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2814 Views 4 Replies Latest reply: Jan 19, 2013 8:53 PM by QincyNL RSS
roksraka Rookie 1 posts since
Jun 21, 2012
Currently Being Moderated

Jun 21, 2012 2:10 AM

Pain on the side of the foot... peroneal tendenitis?

Hello everybody...

 

so, in the last few days i have been experiencing pain in my right foot, on the outer edge of the foot (about an inch lower and further in front from that bone that sticks out of the ankle). it started out a few days ago, but it only lasted about half an hour and than went away. yesterday it got worse, and now i feel it everytime i walk or run. it doesn't hurt when i step on it, but rather when i push of the leg. it also hurts slightly if i apply pressure to it... it does not restrict my motion in any way, it just hurts. i haven't had any injuries in months, especially not ankle/foot injuries.

 

the pain first occoured during running. i jog about 4 times per week for the past 6 weeks (anywhere between 3 and 7 miles, increasing the milage every week, training for my first marathon in september), and occasionally i go cycling (once a week or so...). i don't do any other sports at the moment (i gave up karate 4 months ago). it doesn't matter if i wear shoes and walk around barefoor, the pain will be the same.

 

after some research, i concluded that stress fracture or an injury of peroneal tendent are most likely. my running shoes are mizuno wave nexus 6. i heard shoes with much support can be problematic as well. i don't have experience with similar injuries. If anyone had any similar problems, please share how do i cure it? should i give up running for a few weeks? any sort of feedback is appreciated ˆˆ

 

(and sorry for my bad english)

 

Rok

  • Jasko123 Legend 461 posts since
    Apr 18, 2011
    Currently Being Moderated
    1. Jun 24, 2012 1:55 PM (in response to roksraka)
    Pain on the side of the foot... peroneal tendenitis?

    Hi Rok,

     

    It is important to get a professional evaluation from someone specializing in sports medicine.  I would discontinue the longer runs until you have a clear picture of what is causing the pain in your right foot.  Also, it is important to mention to the doctor your history with the martial arts because they are known to cause tendon, ligament, bone and nerve damage.  Of course the stress of running magnifies any older injuries and/or produces a combination of influences that expose weaker areas of the body. 

     

    In the meantime, you could try arch supports, wrapping and the RICE method.  (Look for the recovery wrap that also provides mid/foot with heel support and ankle protection)  Topical anti-inflammatories might also be of assistance.  In addition, get new shoes and consider custom orthos if those are recommended.  Your current shoes may be fine, but you do not want to place pressure on the same areas over and over, so you need to have several pairs to alternate out for training. 

     

    Hope you are feeling better soon and best wishes.

  • JamesJohnsonLMT Legend 1,153 posts since
    Aug 23, 2009

    I laugh whenever I hear the term "stress fracture," because they are frequently misdiagnosed when there is no other ready explanation for pain felt on contact. I also feel the term "tendinitis" is overused for the same reason. The fact that most medical professionals refuse to acknowledge the role muscles play in the generation and perception of pain exacerbates this problem. Even in the case when a diagnosed stress fracture is "confirmed" by MRI or x-ray, the lesions seen on bone can be and often are produced by strained muscular attachments to the periosteum.

    https://upload.wikimedia.org/wikipedia/commons/8/8b/Gray441.png

    Note the location of the Extensor Digitorum Brevis muscle in the above drawing from Gray's Anatomy, courtesy of Wikipedia. Partly occluded by ligaments in the diagram, the EDB muscle produces a noticeable bulge in experienced runners near the location you mention when the toes are dorsiflexed. Restrictive footwear can be hard on this muscle, which potentially fights the toebox with every stride. I''ve strained mine, and felt severe pain on palpation in the same location you describe.

     

    If you want to locate a real fracture, grab the bone on either side of the suspected break and flex it slightly. If flexing the bone does not produce pain without pinching the potential muscular source, and standing on your toes does not produce pain, and the motion of running produces the pain not from impact, but from the tiring of this muscle, a potential fracture becomes less relevant. A true stress fracture is not the same as a simple fracture through all layers of bone. A fissure or lesion on the bone, even if it were to exist, does not mean the whole bone will crack in two on impact. Your bones are much more complex than a piece of china, composed of many layers and convolutions of partly mineralized and collagen-reinforced tissue. Respect it, sure, but be aware of the many other sensitive tissues over, under, and between these bones, called muscles. Respect those, too.

     

    Regarding tendinitis, a frequently diagnosed injury is the peroneal tendinitis seen where the tendon sheath wraps underneath the lateral malleolus knob of the ankle. You can see the Peroneus (Fibularis) Longus and Brevis tendon sheaths in the drawing. The important point to know, even if there is tendinitis here, is that PT is a symptom of another problem you may need to correct by other means. These muscles are pronators, subject to overuse syndromes if you are an over-pronator. Please have your running form checked on a treadmill for this common problem. If you are not an over-pronator, explanations of PT become weak. If the bone is also ok, the muscle becomes your prime suspect by elimination.

     

    Jasko's advice to switch out shoes is very important, since the EDB muscle can be pinched by the uppers of many shoes even when the toebox does not interfere with its natural movement.

  • mpopovic Rookie 1 posts since
    Sep 5, 2012
    Currently Being Moderated
    3. Sep 5, 2012 12:48 AM (in response to roksraka)
    Pain on the side of the foot... peroneal tendenitis?

    Hi,

    i have exactly the same problem last month after i bought mizuno wave nexus 6. I have switched to different shoes (and reduced running for about 50%) and problems went away. Of course, I can't promise you that this will fix your problem but this is the first case with the same problems with mizune wave nexus 6 i have found.

    I know it has been several months so if you have found the solution please share it

    Regards,

    Marko

  • QincyNL Amateur 10 posts since
    Aug 31, 2009
    Currently Being Moderated
    4. Jan 19, 2013 8:53 PM (in response to roksraka)
    Pain on the side of the foot... peroneal tendenitis?

    I must say James has some great replies on this forum... keep up the good work.

     

    Here another peroneal tendonitis reference video http://www.youtube.com/watch?v=aNTepYqubM0

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