Chronic pain

by Erika
(Freestate, South Africa)

Chronic pain on top right foot (Peroneus Longus Tendon

My daughter, now aged 12 stepped, into a wire 3 years ago, which pierced the bottom of her foot and protruded on the top the foot in the area of the Peroneus Longus Tendon. The foot was put into "moonboot" for 4 weeks and subsequently a foot brace. Initially not much pain or discomfort was experienced only when she played tennis for extended periods. However, last 2 years the pain became chronic and recently started spreading up the side of leg. No amount of pain killers or injections alleviate the pain. Of late another problem occurred: she says it feels like her ankle(inner foot)dislocates, causing great discomfort and pain. With self-manipulation she can "click" it back into place. Our local GP has a theory that the tendon has developed scar tissue which is pressing on a nerve and hence causing the chronic pain which spreads up the leg. Our orthopedic surgeon does not agree and has no answers as to treatment or even pain relief. He thinks it will sort itself out eventually. But it got worse instead of better. My daughter plays provincial tennis championships and is hampered by the constant pain which gets worse as the game progresses. We are desperately looking for answers and or treatment because it not only affects her sporting achievement but also her general wellbeing.
Thank you for taking the time to "listen" to my problem and possible advice.

Regards
Erika
South Africa

RESPONSE

Hi Erika,

With a history of trauma, particularly a wire piercing through the foot, it would not be unheard of for there to be damage to the peroneal tendon, actually both the peroneus longus and peroneus brevis since the wire protruded to the top of the foot.
In cases like this you would think the orthopedist would be better versed in these problems, but I tend to agree more with your GP, up to a point.
There is a very good chance that there is some scaring if not tearing of one of the peroneal tendons. This would certainly cause pain on the outside of the foot, it would also adversely affect the function of the tendon(s) and impede normal function of the foot. In theory this could lead to de-stabilization of the foot and create ankle pain, even on the inside of the foot.
This is probably not going to go away on its own.
I would like to think that your daughter has had an MRI on the foot which would give better detail to the damage to any soft tissue structure on the foot. It would also reveal any possible bone damage.
If she has not had an MRI, then that would be the first thing I would suggest. Find the damage and repair it.
There is good and bad news here. The good news is that she is young and healthy and should she require any surgery to repair the tendon, there is a high likelihood of success.
The bad news is that if nothing is done at this young age, the problem may only get worse as she ages. Any scarring or otherwise irregularity to the tendon will only tend to worsen as she age.
If your orthopedist seems "lost" , go see another orthopedist.

Marc Mitnick DPM
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