Tendonitis Between the Tibia and Fibula: Causes and Treatments - Orthopedics

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Tendonitis between the tibia and fibula, often referred to as tibial tendonitis or peroneal tendonitis, can be a frustrating condition, especially for active individuals like yourself who enjoy running. The symptoms you describe, including persistent pain and discomfort below the knee, are common indicators of tendonitis, which is an inflammation of the tendons that connect muscles to bones.


Causes of Tibial and Fibular Tendonitis
The primary causes of tendonitis in this area typically include:
1. Overuse: Engaging in repetitive activities, such as running on uneven surfaces or downhill, can lead to microtrauma in the tendons.

2. Biomechanical Issues: Flat feet, high arches, or improper footwear can alter the mechanics of your foot and ankle, increasing stress on the tendons.

3. Inadequate Warm-Up: Not properly warming up before exercise can predispose the tendons to injury.

4. Sudden Increase in Activity: Rapidly increasing the intensity or duration of your running can overwhelm the tendons.


Treatment Options
1. Rest: Allowing time for the tendons to heal is crucial. This may mean taking a break from running or switching to low-impact activities like swimming or cycling.

2. Physical Therapy: Engaging in a structured rehabilitation program can help strengthen the muscles around the knee and improve flexibility.

3. Ice Therapy: Applying ice to the affected area can reduce inflammation and alleviate pain.

4. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen can help manage pain and swelling.

5. Orthotics: Custom shoe inserts can help correct biomechanical issues and provide additional support.

6. Corticosteroid Injections: While you expressed concern about injections, they can provide significant relief in cases of severe inflammation. However, they should be used judiciously, as repeated injections can weaken the tendon over time.


Regarding Injections
Corticosteroid injections can be effective in reducing inflammation and pain, but they do come with potential side effects, including:
- Tendon Weakness: Repeated injections can weaken the tendon, increasing the risk of rupture.

- Infection: Although rare, there is a risk of infection at the injection site.

- Temporary Flare-Up: Some patients experience a temporary increase in pain after the injection before improvement occurs.


Chronic Tendonitis Management
If your condition has progressed to chronic tendonitis, it may require a more comprehensive approach:
1. Longer Rest Periods: You may need to take a more extended break from activities that exacerbate the pain.

2. Gradual Return to Activity: Once symptoms improve, gradually reintroduce running, starting with shorter distances and lower intensity.

3. Cross-Training: Incorporate low-impact exercises to maintain fitness without stressing the tendons.

4. Strengthening Exercises: Focus on strengthening the muscles around the knee and ankle to provide better support.

5. Consultation with a Specialist: If symptoms persist, consider seeing a sports medicine specialist or orthopedic surgeon for further evaluation and treatment options.


Conclusion
It's understandable to feel frustrated with conflicting opinions from different healthcare providers. It's essential to communicate openly with your doctors about your concerns and treatment preferences. If you are hesitant about injections, discuss alternative treatments and rehabilitation strategies that can help manage your symptoms effectively. Remember, patience and a gradual approach to recovery are key to overcoming tendonitis and returning to your running routine safely.