pathology: tendinopathy of the fibularis insertion

yogabook / pathology / fibularis insertional tendinopathy

Definition

Insertional tendinopathy of one of the two fibular tendons, that of the fibularis brevis or that of the fibularis longus. In practice, the tendon of the fibularis brevis, which inserts at the base of the fifth metatarsal bone, is significantly more commonly affected than the tendon of the fibularis longus, which crosses the sole of the foot to insert at the base of the fifth metatarsal bone and at the medial cuneiform bone, and where it frequently causes friction with the peroneal bone, a condition which then manifests as Painful Peroneal Bone Syndrome. The latter is more of a mid-portion tendopathy. If the common retinaculum is affected, subluxations/dislocations may occur and the retinaculum may sustain further damage. Split tears frequently occur in the tendon of the fibularis brevis, a condition known as peroneal split syndrome. Splayfoot and calcaneal varus are predisposing factors.

Insertional tendopathy must be distinguished from mid-portion tendopathies, which primarily occur in areas with poor blood supply (Fibularis longus: around the lateral malleolus, fibularis brevis: behind, between the cuboid and the first metatarsal bone)

Cause

  1. Misalignments, particularly of the foot
  2. Instabilities of ankle joints
  3. Overuse

Predisposing

  1. Alter
  2. Being overweight
  3. Smoking
  4. supination injuries sustained
  5. Hollow foot and posterior foot varus
  6. inadequate footwear, particularly shoes that provide poor support, such as worn-out shoes and sandals
  7. Inadequate increase in training volume for running or jumping
  8. Training and activities on uneven surfaces
  9. OS peroneum (relates to Fibularis longus)
  10. prominent peroneal tubercle
  11. existing general predisposing factors for tendinopathies, such as corticosteroid treatment, fluoroquinolones, rheumatoid-like conditions, IBD, hypercholesterolaemia
  12. Weakness or stiffness in the lower leg or foot muscles
  13. Prolonged strain on the feet from standing, walking, running, particularly rapid weight gain
  14. Technical shortcomings during training
  15. Previous foot problems, such as injuries or operations

Symptoms

  1. clearly localised, distinct tenderness at the insertion; in the case of the fibularis brevis at the base of the fifth metatarsal bone; in the case of the fibularis longus, usually the first metatarsal bone or the medial cuneiform bone
  2. pain on exertion: Gehen, Jogging, Running, Abrollen des Fußes, Fußballenstand
  3. Start-up pain, morning pain, morning stiffness
  4. Increased pain during eversion/pronation
  5. Pain on stretching during supination
  6. impaired balance on the affected foot, lateral difference in balance ability
  7. possibly a tendency towards increased supination
  8. swelling, if any
  9. possibly reduced function of the affected fibularis muscle
  10. possibly a feeling of instability, particularly in the OSG, especially on uneven ground
  11. possibly snapping or catching of the tendon in the event of a tendency towards subluxation

Therapy

  1. moderate heel lift (heel-to-toe drop)
  2. avoid flat, hard shoes and walking barefoot
  3. Tightly laced shoes are sufficient
  4. Stress management

Complications

  1. Chronic condition (tendinosis)
  2. Peroneal split syndrome
  3. Partial or complete rupture
  4. Chronic ankle instability
  5. Subluxation/Dislocation der Sehne
  6. secondary damage, such as changes in gait, compensatory posture, as well as cartilage damage and osteoarthritis caused by instability

DD