Rehabilitation is important following a peroneus brevis tendon injury to regain full pain-free movement, strength and balance as well as helping to prevent future injuries.
Aims of rehabilitation
The aims of rehabilitation of a peroneus injury are:
- To decrease the initial pain and inflammation
- Improve flexibility
- Build strength and neural co-ordination of the joint
- Gradual return to full sports specific fitness.
Improve mobility and flexibility
Stretching exercises for the calf muscles and in particular the peroneus brevis muscle should begin as soon as pain will allow. This may be 48 hours after a minor strain or up to a week or more for a more severe injury. If it hurts to perform any of the exercises then wait longer until there is no pain.
Stretching the muscles at the back of the lower leg is important. Stretching with both a straight and bent leg will ensure the Peroneus Brevis and Soleus muscles are also stretched properly. Perform stretching exercises gently 2 to 3 time a day applying ice or cold therapy after stretching in the early stages of rehabilitation to help reduce any resulting inflammation.
Strengthening and proprioception
Strengthening exercises can begin as soon as they can be performed without any pain. This is likely to be at least a week for most injuries. It is far better to delay loading the injured tendon a bit longer than may be necessary rather than over loading it too soon and making the injury worse.
Strengthening exercises should be done for all ranges of movement of the ankle, not just the area of injury. This will ensure good all round strength and help to prevent further injuries. It is important to maintain fitness by swimming or cycling if pain allows or take the opportunity to work on upper body strength.
When the ankle or foot is injured often the proprioception or co-ordination of the joint is also damaged making it less stable in future. Specific ankle exercises to restore proprioception should be done. These include balancing exercises such as balancing on one leg with the eyes closed or using a wobble balance board. Using a balance board will strengthen the ankle and improve proprioception at the same time.
Return to full fitness
When the athlete can comfortably do all of the above and has progressed through specific ankle and wobble board exercises then you are ready to start the next phase and begin to return to activity. They may begin running as long as it is not painful starting with a gentle jog and gradually building up until they can run pain free for 20 minutes before increasing the speed or introducing fast changes of direction.
Gradually introduce sideways or lateral movements and then progress to agility runs involving changes of direction with increasing speed. If there is any pain either during, after or the next day then apply ice, calm things down and take a step back before progressing.
Continue with stretching, strengthening and balance board exercises for a few weeks throughout the rehabilitation program and for a few weeks after full sports specific training has resumed.