Peroneal Tendon problem

[Philkilla]

Good afternoon gentlemen. I'm having an issue with my ankle and I'm looking for some expert advice/insight. I'll start at the top.

During some field training in OSUT back in Benning, a cadre member threw a smoke grenade that started a fire. I ran over to put the fire out and in the process I ran through a sink-hole and my right ankle flopped over and my foot went completely horizontal with the ground which was accompanied with a few loud pops. I went to the TMC and they did a bone scan which didn't really help out at all. They described it as a Level 2 sprain. Ok I thought. The doc said to just RICE it, so I did. Unfortunately I had to finish up the final field training 2 weeks later and didn't want to get seperated from my other prior-service buddies in training. Basically, I didn't rest/recover as much as I should have.

Over the past few months during SOPC/Selection/CLT and everything in between there has been the occasional ankle roll and what not, but I just drove on through it.

Fast forward to recently: During the indoc. section of language school, I had just completed the 6 mile ruck. I had one little ankle roll, but it wasn't bad so I kept moving. I completed everything fine, took off the ruck and rested with my friends for about 10 minutes. Afterwards I jumped on the bus and headed back to the B's. Once I got off the bus every step I took the outer portion of my right foot was just screaming. I went through the rest of the day dealing with it and trying to stretch it.

I hooked up with my mom and she has been an MRI tech. for 25+ years. She's not a doctor of course, but her prognosis is that it is a Peroneal Tendon issue. I think I narrowed it down to either the Peroneus Brevis or Peroneus Longus.
http://www.orthogate.org/patient-education/ankle/peroneal-tendon-problems.html

She's going to give me an MRI tomorrow to see how bad it is, and then I'm going to speak with my TAC on monday to see what he recommends/suggests for me.

I'm debating if I would want to get surgery, or see a physical therapist. With company rules, we can't be out of training for more than 90 days. Now I would love to have it repaired completely (if military surgeons can do that) but I'm not sure if I want to put myself in the mercy of the big army, or risk just sucking it up.

Sorry for the long write up, I just need an educated suggestion. This has all started from an injury months ago (October 08') and it seems like it is going to keep escalating until it is solved. With SUT coming up in a few months, I don't want to become another statistic.

Thank you.

[Philkilla]

I got an MRI done; my mother said it is tendonitis. I went and saw the doc, all he did was give me a couple of days profile and some naproxen...:boohoo

My buddy is letting me use his ultrasound machine and I'll be icing liberally and using an ankle brace for support and low impact PT to fix it myself I guess.

Oh yah, they made me an appointment for physical therapy...a month from now. ;)

[Blitzzz (RIP)]

I don't know this Ultrasound machine (Quality). You should know the precautions with it. However 3mHz X 3mins Underwater to the Peroneus Brevis or Peroneus Longus both, as there Insertions are at the same points. Do use Ice massage to that area several times a day. Exercise by light resisted rubber bands. HOW.. seated with leg extended before you, heel placed ground and toes pointed up, anchor (hold) one end of the band at about mid inner thigh level...wrap the band around your foot and anchor on the outside of that leg with the foot rotated in (inverted) with bands tight in this position you then evert the foot. Pull against the band outward, do a smooth movement (normal speed) about 60 reps puling foot outward only just pass nuetral. Any questions and you can call me at home. I'll PM you my phone #. Blitzzz

[Philkilla]

Thank you for your input Blitzzz. I'm not aware of any pitfalls with the ultrasound, but I'll double check. I've been using lots of ice (my foot is numbing while I type) and it certainly helps. I have a big rubber tube as well, I will give what you recommend a try.

Thank you.

[Blitzzz (RIP)]

Too much resistance in the exercise can slow or stop healing. Start almost embarrassingly low.
Good luck Blitzzz

[Pocket NCO]

Hey Philkilla,

I personally would get in to see a Physical Therapist or Athletic Trainer so that they can evaluate it and provide you with a solid rehab plan. With that said, There are a couple of things you can do on your own along with the ice and strengthening exercises that should be done in order to optimize the healing process. 1) Reduce Pain and Swelling (seems like you got this down with the ice and Naproxen). 2) Restore range of motion. This means you need to move it in pretty much every direction as far as you can PAIN FREE. Pain is a message from your body saying its still hurt. 3) Reestablish balance. Extremely important to the health of your ankles, knees, hips, and back. This can be done by standing on one foot for 30 seconds, resting for 30, and repeating 10 times for each foot. 4) Restore strength, endurance, and power. The tubing is good but like Blitzzz said, take it real easy and it should be pretty well pain free. That's a real basic explanation of the rehab process but should give you a general idea of the things you'll need to do to fix the problem. Another huge issue is protection. You should be in an ankle brace of some sort to help prevent the reoccurance of the problem. Hope this helps.

[MiTTMedic]

After working in the PT world for 30-years (20 in the Army), here's my opinion.

1. See a PT to rule out anything underlying. Many Military PT's are now DPT's, so their training has come a long way. Many are also Ortho-Certified.

2. Use the tubing sparingly, like the other posts said. Think RE-EDUCATION, not strengthening. Peroneals really have a point to where over strengthening doesn't help anything. High rep, low resistance.

3. Your ankle may be painful because your proprioception is not where it should be. Try comparing your balance on one foot & then the other. If you are equal, try with your eyes closed. Poor proprioception will cause your balance to be off enough to cause psuedo-instability. You decribed your injury as a grade-2, so that tells me that you have the ligaments you need (may be damaged, though). If you've been walking around for a while, chances are that your peroneals are strong enough. That leaves propriception. Do a Google search for proprioception exercises. There's a million different ones, and they are all simple & effective. A good number of grade 1 & 2 sprains don't heal correctly because propriception wasn't addressed.

Let me know if it doesn't help, and don't skip point #1!!!!


Mittmedic

[Philkilla]

My mother had a doctor look at my MRI, and he said it is a partial tear of the Peroneus Brevis tendon. My self diag. was somewhat accurate lol..

I've still been icing and rehabbing. I can run and it doesn't hurt, however, I did a 5 mile ruck/run the other day with an ankle brace on, and that seemed to impact the problem and make it hurt like hell.

I think the brace is adding so much pressure on the bottom of my foot with the swelling from the constant pounding of my feet to make it hurt.

So, now more trial and error I suppose. I'll have to modify the brace probably.

Thank you everyone for your advice and help. It is appreciated very much.

EDIT: att. MiTT Medic: I a PT session scheduled for the 24th of this month. I'm going to go see them and I will follow up again.