains occur in outdoor sports like soccer, baseball, lacrosse and of course track and field. Ankle sprains have been reported to be approximately 20% of all sports injuries with more than 25,000 occurring every day in the United States.

Uneven, wet fields coupled with early season fatigue and competitive full-contact intensity equal injuries. The ankle is the joint that compensates for uneven surfaces. 85% of ankle injuries are sprains, which are caused by a failure to compensate for this uneven footing. Jumping, cutting, and pivoting put the ankle at risk. Many athletes put themselves at further risk by not rehabilitating these injuries properly, returning to sport too early, and giving themselves an inadequate adaptive ability to uneven surfaces or sudden twisting. The use of narrow cleats with minimal arch support or the use of running shoes for a court sport can also place an athlete at risk for ankle sprains.

Ankle sprains occur in runners mainly because they are chatting away as they are on a long run and are simply not paying attention. How many runners have you seen fall off the curb or in a pothole while running? Lots…Pay attention to where you are going and you can prevent this type of injury. If you know you are a klutz, run on an even surface, like a track, when you are tired or distracted.

If you have an ankle sprain, you should be evaluated by a sports medicine podiatric foot and ankle surgeon if you have localized pain, swelling and bruising, as well as inability to walk more than 5-7 steps comfortably. Many a foot fracture has been missed in the emergency room when x-rays were taken only of the ankle and not the foot. The fifth metatarsal is often broken with the same mechanism of injury of an ankle sprain, so the foot should be evaluated as well. If severe ligament injury is suspected, an MRI can evaluate the grade of injury. This is really what decides whether surgery is needed for full recovery.

Treatment for ankle sprains really depends on the degree of severity, which can only be determined by your doctor. Initial treatment always includes “R-I-C-E” therapy – Rest, Ice, Compression, and Elevation. Pain and edema is usually controlled with NSAID’s (non-steroidal anti-inflammatories) like ibuprofen. Bracing or casting coupled with non-weightbearing on crutches may be needed in more severe injuries to rest and stabilize the ankle while it heals. Return to pain-free range of motion (ROM) and stability is the goal. Surgery is only recommended in Grade 3 severe injuries in athletes or in those patients who have had multiple ankle sprains and suffer from chronic ankle instability. Long-term ankle instability can often be avoided with an aggressive physical therapy program. Bracing should only be used in the short-term during rehabilitation because long-term bracing actually causes atrophy and decreased ROM.

Physical therapy is needed for all ankle sprains. The goals of physical therapy should be to regain full ROM, strength and proprioception (where your brain thinks your ankle is in space). Regaining strength in the peroneal tendons as well as overall balance training are the keys to successful rehabilitation of an ankle sprain. A maintenance program of ankle strengthening, stretching, and proprioception exercises helps to decrease the risk of future ankle sprains, particularly in individuals with a history of multiple ankle sprains or of chronic instability.

Bottom line: if you happen to fall down and go “Boom”, have your ankle sprain evaluated by a podiatric foot and ankle surgeon. Delaying treatment and rehabilitation can lead to life-long instability.

For more information on ankle sprains, go to our home page and click on "All About Feet".