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Lateral ligament injuries of the ankle are particularly common in association with 5th MT fractures. Trigger points in the peroneus muscles of the lower leg are a common, but relatively unknown, source of ankle pain and weakness. It is very common for the ankle pain and tenderness produced by these trigger points to be mistaken for ankle joint pain itself (coming from damaged ligaments and the joint capsule).
Function: In everyday activity, the peronii muscles act to control the balance and placement of the body weight on the planted foot during walking and running. The peroneus longus muscle is the most superficial muscle in the lateral compartment of the leg. Muscle Actions: All three muscles act to evert or pronate (turn the sole of the foot outwards slightly) the foot at the ankle. Contraction of both the peroneus longus and peroneus brevis also produces plantar flexion (pushing down) of the foot at the ankle. Contraction of the peroneus tertius also produces dorsiflexion (lifting) of the foot at the ankle.
The toe extensor muscle (extensor digitorum longus) assist all three peronii muscles in everting the foot.
The peroneus longus and brevis assist gastrocnemius, soleus, and tibialis posterior in plantar flexion of the foot.
The tibialis anterior and tibialis posterior oppose the eversion of the foot produced by all three peronii muscles. The plantar flexion produced by the peroneus longus and peroneus brevis is opposed by the tibialis anterior, peroneus tertius, and toe extensor muscles, which dorsiflex the foot. The peroneus brevis trigger point is found in the same vertical plane as the peroneus longus trigger point, but farther down the leg towards the lateral malleolus.

The two peroneus tertius trigger points are found just above and a little in front of the lateral malleolus. The diagram above also shows the referred pain patterns associated with the peronii trigger points.
The peroneus longus and peroneus brevis trigger points both refer pain and tenderness to the outside of the ankle, focusing on the lateral malleolus.
The peroneus tertius trigger points project pain to the front of the ankle with spillover to the outside of the heel and behind the lateral malleolus. Pain and tenderness on the outside of the ankle, in and around the lateral malleolus (outside ankle bone) region. Foot drop: client may be unable to lift their foot properly while walking, causing it to drag behind. A side-to-side rocking (with or without pronation) of the foot may be observed while the client is walking.
Muscle Weakness Test: with the client face-up on a table, the therapist places the palm of their right hand on the sole of the client’s right foot (or vice-versa) and turns the sole of the client’s foot to the outside (eversion or pronation of the foot).
Sleeping with the foot plantar flexed (bent down) because of a heavy blanket or from sleeping on the stomach can shorten the peronii (and calf) muscles causing them to develop trigger point activity.
A Morton foot structure can destabilize the foot and perpetuate trigger points in the peronii and tibialis muscles (more information below). Morton’s Foot Structure: A variation of the boney structure of the foot where the base of the second toe (next to the big toe) is farther forward than the base of the big toe. Click on the image below to use our Trigger Point Locator video on YouTube to learn about the trigger points that are causing a specific pain.
Athletes presenting with increasing pain, often with a further marked increase that precipitates presentation, should be suspected of having a stress fracture.

If ankle pain persists after an ankle sprain or fracture has healed, you can bet that these trigger points are responsible for it.
It originates along the bottom half of the fibula bone and its tendon travels with the peroneus longus tendon behind the lateral malleolus to attach to the fifth metatarsal bone on the sole of the foot. It originates along the front of the lower fibula bone and its tendon wraps around the front of the lateral malleolus to attach to the forth and fifth metatarsals on the sole of the foot.
The pain may spillover into the outside of the foot and sometimes up into the outside of the lower leg. The client is then asked to plantar flex (push) their foot against the therapist’s hand who attempts to match the pressure. Typically seen in runners that over-pronate their feet while running, anyone suspected of having this condition should be referred out for testing of the pressure in the lateral compartment of the leg to confirm the diagnosis immediately.
Compression of this nerve may affect both the superficial and deep peroneal nerves that branch off of it, weakening both the peronii and tibialis muscles groups and causing a small triangular patch of numbness on the top of the foot between the big toe and the second toe.
Be sure that the clients toes are relaxed and that their foot is everted as the client pushes against your resistance. This condition causes side-to-side instability in the foot which can overload the muscles that act to stabilize the foot, such as the peroneal and tibial muscle groups.
Compression of this nerve can weaken these muscles dramatically, causing a serious case of foot drop. The peroneus longus tendon wraps around behind the lateral malleolus (ankle bone) and under the sole of the foot to attach to the first metatarsal bone.

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Comments to “Lateral foot pain”

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