Therapy for tendonitis of the ankle and recovery times
Most tendinitis heals with rest, physical therapy, and medication without the need for surgery.
This is possible because this injury was caused by overexertion and can therefore heal with immobilization.
If the pain is very severe, a support bandage should be put on for a few weeks.
If there is no stiffness when walking, an ankle brace could be of benefit.
Patients should avoid long periods of standing and walking until the pain subsides.
This usually takes a few weeks. The resumption of activities must be very slow and dependent on the pain sensation.
If the patient has a tendency to rotate the heel into varus, an insole can help tilt the ankle to the opposite side, relieving stress on the peroneal tendons.
A discussion with the doctor is important and helps to correct the training behavior, for example by recommending the use of new running shoes.
Physical therapy is also very important.
In the case of an ankle sprain, for example, it can be used to strengthen the
tendons are used. Platelet-rich plasma (PRP) injections to stimulate healing processes
have attracted much interest recently . There are currently no studies demonstrating the benefits of such treatment for the peroneal tendons. Cortisone injections are more likely to be avoided because they can weaken the tendon. Surgical intervention should only be considered if the pain does not improve with conservative treatment methods. These can last up to a year before surgery is considered. If there is a lesion or fissure, ie a tear running down the length of the tendon, surgery to clean or repair the tendon may be considered.
In some cases, the groove that the tendons pass through can be deepened at the back of the fibula, giving the tendons more room.
With advanced degeneration of the tendon, it may ultimately be necessary to cut the tendon and unite the short and long fibula muscles.
Usually only one of the two peroneal tendons is affected, but on rare occasions both are injured.
Conservative treatment for tendonitis
Tendonitis of the peroneal tendons in the absence of significant damage can be successfully treated without surgery. Treatment aims to relieve pressure on the peroneal tendons and then control the inflammation.
Conservative treatment includes :
- anti-inflammatory drugs to relieve tendinitis;
- use of a brace or ankle brace to reduce inversion motion;
- Avoiding symptom-aggravating activities for a few weeks to allow inflammation to subside;
- Use of physical therapy measures (e.g. laser therapy and ultrasound ) and physiotherapy to relieve inflammation and strengthen the ankle;
- Avoid jerky and rapid movements that would reload the peroneal tendons, allowing the inflammation to subside. This includes straddling movements and changes of direction;
- Use of insoles in which the area under the head of the first metatarsal is lowered. In the case of a pes cavus, such an insole can completely or completely correct the position of the rear foot. Intuitively, one assumes that a pes cavus should be supported by an insole with a high arch. In reality, however, such a high arch is not recommended because it tends to rotate the foot inwards (supination) and puts more stress on external structures such as the peroneal tendons.
- Apply cold compresses to the affected area for 10-20 minutes at a time to relieve acute symptoms.
Kinesio Taping for Sprain, Swelling of the Foot and Ankle: Action: Drainage. Shape: Two Stripes Fan. Length: 25cm. Apply the strips so as to form a double fan-shaped cross section on the ankle. Place in the stretch of the ankle and apply without tension.
Surgical treatment for tendonitis
Surgical intervention can provide relief when there is a severe lesion of the peroneal tendons or a bony prominence that irritates the tendons; this may be a protruding peroneal tubercle or a bony spur at the back of the fibula. Surgery consists of cleaning the tendons (debridement) or synovectomy to repair major tendon damage.
A tear (rupture) of the peroneal tendons is common. If the longitudinal tear covers less than 50% of the tendon, the torn portion of the tendon is removed. If it is larger, the tendon is cleaned and the affected tendon is sewn up with other tendons.
Recovery in tendonitis
Normally, the state of health is fully restored. However, this can take a long time. One must not be impatient and must give the tendon time to heal before resuming activities.
Complete immobilization is necessary after a surgical procedure.
Typically, patients are not allowed to put their foot down for about 6 weeks.
Once the surgeon prescribes physical therapy and rehabilitation, an exercise program must be started to regain mobility, strength, and balance.
Treatment outcome in tendonitis
The end result is usually good. Still, healing is sometimes extremely difficult and takes more time when patients have to resume activities. If chronic damage develops, tendon thickening forms, which does not give hope for good prospects.
Complications of tendonitis
Without a visit to the physiotherapist, tendinosis can become chronic and the risk of a tendon rupture increases. The weakened tendons can also lead to sprained ankles.
There is a risk of infection during a surgical procedure.
The sural nerve runs along the outside of the leg and takes over the sensitive supply of the foot.
Overstretching or straining this nerve can cause serious symptoms, such as loss of sensation and muscle paralysis of the foot.
- Tendinitis of the peroneal tendons
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