Peroneale Tendonitis en Enkelskade: Uitgebreide Feitenkontrole

(crashing) - This is Tom Biernacki. And do you have a peroneal tendon problem?

That's this muscle on the outside of your ankle. If you have outside of the ankle pain, I'm gonna show you how to solve that pain

as soon as possible with stretches, exercises, shoes, braces, all the equipment you need at home right now. (light music)

Guys, thank you so much for watching our video on peroneal tendonitis. Give us a like, tell us how you injured yours.

It really helps in the YouTube algorithm. We need your help. This is your fibula along the outside of your foot. It's a thinner bone that helps make up

your ankle joint in your lower leg. That's the blue bar here. Up here is the muscle belly for your peroneus longus.

So this is the longus and the tendon comes down around the outside of the fibula. This is the peroneus brevis.

So together the peroneus brevis and the peroneus longus make two tendons that run together. Your peroneus brevis connects to the outside,

which is your fifth metatarsal right here. And your peroneus longus comes down around the middle of your foot and inserts underneath.

So if I come down, underneath all these muscle layers, you could see it actually connects down to this area right here.

So it connects into the bottom of your fifth metatarsal. You could see how much muscle. Look at that. That's all the muscle it's hiding underneath.

It's a lot of stuff underneath there. It's a complicated tendon. Not only is it hard to pronounce,

but it comes down underneath. Whereas right here, your fifth metatarsal is where the parent brevis inserts.

Your peroneal tendons function to turn your foot out. So taking a look here as they insert into your fifth metatarsal,

what happens is they turn out when they flex. So when the muscle belly shorten, they turn out. So the short one especially

works only on turning your foot out, whereas the longus comes down underneath the side of your foot

and into the bottom of your foot. So it turns your foot out and down at the same time. So that's external rotation and plantar flexion.

So longus turns it out and down, whereas the brevis just turns it out. So together they push your big toe down into the ground

and turn your foot out. What this specifically does, yeah, so you can look at the longus here,

it's turning your big toe down and stabilizing it outward. It's kind of a confusing function because what it really does is it stabilizes your foot.

The way you wanna feel this is, if up here is sore, first, what you want to do is back here. If this area is sore, then you probably

have a peroneal tendon problem. But if up here is sore, you have a peroneus longus problem. If down here is sore, you have a peroneus brevis problem.

If you can't turn out, so if I hold this and I can't turn out, that means it could be both of them.

But if I have a hard time pushing down with my big toe and out, it's probably just the longus. The peroneal tendon is on the outside of your ankle,

right here, you can see with this elastic. It hurts when your foot turns in and your foot spasms out when it's aching.

There are four major types of peroneal tendon injury. There is tendonitis, which means inflammation, irritation.

That means your muscle and your tendon are working too hard. Even doing all the right stuff, it can take two, sometimes four, sometimes six,

there you go, six weeks to get better. Even doing all this great stuff in this video. So don't get discouraged, these are tough problems

because you're walking on your feet the whole time. If this peroneal tendon has been hurting you for six months or more,

you might have something called tendinosis. This means long-term tearing and scar tissue within the muscle belly.

That can take even longer. We're talking two, three, sometimes up to six months of doing all the right stuff.

With the foot it's a little bit different than other parts of the body, because the problem is you're putting all your body weight

on this muscle right here, 10,000 times a day. If you're a factory worker, if you're a nurse, if you're going to school, if you're a teacher at school,

if you're somebody who's on your feet the whole time, you have to do all the stuff we talk about here. So we're talking stretches, massages, exercises.

We're talking good shoes, good braces, icing, potentially even stuff like the Cryosphere. But this stuff, the more you do, the more it'll help,

the faster it will get better, but it's never gonna be in one day or so. See this right here?

When I let go, see how it can snap forward? The peroneal tendon can actually dislocate. If you hear popping or snapping, so see this right here,

we've got a pop. See that popping right there? That popping, if you hear clicking in your tendon,

and if you feel across here and you can feel the tendon kind of popping out like this, you can see it's busting.

That's a subluxing peroneal tendon. A subluxing peroneal tendon can take a little while to get better.

This might need surgery. That means this ligament, actually right here, see where I have this tape?

That's your peroneal retinaculum. If that ruptures, right there, look at how these pop out. It's not quite that much in your ankle,

but that might be a surgery. So sometimes I see people with this injury long-term, and they should go see a podiatrist

or their foot and ankle orthopedic surgeon to go get checked out. It's also possible for this ligament

if I cut it like a tear. Most tears are vertical, in line with the tendon, but it could also go across this way.

If it's across that way, it might need surgery. It's very, very rare. Like, I mean, I can't even remember

the last time I saw one like that, and I see hundreds, if not thousands and thousands, of these injuries.

You know, we see a lot, and it's almost never a complete transverse tear, unless you're really messed up.

Like I'm talking car accident or like 80-year-old with crippled arthritis and more. One great exercise I recommend is a massage roller.

Oh yeah, I can feel that on both peroneal tendons. So up here is the peroneus longus, right there is the peroneus brevis.

Also, right here you have a nerve that runs over the skin to both of these. This is called your sural nerve.

So your sural nerve could also be injured. If injured and damaged in an ankle sprain, this could take three months to get all the way better.

So that could take three months. Ice works great. Freeze an ice bottle and use it

to get the inflammation down in the bottom of your foot. You can rub it along the outside of your ankle, your peroneal tendons.

I'm not showing the peroneal tendons in this video. This is my plantar fascia icing video, but the same concept applies.

Just lay on your side, roll across it. You could use the ice as a frozen bag of peas and then use a massage roller

on the outside of your peroneal tendons. Kind of how I showed you in the video right before this, but ice takes the inflammation down

and then massage takes it down even further and loosens up the muscle. That won't cure it itself, but it works better than heat.

Don't use heat. That's a heat bag right there. Toss this guy away, stick with ice, especially after you injure the peroneal tendon.

So there's also stuff like this called a Cryosphere. So there's a lot of great products around here. It's really good for the upper body.

A lot of professional athletes use stuff like this. Something like this might be a little bit better for the calf muscle, the peroneal tendon.

It doesn't work as great for your plantar fascia at the bottom of the foot. But you could see, on your leg muscles,

this can roll across these areas like your plantar fascia and the inside of your ankle, but see you can't set it down.

You gotta hold it with your hands. That can work really great. But as I mentioned, it can pinch your skin.

So for phase one, controlling the inflammation, my two favorite things, an ice ball, or just a bottle of ice,

massage that peroneal tendon. These things are linked down in the show notes. We're talking a couple bucks.

This is like a $7 massage roller. You don't need to spend a lot of money. But, the plantar fascia, the peroneal tendons, loosen it up.

We're gonna show you how to actually stretch out these muscles later, once the inflammation is gone,

cause the real key is to stretch it out. That's how you really keep it away because inflammation control will only let you

cause more problems as you feel better. Fix it permanently. So the first thing you wanna do,

and I'm a huge fan of that, get a great shoe. You want a stiff heel. So see if I can't move the heel,

I'm trying to really push it down, that's a good heel. What's a bad heel? Right here. See how this isn't supporting?

See how flexible it is? That's giving you no support, even though these, on the surface, both look like running shoes.

Look at, this one's very supportive in the back and I can't bend it in the middle. And also it has an orthotic.

What does an orthotic do? An orthotic, right here, look at when I push down, it keeps the ankle nice and stable.

This is me pushing as hard as I can down. But watch this, if I push down on my hand, it just bends out.

See that? That bends and makes the tendon unstable. But with an orthotic, you don't have to worry about that.

Whereas without it, you have a lot more bend and that peroneal tendon has to work harder. But check out the show notes.

We show you great low-cost, budget, but still effective, over the counter orthotics. You don't have to get a $500 custom orthotic

unless you really have a lot of problems. So the way to fix that is a great orthotic. So you can see right here,

my foot can't twist in or out quite as much with the arch. So it doesn't twist one way or another. Whereas without the insert,

they can really twist a whole lot more easily. So if I put that there, it's a pretty easy twist. You know what else works great? Ankle braces.

I love ankle braces. They really keep that ankle stable. I'm a big, big fan of ankle braces and they do a really nice job.

They're low cost, they're like 20, $30 online. So get yourself an ankle brace, an ankle brace. So if you have severe tendonitis, a lace-up ankle brace.

Number one, compression braces are pretty good. And number two, stability braces are pretty good. Number three, if you have a tear, you have to be in a boot.

If the ankle brace isn't working, sometimes you need a hard cast. Sometimes you need a walking boot.

Personally, if you're having a lot of pain, I recommend the hard cast. If you come see me in the office,

a lot of times with the hard cast, we can stretch out any tightness, any scar tissue, while you're healing.

A boot can't really do that type of stretching. But a boot is removable. You can shower. You don't have to wear it to bed.

You don't have to wear it while you're watching a movie. So it does have some benefits. This may even need surgery.

How long does it take to heal peroneal tendonitis? I would say on average with good brace and good shoes, good orthotics, 50% improvement in six weeks

is a ballpark. One way to tell how swollen your peroneal tendons are is your flexibility.

So generally the one that's more sore, so you can see the right side here is more tight. You can't bend up because the peroneal tendons hurt more.

So the right side in this case, look at the left side stretches up, but right here the peroneal tendons are sore,

they're spasming, you can't turn it back quite as much. That's called ankle joint equinus, stretch it out. The best exercises for peroneal tendonitis are

to work on soreness throughout your entire body. So the first thing is loosening up your glutes and your hips because when those are functioning better and less sore,

it takes pressure off your peroneal tendons. This can take months to get better. And then use the massage roller stick,

get the actual calf muscle, the peroneal tendons. And we're talking like 30 to 60 seconds in the morning.

Don't go crazy doing like a one hour yoga routine every day. But 30 seconds, get those perennial tendons get the plantar fascia,

these are all tight sore joints that you can loosen up and tight sore ligaments that will make the peroneal tendons work less hard.

So in the morning, just stretch out and massage out your ankles, rotate them, massage them, 30 to 60 seconds.

And then, after you warm them up and massage them with the massage roller sticks, stretch the ankles a little bit.

If the ankles are flexible and the calf is flexible, the peroneal tendons don't have to spasm as hard to compensate for these other muscles

that are not working as well. This is the counterintuitive trick. Make sure your entire foot is symmetrical and flexible.

Another great way to do it, a towel. Get your feet up. This will feel the stretch through your peroneals, through your calf muscles.

If you understand the anatomy, you can see that these work great. So loosen up your hamstrings, your groin,

the inside of your thighs, so your foot's not rotating when you walk. And you know if you're doing this,

you can tell your feet are rotating out. So this is like 10 to 15 bucks for this half-moon shaped device.

It's down in the show notes if you want to take a look at it. But I prefer doing both at once.

An ankle slant board. This thing is amazing. It works really well and it stretches both feet At the same time.

I always do the early massage routine. And then I stretch both feet while I'm drinking my coffee or brushing my teeth or doing whatever in the morning.

This is a quick efficient habit that doesn't take a lot of time and you can work your way up the levels

and gradually get more and more and more of a stretch. That's the real key, an easy, quick routine. When you're doing this, put the insoles in there,

put the right shoes on. This will force it more through your peroneal tendons and your calf muscle,

rather than just bruising up your foot. That's really the secret in this case, you know, orthotics, great shoes to prevent the damage from happening,

and then massaging and stretching both feet at the same time. You do a couple minutes a day.

You're getting healthier, your legs are getting stronger. It's not about doing one-hour yoga sessions. It's about targeting the sore, weak muscles

and making sure they're not overloaded. And this works great. All three of these devices work. Guys, thank you so much for watching

our video on peroneal tendonitis. Give us a like, tell us how you injured yours. It really helps in the YouTube algorithm. We need your help.