Peroneal strain?

[msk101]

HI There,

Apologies for delay in reply.
Re tuning fork: it's a rudimentary test for bony irregularities and stress fractures as opposed to peri-osteal inflammation. You basically whack the tuning fork on a bench (NOT the patient) to get it vibrating then put the single tip end of the fork onto a bony prominence or as close to the "sore" spot as you can along the bone concerned. The fork causes a vibration in the bone... if there is a stress fracture you will be peeling your patient off the ceiling (it hurts!), if it's just periosteal inflammation it will be a tad uncomfy but nothing much. if there's no problem it just feels a bit tickly. good for testing 2nd MTP stress fracture points, and medial tibia too and far simpler than going for a full bone scan when treatment-wise, there would be no difference. but can't be done on bones which aren't so superficial.

Ultrasound works on the same principle that it's vibration effect on the periosteal surface hurts if there is a bony fracture. still keep the US head moving tho... the aim is NOT to cause a periosteal burn!

Re peroneal taping: Basically the principles of all taping apply to offload the muscle group so i would be placing the peroneals in a slightly shortened position (evert the foot slightly + or minus dorsiflexion depending on whether you suspect peroneus tertius to be involved as well), then tape along the line of the muscle to support it. i would also probably do a few perpendicular tape lines across the muscle belly as a means of force distribution. It's hard unless the patient is quite big, to do a full offload square/triangle around the sore part of the muscle but worth a try. remember don't use rigid tape for a full circumferential limb tape tho.

I hope that makes sense.

msk101

[Sports_Rx]

I know of a physio who's used a mobile phone on vibrate too

[thabiso]

Cool! Now all I need is someone with a stress # to test it on...

[Sports_Rx]

Update: patient didn't hit the ceiling when I tested for stress # with ultrasound. Last treatment I did some more myofascial release and worked on the trigger points. TPs since gone.

She said it was getting better (no running), has done cycling and swimming to maintain CV. Can walk upstairs on her toes and now do single leg calf raise pain-free. Single leg hopping is still painful and still feels 'weak' compared to other leg.

This bit's interesting: she used a foam roller on the outer shank and experienced severe 'electric shock' pain in the peroneal area. Afterwards leg was sore again as though healing was put back.

Could this have irritated the peroneal nerve? She reports soreness when sitting with legs folded underneath her (compressing the tissues), and can only stand light pressure on massaging the area.

Any feedback / comments welcome

[Physio Dace]

Hi Sport-Rx,

Sounds like it may be an irritation of the common peroneal or its branches - superficial likely given the symptoms reported. Either that or a superior tib-fib joint issue or both.

You mentioned SLR was -ve and I'm assuming you added distal sensitizing components (DF/PF inv etc). Did you try adding hip adduction at the limit of hip flexion - I find this works quite well in picking up neural tension disorders in this area. You can also add accessory movements to the superior tib-fib and assess its affect on symptom response.

What were the accessory movement of the superior tib-fib joint like?

[Sports_Rx]

Hi Sport-Rx,

Sounds like it may be an irritation of the common peroneal or its branches - superficial likely given the symptoms reported. Either that or a superior tib-fib joint issue or both.

You mentioned SLR was -ve and I'm assuming you added distal sensitizing components (DF/PF inv etc). Did you try adding hip adduction at the limit of hip flexion - I find this works quite well in picking up neural tension disorders in this area. You can also add accessory movements to the superior tib-fib and assess its affect on symptom response.

What were the accessory movement of the superior tib-fib joint like?

Hi, thanks for your reply. Yes SLR with PF & Inv was more painful on the affected leg, pain in the area of her complaint. I checked sup tib fib - NS accessory mvt on posterior anterior pressure. Are there any other tests for this joint I should consider?

Also both fib heads are tender on palpation (peroneal nerve again).

Patient has improved, resting from running's helped obviously. There is very slight discomfort on repeated single leg hopping so I've advised no running yet.

[Physio Dace]

Hi,

Most people are tender of the fibula head. Have you trialled neural mobilisations as a Rx?

[Sports_Rx]

Hi,

Most people are tender of the fibula head. Have you trialled neural mobilisations as a Rx?

No I haven't... like a slump but sensitised for the peroneal nerve?

Thanks for your input, much appreciated.

[bob78h]

Hi Sports_Rx, I am experiencing many of the same symptoms you described in your patient. Could you tell me what the final diagnosis was and what worked in rehab and return to activity? Thanks.