The peronei muscles (peroneus longus and peroneus brevis) and associated tendons are muscles used to evert or pronate the foot. Their main role is actually control. In this case control of the amount of inversion or supination of the foot. They slow inversion and control position of the foot in space when both non weight bearing and during weight bearing.
The muscles work closely with the lateral ankle ligaments to prevent hyper inversion in particualr with the anterior talo fibular ligament (ATFL). In fact research has shown that injury to the ATFL can inhibit the actions of the peronei (just when you need them most).
Because of their role in stability the peronei are susceptible to overuse injuries, inflammation and scar tissue formation.
Pain on the lateral edge of the tibia (often referred to as shin splints in the popular media) can often be attributed to the peronei. This pain can extend the whole length of peroneus longus from the knee right into the ankle and around the tendons under the lateral malleolus.
The muscles are normally painful to palpate and will often demonstrate hyper sensitive spots (people may call these trigger points). Deep massage or tissue release will normally relieve these symptoms but is labour intensive and difficult to perform on the whole of the muscles and the tendons at once.
In many cases the relief from these treatments can be short lived.
Shockwave offers a fast and effective treatment for peroneal pain which can be used in both the acute, sub acute and chronic patients.
Below is an example series of treatments for this problem in the acute (on chronic) patient.
Extracorporeal shockwave to the peronei (3rd treatment)
Machine: Enraf Nonius 811
Settings: 90mj 2000 shocks at 12hz using a 30mm head
Medium: Castor oil
Patient: Longstanding pain from impact activities, previously danced ballet. Strong symptoms across the whole area for many years, recently worse with high impact exercise class. This is the 3rd session of shockwave. Symptoms now minimal during the day but still present on impact activities.
Extracorporeal shockwave to the peronei part 2 (4th treatment)
Machine: Gymna Shockmaster 300
Settings: 2.5bar 2000 shocks at 12hz using a 15mm head
Patient: Has seen improvement overall but has some swelling above the lateral malleolus where there is still significant pain.
We have decided to increase the pressure from the last treatment and decrease the head size to allow better treatment near the ankle.