Explanation of Diagnosis

A peroneal tendon strain occurs when the peroneal tendons, which run along the outside of the ankle, become stretched, irritated, or torn due to overuse, repetitive ankle motion, or an ankle sprain. Symptoms include pain along the outer ankle, swelling, tenderness, weakness, and instability. This condition is common in runners, athletes, and individuals with high arches or ankle instability.

Specific Work Modifications

• Avoid prolonged standing, walking, or uneven surfaces.
• Wear supportive shoes with good lateral stability to prevent further strain.
• Use an ankle brace or compression sleeve for added support.
• Take sitting breaks and elevate the foot if swelling occurs.
• Modify tasks to reduce excessive ankle motion and weight-bearing stress.

Specific Activity Modifications

• Avoid high-impact activities such as running, jumping, or cutting movements (e.g., tennis, basketball).
• Modify workouts by switching to low-impact exercises like swimming, cycling, or elliptical training.
• Use ankle taping or bracing when returning to sports.
• Perform strengthening exercises before resuming high-intensity activities.

Recommended Supplements

• Collagen peptides (10 g daily) – Supports tendon healing.
• Vitamin C (500 mg daily) – Aids in collagen synthesis.
• Magnesium (300-400 mg daily) – Helps with muscle relaxation and recovery.
• Omega-3 fatty acids (1000 mg daily) – Reduces inflammation and stiffness.
• Turmeric (500 mg twice daily) – Provides natural anti-inflammatory benefits.

Recommended Nutrition and Hydration

Diet Recommendations:

• Anti-inflammatory foods: Fatty fish (salmon, sardines), turmeric, berries, nuts, and leafy greens.
• Collagen-boosting foods: Bone broth, citrus fruits, and bell peppers.
• Protein-rich foods: Chicken, eggs, lentils, and dairy to support tendon repair.
• Limit processed foods, sugar, and alcohol, which can worsen inflammation.

Hydration Tips:

• Drink at least 2–3 liters of water daily to maintain tissue hydration.
• Limit caffeine and alcohol, which can slow healing.

Home Exercise Prescription

Perform 2-3 times daily to improve ankle mobility and strengthen the peroneal tendons:

Phase 1: Early Recovery (Days 1-5, Reduce Pain & Swelling)

1. Ankle Alphabet Exercise

1. • Use your toes to "write" the alphabet in the air.
   • 1-2 times daily.

2. Ice & Elevation

1. • Apply ice for 15-20 minutes, 3-4 times daily to reduce swelling.

3. Ankle Pumps (Gentle Mobility)

1. • Move your foot up and down to maintain circulation.
   • 10 reps, 2-3 times daily.

Phase 2: Strengthening & Stability (After Pain Improves, 1-2 Weeks In)

4. Resistance Band Eversion (Strengthens Peroneal Tendons)

1. • Secure a resistance band around your foot and push the foot outward against the band.
   • 10 reps per side, 2-3 times daily.

5. Heel Raises

1. • Stand and slowly raise onto your toes, then lower.
   • 10 reps, 2 times daily.

6. Single-Leg Balance Exercise

1. • Stand on the affected foot for 15-30 seconds, increasing time as tolerated.
   • Repeat 2-3 times per leg.

Phase 3: Return to Activity (After 2-3 Weeks, Once Pain is Minimal)

7. Lateral Hops (Only If Pain-Free)

1. • Hop side to side on one foot to improve dynamic stability.
   • 10 reps, 2 times daily.

8. Heel-to-Toe Walk (Tightrope Walking)

1. • Walk in a straight line, placing one foot directly in front of the other.
   • 20 steps, 2 times daily.

⚠ Avoid running, jumping, or sudden lateral movements until fully healed (typically 4-6 weeks).

Helpful Books

1. "Rehab Science: How to Overcome Pain and Heal from Injury" – Tom Walters, DPT
2. "The Athlete’s Guide to Ankle & Foot Injuries" – Brian Shiple, DO

Contact the Key West orthopedic clinic or reach out to Dr. Jason Pirozzolo.