Peroneal strain?

[Sports_Rx]

Hi guys, some advice please from any sporty physios!

• History:female patient recreational runner, presenting with R) lateral lower leg pain, 1/52 P=6/10. Age 42, forefoot runner, 49kg. No change in footwear.
• Pain comes on during running ~1.5 miles. Has increased distance from 12 miles p/w to 15 miles p/w. Mixed terrain.
• Felt niggle on last run but disappeared after 1 mile. Felt it next 24hrs and since. Rested from running for 1/52.
• Pain on toeing off during walking and worse going down steps (ecc mvt) - feels like lateral lower leg is 'giving way' and weak.
• Calf raise bilateral ROM ok, slight pain on R).
• R) leg calf raise ROM reduced & slight pain.
• Doing calf raise with knee bent reproduces her pain significantly and whole leg shakes (+ feeling of giving way). Cannot walk upstairs on tiptoes.
  
• Full ankle ROM DF, PF, Inv, Ev.
• Passive Inv is painful.
• Had R) lateral ankle sprain GII 2 years ago.
• Knee ok.
• Hip ok (ltd LR) but NS.
• Lx ok.
• SLR -ve, good hamstring & calf flexibility. Single leg balance good both legs.
• Normal reflexes.
• Palpation on mid-belly of peroneal gives pain & numb feeling from ankle to hip (L5 dermatome).
• Several trigger points along lateral and posterolateral lower leg.

Have treated trigger points and some myofascial release on lower leg. Advised her to rest from running but cross-train. She has foam roller but I advised not to use it yet as palpation was v. tender. Anything else I should have checked..? Treatment - the usual rest, heat & stretch for a muscle strain?

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