Peroneal Tendonitis Brace- An Evidence-Based Guide for Choosing the Best Brace

One of the most frequent foot's injuries is little described in the scientific literature and often goes unnoticed in a first medical evaluation.

Peroneal Tendonitis is defined as the inflammatory process triggered by the micro-injury in the tendons of the posterolateral muscles of the leg (peroneous brevis and longus).

It's a relatively frequent problem in the general population, but is usually more frequently observed in runners and older adults.

Usually, the patient with this foot injury will develop the classical inflammatory symptoms in the lateral side of the foot, which includes: pain (mostly associated with movement), edema (swelling), redness and heat (increased blood flow).  

Etiologic speaking, the process that leads to the development of a Peroneal Tendonitis is multifactorial.

However, this type of injury is mostly associated with one observed frequent traumatic cause: Ankle sprains.

According to the literature, Peroneal Tendonitis is a risk factor for the chronic ankle instability (CAI), a condition described by the propensity of recurrent injuries due to the weakening of the joint stabilizers.

The repeated sprains often have greater severity than the initial injury and can cause substantial pain and physical restriction.

Therefore, it is possible to observe that Peroneal Tendonitis is not a simple injury and, in order to improve treatment options, is necessary to optimize the effectiveness of strategies to prevent these injuries.

Top Picks: Brace for Peroneal Tendonitis

For patients with unstable ankles, ankle braces may provide external rigid support and sensory input in order to increase mechanical stability, avoid excessive ankle range of motion, and improve joint position.

The benefits of a particular brace, however, depend on its design and, sometimes, materials.

From the patient's point of view, choosing the ideal stabilizer for his/her particular case can be a difficult task and requires understanding of it's own injury and a minimalist research in the web or local stores.

This guide should serve as the starting point in this endeavor.

Why Wear a Peroneal Tendonitis Brace?

As mentioned above, lateral ankle sprains are one of the most common acute musculoskeletal injuries in the general population.

And is also, the most described traumatic etiology associated with Peroneal Tendonitis, with 38 to 40% of ankle sprains leading to peroneus brevis tendon tears.

Most cases of ankle sprains occur because of foot inversion as a result of loss of balance, which may cause stretching or rupture of the tendons and ligaments of the joint.

This type of excessive ankle rotation is common during sports, and one of the leading cases of injuries in many different modalities.

The severity of the ankle sprain varies according to the involvement of the structures present in the affected region and can be divided into three types:

Grade I

Stretching of the ligaments, with formation of edema and presence of pain.

Grade II

Partially ruptured ligaments and joint instability, with presence of edema and rigidity in movement. Pain of moderate intensity.

Grade III

Total rupture of the ligaments and much instability in the foot, with great difficulty to keep standing and intense pain.

Peroneal tendonitis associated with ankle sprains can cause several residual problems, such as:

  • Instability,
  • Chronic pain and
  • Functional limitations. 

Ankle brace is a conservative treatment tool that can be used in different stages of foot tendonitis and for different purposes.

In a recent meta-analysis (the gold standard practice of scientific studies), bracing was an intervention highly associated with both prevention and treatment success in patients with CAI.

Brace As a Preventive Measure

According to the literature, ankle braces are effective for the prevention of acute lateral ankle injuries, and reduces the overall injury rate by 50%.

Braces are recommended for patients with a previous history of ankle sprain, particularly when engaging in high-risk activities such as indoor and field sports.

Brace As a Treatment

The loss of proprioception is one of the symptoms associated with peroneal tendonitis, and that can lead to repetitive injuries.

Improve proprioception is one of the main aims in all stages of rehabilitation.

Previous studies reported improved ankle joint proprioception with interventions that included ankle braces.

This can be associated with other scientific findings showing that bracing reduces the incidence of recurrent ankle injuries.

How to Pick the Correct Peroneal Tendonitis Brace

The choice of the ideal ankle brace should meet the needs of each individual and also the anatomy of the feet.

In sports equipment stores, it is possible to find various types of ankle brace.

The preventive model, for example, is designed to protect the joints without interfering in comfort. Having a preventive function, this brace is designed to exert a necessary compression for the protection of the joint.

It is very useful for those who are returning to practice a sport after recovering from an injury.

The second type mostly frequented found is the semi-rigid ankle brace.

Having a stabilizing function, this brace supports and promotes the correct movement of the joint.

It is often accompanied by elastic bands that allow the patient to adjust the ankle length according to the desired level of protection.

Scientific evidence supports the mechanical superiority of this type of brace for restriction of ankle inversion and eversion movements compared to other common braces.

Size guide (according to literature)

Place a flexible meter around the ankle, more precisely 5 cm above the malleolus. After measuring the circumference, you are able to hit the ankle size.

  • Size 1: from 20 to 22 cm
  • Size 2: from 22 to 23.5 cm
  • Size 3: from 23.5 to 25 cm
  • Size 4: from 25 to 26.5 cm.

Best Peroneal Tendonitis Braces Reviewed

Market is filled with different type of braces, sometime it is frustrating to pick one of them. 

Here is our reviews of top 5 braces that can help you in peroneal tendonitis.

Bracoo Ankle Support

Material: Neoprene

Best fits for: Treatment/recovery phase, you already have the injury and wants to avoid excessive movement; Prevention of new injuries.

Pros: adjustable, latex-free (hypoallergenic), fits in a shoe (according to reviews by some users).

Cons: only two sizes

ASO Ankle Stabilizer

Material: Cotton/Nylon.

Best fits for: Treatment/recovery phase, you already have the injury and wants to avoid excessive movement; Prevention of new injuries.

Pros: 8 different types of sizes with a size guide chart.

Cons: Not returnable if doesn’t fit.

Liomor Ankle Support

Material: Nylon and Lycra.

Best fits for: Prevention purpose (minimize risk injuries).

Pros: Adjustable. Keep feet dry & cool.

Cons: Only two sizes. According to user reviews, movements can be impaired by this brace. Although some resistance is needed, the joint must be able to perform the movements almost freely in order to be functional for daily-life activities.

Sleeve Stars Brace

Material: Lycra.

Best fits for: Prevention (minimize risk injuries).

Pros: Adjustable, light weight.

Cons: Lack of specificity. One size.

Bauerfeind MalleoTrain Ankle Support

Material: Knit.

Best fits for: Prevention (minimize risk injuries).

Pros: Light weight. Specify for lateral strains and peroneal tendonis. 6 sizes with guide.

Cons: Expensive for a preventive brace.

Hope this guide will help you chose the right brace for peroneal tendonitis.

But always remember that you should avoid self-diagnostic and value a professional opinion! It is important to always consult your orthopedist or physiotherapist before deciding the best treatment for you.

References.

1. Thijs K, Huisstede B, Goedhart E, et al The preventive effect of a soccer-specific ankle brace on acute lateral ankle sprains in girls amateur soccer players: study protocol of a cluster-randomised controlled trial Injury Prevention Published Online First: 27 July 2017. doi: 10.1136/injuryprev-2017-042465
2. Doherty C, Bleakley C, Delahunt E, et al Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis Br J Sports Med 2017;51:113-125.
3. Van Dijk PAD, Lubberts B, Verheul C, DiGiovanni CW, Kerkhoffs GMMJ. Rehabilitation after surgical treatment of peroneal tendon tears and ruptures. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24:1165-1174. doi:10.1007/s00167-015-3944-6.
4. Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg. 2003; 42(5):250-8.

Dr. Sachin
 

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