Peroneal Muscle Pain from Chronic Muscle Scarring

Peroneal muscle pain due to peroneal muscle scarring is a common cause of chronic lateral lower leg pain. It typically develops following an injury to one or both of the peroneal muscles -the peroneus longus and peroneus brevis. The strained muscle then heals with scar tissue. Symptoms of pain and discomfort in the outside of the lower leg may occur with activities such as walking and running. The location of the symptoms depends on where the muscle scarring has occurred. The location is commonly lower down where the peroneal muscles join the peroneal tendons.

Symptoms of Peroneal Muscle Scarring

Patients will report various levels of discomfort in the outside or lateral part of the lower leg. Often symptoms are only present with activities, such as walking or running. Pressure on the affected area can re-create discomfort. Sometimes a harder area of scar tissue can be felt with direct pressure. Forcing the foot to the outside (eversion) may re-create discomfort as this will stress the perineal muscles.

Imaging Studies

Clean x-rays of the lower leg and ankle are usually normal. Occasionally, more severe scarring locations in the soft tissues can be identified.

An MRI will often visualize the scarring in and around the affected peroneal muscle.

Treatment of Peroneal Muscle Pain Due to Chronic Scarring

Conservative treatment of chronic peroneal muscle pain due to scar tissue formation can often be quite successful in improving a patient’s symptoms. The main treatment is physical therapy. Soft tissue mobilization to breakdown the scar tissue is a particularly important component of the therapy. There are a variety of different strategies to mobilize the soft tissues. Treatment may require a number of weeks to improve the scar area and decrease the pain. A short course of anti-inflammatory medication may also help a patient’s symptoms.

Surgical Treatment

Some patients will not achieve an acceptable result with conservative management. These patients may benefit from surgery to free up and remove the scar tissue. The surgery involves releasing the overlying fascia; identifying the area of scar tissue; and removing the scar tissue if possible. The surgery is combined with physical therapy to keep the area mobile. A risk of surgery is that it will cause a certain amount of scar to reform, so therapy is required to minimize scar formation and optimize the patient outcome.

February 1st 2024