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Peroneal Tendonitis Toleration Techniques

PupManS

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Hi Wise People of Pugski:

I didn't see this addressed exactly in the searches so here goes. Hopefully someone has a tip.

Back in September I injured my peroneal tendon on the left foot. Nothing more than decending the stairs in the middle of the night carrying a toddler, then there was a pop with pain and limited range of motion. An hour later I was rolling my ankle around and another pop and everything was better. Didn't think much of it until out hiking a few days later with again, a toddler on my back, and another pop. Unfortunately in that case I had 3 miles of walking to get back to the car and at the end of it I had swelling and pain. Checked by doc who diagnosed peroneal tendonitis and an xray that didn't show a tear, so ice and PT seemed to put me right. Since early November I haven't really thought of it- just some occasional tightness (mainly when squatting or kneeling) but otherwise ok.

After moving to Tahoe for the winter I got out on skis the first time last week and had fairly annoying pain- to the point where getting the ski up on edge to carve a right turn (with bad ankle on the outside) was very difficult. Notably, this was on groomers skiing on my rock skis, a set of Skilogik Ullr's Chariots that are a 101mm waist and very aggressive sidecut. Wonderful spring condition skis which is what we have now. Strangely, as soon as I got the boots off, felt almost fine again, just a little annoying.

Today, I did all my PT stretches (which are more focused on calf and arch vs the ankle, but whatever) and went out on Laser AXs, narrower at a mid-80s waist. Results were better- pain is still there, (a bit less) but I was able to carve a turn. Again, after I took the boots off, very minimal pain only. Hard to say if the stretching made a difference, or it was the narrower ski that's easier to get on edge.

This is very odd. You'd think a boot beats the heck out of a laceup brace but so far, the boot seems to make me miserable.

Anyone have peroneal tendon issues before and dealt with this? Or failing that, can recommend a good PT in north Tahoe (I'm in Incline) that would know what to do? it seems to be quite skiing specific.

Thanks!
PupManS
 

neonorchid

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I have and once past it (took several months) I had no issues with skiing or being in a ski boot. However I did give up on low cut speed skates but am back in more of a short track height skate which hits above the affected area . We are all different. My advice, do PT and follow what they say to the letter. You do not want to exessserbate it, the tendon will contine to thicken and could end up requiring surgry and never being quite right again.
 

cantunamunch

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Yup. In fact I am just dealing with the aftermath of my second one of these now. Calf massage daily, stretching daily. Took 10-12 weeks+ for the tendon to remodel the first time - and I was lucky enough to have a pro massage therapist 3x a week.

Not surprising that the ski boot is making you miserable - the lace up brace doesn't close your ankle and tension the calf muscle. Also, when you walk you're not trying to twist the foot with weight on it.

Strong suggestion: stay with the 80mm or skinnier ski. Also take warming up very seriously, do not just launch into full-on efforts.
 
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PupManS

PupManS

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Yup. In fact I am just dealing with the aftermath of my second one of these now. Calf massage daily, stretching daily. Took 10-12 weeks+ for the tendon to remodel the first time - and I was lucky enough to have a pro massage therapist 3x a week.

Not surprising that the ski boot is making you miserable - the lace up brace doesn't close your ankle and tension the calf muscle. Also, when you walk you're not trying to twist the foot with weight on it.

Strong suggestion: stay with the 80mm or skinnier ski. Also take warming up very seriously, do not just launch into full-on efforts.
Cantunamuch and Neonorchid-

Thanks for the advice. @cantunamunch I think you're right that the boot is an issue but closing my ankle out of it or tensioning my calf under normal conditions doesn't hurt.

I did notice though that my boots that have a pretty tight, heat molded ankle pocket (Xpros, sized down and aggressively heat molded to fit) feel VERY tight on the impacted ankle, and though it isn't tender, I definitely have more swelling and fluid on that side now around the ball of the ankle. I'm wondering if the boots are just putting too much pressure on the area.

I hope not- these are the best skiing boots I've ever owned apart from some plugs I could only tolerate for 2 or 3 hours.

Did you have issues with a tight boot?
 

cantunamunch

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No - but I suspect I am not as inflamed as you are now because I've been nursing mine longer. Consistent pressure on that spot is painful and I have to remind myself not to put any pressure on it, like by crossing legs at my work station or in bed.
 

Kneale Brownson

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I THINK I had a similar injury a couple seasons ago. Didn't get an official diagnosis. Work Comp physician and PT both recommended Epsom salt soaks like this: (I used two 5-gallon pails) Hot as I could tolerate for 2 minutes, cold as I could tolerate (ice in the water) 2 minutes. Back and forth for total of about 20 minutes. I used the stopwatch on my iWatch. The salt went into just the hot water.
 

Mike King

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I had a peroneal tear in my right ankle that had to be surgically repaired. It took a year after the repairs before the range of motion and strength returned to the ankle.

You mention stretches, but are you doing any exercises to strengthen the foot and ankle? Retraction of the foot gripping a towel? Picking up marbles with your toes? Tibialis anterior isometric exercises? Lateral foot raises? Rolling the heel to gain mobility in the subtalar joint?

I'd go see a PT. Alternatively, you could contact @tomgellie who may be able to give you some skiing specific exercises to strengthen your foot/ankle and regain mobility.

Mike
 

chris_the_wrench

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Talk about timing.

3 days ago all of a sudden I started developing, what I think is, peroneal pain in both of my legs. The pain is basically behind the ball of my ankle up the outside/rear part of my calf. Does that correlate with the peroneal/peroneous?

The past couple weeks have been a bit of gear fiasco with me. I got new boots(old didn't fit well and were too soft) back on the 4th(this was planned). So I've been slowly getting those dialed in skiing everyday and about 6 boot fitter trips getting the shells and liners real nice, then about 1.5 weeks ago my 96mm daily driver came apart on me and I've been using a 109mm as my daily even though it's been groomer days.

Im not sure if the wider skis are the cause or just aggravating/multiplying the issue. I've never had this pain before in a lifetime of skiing. I find by getting the skis on their inside edges the pain goes away. So big gs turns, no problem with my left leg when turning right and opposite. But short quick turns with alot of back and forth, ouch. Or even long flat cat tracks, ouch.

Since the pain goes away when I get that angle of the boot/ski, I would think it's a canting issue that I never realized before with narrower skis, but the daily use of the wider skis is really exaggerating it. That's my theory. Ideas, thoughts??

I can't get back into the bootfitter till Tuesday. The pain was so bad I didn't ski yesterday, and I NEVER skip a weekday. I skied a couple hours today, but not very comfortable. Based on how busy the hill was today and how the weekends have been, I may do some Nordic skiing this weekend. I didn't alpine yesterday because of the pain and went nordic instead, no pain doing that and felt great. The pain doesn't seem to linger after skiing.

Thanks
-Chris
 
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neonorchid

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Talk about timing.

3 days ago all of a sudden I started developing, what I think is, peroneal pain in both of my legs. The pain is basically behind the ball of my ankle up the outside/rear part of my calf. Does that correlate with the peroneal/peroneous?

The past couple weeks have been a bit of gear fiasco with me. I got new boots(old didn't fit well and were too soft) back on the 4th(this was planned). So I've been slowly getting those dialed in skiing everyday and about 6 boot fitter trips getting the shells and liners real nice, then about 1.5 weeks ago my 96mm daily driver came apart on me and I've been using a 109mm as my daily even though it's been groomer days.

Im not sure if the wider skis are the cause or just aggravating/multiplying the issue. I've never had this pain before in a lifetime of skiing. I find by getting the skis on their inside edges the pain goes away. So big gs turns, no problem with my left leg when turning right and opposite. But short quick turns with alot of back and forth, ouch. Or even long flat cat tracks, ouch.

Since the pain goes away when I get that angle of the boot/ski, I would think it's a canting issue that I never realized before with narrower skis, but the daily use of the wider skis is really exaggerating it. That's my theory. Ideas, thoughts??

I can't get back into the bootfitter till Tuesday. The pain was so bad I didn't ski yesterday, and I NEVER skip a weekday. I skied a couple hours today, but not very comfortable. Based on how busy the hill was today and how the weekends have been, I may do some Nordic skiing this weekend. I didn't alpine yesterday because of the pain and went nordic instead, no pain doing that and felt great. The pain doesn't seem to linger after skiing.

Thanks
-Chris
See your boot fitter.

You wouldn't all of the sudden be ok and pain-free when out of the Alpine boot if peroneal tendonitis, maybe relief for a little while at rest, then something else would continue to set it off. And you certainly would not be out Nordic skiing a few days afterward.
The local Orthopod I saw first suspected a stress fracture with the possibility of both a stress fracture and damaged peroneal tendon.
 

ted

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Too much upward pressure on the first metatarsal head stress the peroneals. If your ankle dorsiflexion is limited and your boot has too much forward lean, you either need to fix the ankle flexion or the boot.

To fix the ankle flexion- ankle mobilization and /or stretching is the answer.

To fix the boot in order of ease-
1. Heel lift
2. Straighten the cuff
3. Different boot.

Also some feet have a lower first metatarsal head than the rest of the foot. They need a well for it to sit into. Make sure there is no varus build up under the first metatarsal head.
Here is a prefab that has this feature-

 

chris_the_wrench

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Well I figured out my issue, quite simple in retrospect. I was banging my head trying to figure out what caused my pain to start so suddenly. I then realized I had gone into the boot fitters that morning and had some more of the Head liquid fit paraffin injected into my liners to take up some heel slop. I'm finding that stuff takes a day or two to find it's home. This morning I could feel 'clumps' of it pressing on my leg in the spots of issues. I manually worked the material to spread it out abit and instantaneous relief.

-Chris
 
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PupManS

PupManS

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So it seems I need a good boot tech and a PT in Tahoe area.

Long story short, I went to see an orthopod (Kyle Swanson for those of you in Tahoe area) and his belief was my pain was from 1 of 3 causes- a bone chip, a mild longitudinal tear in the tendon or the boot itself. Xray ruled out the bone chip and the way I was able to do most anything OUT of the boot suggested that a longitudinal tear aggravated ONLY by the boot seemed extremely unlikely. However, when I did a standard range of movements with the ortho's hand applying pressure on the tendon it hurt again. The day before I did a 4 mile snowshoe hike with 30 lbs of toddler and carrier on my back and just had mild tightness, so it's definitely connected to pressure on the tendon.

So the reco is some rather specific PT (not in terms of specific exercises, but in terms of being skiing oriented) and some boot work to alleviate the pressure. I skied yesterday for a few hours at Alpine on 82mm width skis and stretched like crazy beforehand and it was tolerable. Loosened my boots and while control was meh, comfort was great.

Being new to Tahoe I don't have a relationship with an existing fitter here (Jeff Rich was the last guy to mess with them) but have always thought Starthaus seemed like a serious place. I've also heard recos for a Dana at Blue Zone in South Lake and I do believe the proprietor of this site does boot work though I don't know where. @Philpug @Tricia where do you guys work, any recommendations? I'm in Incline but happy to travel (though that may be interesting over the next few days). Weekday afternoons preferred.

Additionally, I'd love recos for a PT in the area who really gets skiing.

Thanks all!
 

Tom K.

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Back in September I injured my peroneal tendon on the left foot.

After moving to Tahoe for the winter I got out on skis the first time last week and had fairly annoying pain- to the point where getting the ski up on edge to carve a right turn (with bad ankle on the outside) was very difficult.

Today, I did all my PT stretches (which are more focused on calf and arch vs the ankle, but whatever) and went out on Laser AXs, narrower at a mid-80s waist. Results were better- pain is still there, (a bit less) but I was able to carve a turn. Again, after I took the boots off, very minimal pain only. Hard to say if the stretching made a difference, or it was the narrower ski that's easier to get on edge.

I did what sounds like the exact same thing getting out of my Raptors in the parking lot on a 10 degree day in Spring 2019. Same symptoms. Putting a ski into a high edge carve? NOT POSSIBLE. Skate xc skiing? See previous answer. Possibly the worst thing I tried.

Sadly, I found no magic bullet other than patient rehab and time. I didn't forget about the injury until July -- but it was fine for the start of the next season.

Some good insight from many Puggers in my old thread, especially by @eok IMO: https://www.SkiTalk.com/threads/ankle-tendons-ligaments-ouch.14647/#post-338811

Right after the injury, I spent a week-long trip with my wife in Sun Valley, just kind of skidding around on groomers and not much else. Luckily there was also food and drinking and classic xc on the trip!
 

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