How to prevent peroneal tendonitis?

[Karoliina]

I apologize in advance for the novel I'm going to write about my history with peroneal tendonitis.

I've been running BF/minimalist for about two and a half years now on and off, mostly summers on and winters off. This is the first winter when I haven't taken a break from running. I first experienced pain behind my right lateral malleolus in the summer of 2010, after a few months of running in VFFs. I self-diagnosed it as peroneal tendonitis and have since switched to running BF in the summer. Now I'm running in VFFs again until the snow melts.

This injury initially went away with rest, and last summer I went back to running BF and built up slowly to about 30 km/week, without the leg bothering me. But now it's back. I think my form has been slowly getting better throughout the time I've ran BF and is now pretty good.

I didn't run at all in December, but then picked it up again and have slowly increased my weekly distance. Two weeks ago I hit an all-time high of 44 km, including my longest run ever (16.6 km). The familiar twinge had been slowly coming back for about a week or so, but as it didn't really hurt, I ignored it. Stupidly. After that week the pain was back, and now I've done the usual rest/ice/ibuprofen for a week and it's almost healed now. I'll try to go for a short run tomorrow and see how I feel.

How can I prevent this from happening again? Is it really a form issue, or am I just too fragile to increase my distance at this rate, even though I don't think I've increased it very fast? I've used a wobble board quite frequently for a few months now and will continue doing so, in addition to some other exercises and stretches I've found online. Is there anything else I should do? I have my first half marathon coming up in exactly two months and I really want to be able to train for it injury free.

 

[Barefoot Dama]

I will stay away from the pain pills and instead massage the sore area, sumerge the lower legs in a bucket of icy water for 15/20 mins but it is very important that you don't iced longer than 20 mins and lastly use compression after you runs.
Good luck.

 

[Karoliina]

I will stay away from the pain pills and instead massage the sore area, sumerge the lower legs in a bucket of icy water for 15/20 mins but it is very important that you don't iced longer than 20 mins and lastly use compression after you runs.
Good luck.

Thanks for the advice, I'll be sure to keep icing it. Why not take ibuprofen though? From what I've understood, it's recommended for this type of injury because it's anti-inflammatory and not because of its pain-relieving effect. This has never been painful enough for me to really need pain killers...

 

[Barefoot Dama]

As I understand anti-inflamatories prevent the body from healing itself.
Not only that they are not good for your liver and you should be very careful when you engage in vigorous exercise as they also raise your heart rate.

 

[migangelo]

inflammation means increased blood flow which means increased healing. i was taking A LOT of nsaids the other week and hurt my calf. for your tendonitis i'm wondering if you're over striding. see if you can get someone to video tape you running and see how your feet are landing. they should land 90 degree or greater, not less. less than 90 means braking and if your landing forefoot too far in front it would place a lot of stress on your metatarsals.

and i bet you thought the switch would be easy right? me too.

 

[peacekaren]

I ended up with peroneal tendonitis after doing TMTS my first 2 weeks in VFFs. I found doing these rehab exercises very helpful in my recovery.
http://www.summitmedicalgroup.com/library/sports_health/peroneal_tendon_strain_exercises/
I still do those exercises (especially the wobble board) on an occasional basis, especially any time I feel any tightness in my feet and ankles.

I also found that switching to completely BF (no more VFFs) made all the difference for me. As I was healing from the tendonitis I would do fine BFR but throw in any VFF running or activity and I'd start to notice that ankle again. I quit running in the VFFs and switched to 100% BFR.

My one bout with PT was 2.5 years ago. It took about 3 months for it to completely heal and I haven't had a problem with it since.

Good luck!

Peace,
Karen

 

[Karoliina]

Thanks for the replies everyone. I'll stop taking ibuprofen now and see if there's any difference in healing.

migangelo, I do consider myself fully transitioned to BF so I don't really know what you mean. Last summer I could comfortably do 10+ km runs barefoot. I've videotaped myself and checked my form in the mirror when I'm on the treadmill at the gym, and I really don't think I'm overstriding... What does it mean to "land 90 degree or greater"?

peacekaren, believe me, I would run BF all the time if I could... But in this climate it's impossible as I don't want to spend the whole winter on a treadmill. Maybe this won't bother me anymore in a month or so, when I can run BF outside again? I hope so. Those exercises definitely seem helpful!

 

[migangelo]

it's the relation of your shin to your foot. 90 being straight shin with your foot landing under you so if you go past 90 your knee is bent with you foot under you. less than 90 is over striding which can be a breaking motion.

i'd like to be video taped sometime. i know my left foot lands awkward because of how my shin feels afterwards.

 

[NickW]

Mike all you gotta do is ask. I have an HD video recorder thing thats kinda like a flip video. It's water proof so remind me on our next run and I'll bring it.

 

[jldeleon]

it's the relation of your shin to your foot. 90 being straight shin with your foot landing under you so if you go past 90 your knee is bent with you foot under you. less than 90 is over striding which can be a breaking motion.

i'd like to be video taped sometime. i know my left foot lands awkward because of how my shin feels afterwards.

Come to the next Minimalist Monday that you are able to, and Sanatan will video tape you. You have spring break coming up soon, right? Maybe you could do it then.

 

[jldeleon]

it's the relation of your shin to your foot. 90 being straight shin with your foot landing under you so if you go past 90 your knee is bent with you foot under you. less than 90 is over striding which can be a breaking motion.

i'd like to be video taped sometime. i know my left foot lands awkward because of how my shin feels afterwards.

That's cuz of your over-pronated foot. BTW, since I have been doing arch exercises (for my overpronated foot -also the left one) and I have noticed many significant positive changes on that side in my foot/ankle/calf/knee/thigh/hip -and my foot strike is very good now compared to what it was on that side.

 

[jldeleon]

I agree about the pain killer/anti-inflammatory thing completely. Makes you way more prone to further injury since you can't feel what's really going on. Also, I notice an immediate negative difference when I wear my VFFs, even if it's just for walking around -heel pain, calf pain, toe numbness, just weird stuff. I would walk/run/lope around in sandals if you are able to, instead of VFFs.

 

[Karoliina]

Also, I notice an immediate negative difference when I wear my VFFs, even if it's just for walking around -heel pain, calf pain, toe numbness, just weird stuff. I would walk/run/lope around in sandals if you are able to, instead of VFFs.

Yeah, I wouldn't wear the VFFs if I could avoid it... But I'm too much of a sissy to wear sandals in the snow. Or go barefoot in this weather. I do spend most of my time indoors fully barefoot, and I've only worn VivoBarefoot Neos as my day-to-day shoes for more than six months now.

I bought some kinesio tape and looked up instructions on YouTube for how to use it for this injury. I'm hoping that it'll make this heal faster, it's now been a week since my previous run.

 

[ElyDave]

google or other web search Phil Maffetone and see what he says about NSAIDS. He's a doctor who was also a very god athlete in his day and a coach to others. I've got a kindle copy of The Big Book Of Endurance Training and Racing, which is a great read. He explains in soem detail how the NSAIDs interfere with the body's own healing processes and lead to later problems.

As for the peroneal tendinitis, I think I've had soem degree of it for years due to old rugby injuries. My right ankle is by far the worst and I really feel it after running in soft ground. I had an acute bout last summer, brought on I think by my Birkenstocks (which I've never worn since). My remedy was basically RICE, with rolling the base of the foot hard on a golf ball being helpful as well. I was training on the bike and rower within a week, but I think I was off running for a fortnight without going back to check my log.

 

[Barefoot TJ]

I've read that a lot about NSAIDS slowing the healing process.

 

[Barefoot TJ]

Lately, that is. Trying to type on the iPad sucks.

 

[Barefoot TJ]

I think some people have toe pain from wearing the VFFs because their toes are unnaturally being separated which is opposite from the enclosed toe box shoes cramping them together. That's why it's so important to find the right shoes for you and to ditch any at the first possible hint that they could be damaging your feet and/or body. I tried wearing my VFFs twice this past week, and after just a short amount of time, I was in a lot of pain. Before the neuroma surgeries, I was able to wear them for about a half hour. Before the worst of the nerve pian, I was able to wear them much longer. Now that the neuromas have been removed, I'll just have to see how it goes for me as I continue to heal. For now, I now that the VFFs cause pain, so I won't wear them.

 

[NickW]

TJ, for me the vffs hurt because my big toe is too big and doesnt allow my others to seat all the way in the slots. This causes the littler toes to not be able to splay which hurts something fierce.

 

[Karoliina]

That's very interesting about the NSAIDs, I hadn't heard that before. I definitely won't be using them anymore for this type of injury.

The VFFs have never hurt my feet in any way - they are actually the only shoes I can comfortably wear now. My feet have widened so much from BF running that even Vivobarefoot's models (I have the Neo and the Evo II) are a little too narrow at the toebox. I also have a pair of Merrell Lithe Gloves and they are so narrow overall it really hurts to even walk in them.

I just realized that this might not be a tendon problem after all. I have been resting and icing it for a week now and it's not getting any better. The pain is quite different than it was when I first had problems in this area. It's not really below or behind the lateral malleolus but rather a little upward from there, and it doesn't hurt at all when squatting down on the leg. That's what caused the most pain 1.5 years ago when I had this injury. Now it just gets sore after any use, even walking. The tendon area is not tender to touch at all, but the muscle above it... Ouch. Also on the left leg, where I haven't had any pain walking or running. Maybe it's just that my peroneus muscles are too tight. I'll try to gently massage and stretch them and see what happens.

 

[jldeleon]

Karoliina,

Here is a link to a trigger point chart I use for finding where knotted muscles are. I find it super useful, especially since the muscles causing the pain are not necessarily the muscles that have the pain. It will show you exactly where to massage for your specific problem. You may want to also look up "how to" massage the knots, because there are actually specific techniques. I have found that trigger points in my lower leg are some of the most painful I have ever worked out, so brace yourself.

http://www.triggerpointmaps.com/tp_finder.html