Trigger points in the Peroneal muscles of the lower leg are a common, but relatively unknown, source of ankle pain and weakness. People who suffer from frequent and reoccurring ankle sprains are likely to have chronic peroneal trigger points perpetuating this condition. Provided below is a description of the peroneal muscles and their trigger points.
Anatomy of the Peroneal Muscles
The Peroneus muscle group is located on the outside of the lower leg and is composed of three muscles:
- Peroneus Longus: The most superficial and the longest of the three muscles, this muscle attaches superiorly to the head of the fibula, along the upper half of the lateral aspect of the fibula, and to the intermuscular septa. The tendon of this muscle wraps around behind the lateral malleolus and then across the sole of the foot to attach inferiorly to the medial cuneiform and first metatarsal bones. The Common Peroneal Nerve passes between the two upper attachments of this muscle on the fibula.
- Peroneus Brevis: This muscle is shorter than the peroneus longus and lies partially underneath it. It attaches superiorly to the lower 2/3 of the fibula, and its tendon joins the tendon of the peroneus longus as it wraps behind the lateral malleous. It then attaches inferiorly on the lateral aspect of the fifth metatarsal bone on the foot.
- Peroneus Tertius: The smallest of the three muscles, this muscle attaches superiorly to the anterior surface of the lower fibula. Its tendon runs downward across the front of the ankle region to attach to the fourth and fifth metatarsal bones of the foot.
Function of the Peroneal Muscles
Contraction of the Peroneal muscles cause the foot to abduct (toe out) and evert (elevation of the outside of the foot) when the foot is dangling and free to move (non-weight bearing). The Pernoneus Longus and Brevis also act to assist plantar flexion of the foot, while the Peroneus Tertius can assist dorsi-flexion of the foot. During everyday activity, these muscles function to adjust the placement and orientation of the foot during walking.
The Peroneal Trigger Points & Symptoms
People with trigger points in any of the three peroneus muscles will complain of “weak ankles” with pain and tenderness on the outside aspect of the ankle. These trigger points typically occur secondarily to an ankle fracture or sprain, but they can also occur without a corresponding ankle injury. People who over-pronate their foot when they walk may do so because of these trigger points. The location and referred pain pattern for each of these trigger points is as follows:
- The trigger point in the Peroneus Longus muscle is found 3-4 inches below the knee on the outside of the lower leg. It refers pain to the region around the lateral malleolus of the ankle, and sometimes along the outside edge of the shin.
- The Peroneus Brevis trigger point is found a few inches directly above the lateral malleolus, and also refers pain to the lateral ankle region.
- The Peroneus Tertius muscle will often have two active trigger points in it that are found just above and slightly anterior to the ankle region. Both trigger points refer pain along the front of the ankle and to the lateral heel region as well.
Associated Trigger Points
Referred pain that shoots down the leg from gluteus minimus trigger points (side sciatica) may activate trigger points in the peroneal muscles. Additionally, the presence of gastrocnemius trigger points, soleus trigger points, and the tibialis anterior trigger point may weaken their respective muscles and in turn overload the peroneul muscles, causing trigger points to form in them.
Treatment of Peroneal Trigger Points
An effective and long-lasting release of the peroneal trigger points requires attention to be paid to the associated trigger points mentioned above, especially the trigger points in the gastrocnemius and tibialis anterior muscles. To learn the techniques that I use to recognize, locate, and release these trigger points in my daily practice, please consider purchasing the Trigger Point Therapy for Peroneal Muscles Video Download.
More Links & Information:
- Myofascial pain and dysfunction: the trigger point manual – Google Books Result
- A Podiatrist’s Guide to Trigger Points & Myofascial Pain Syndrome
- Trigger points that cause ankle pain and ankle weakness
- Peronius Brevis-Ankle Pain-Trigger Points
- The Trigger Point Therapy Workbook: Your Self-Treatment Guide for … – Google Books Result
- Peroneus longus - Wikipedia
- Peroneus brevis - Wikipedia
- Peroneus tertius - Wikipedia
Related Instructional Products:
Description: This video download provides step-by-step instructions for locating and releasing the peroneal trigger points. Also included are anatomical and biomechanical diagrams for the peroneal muscles, and the common clinical findings for their trigger points. Learn more at Trigger Point Therapy for the Peroneal Muscles. Learn more about video downloads here > Trigger Point Video Downloads.
Description: Learn the trigger point techniques and routine that Dr. Perry uses in her pain clinic to address the needs of athletes and runners that suffer from heel pain, ankle pain and instability, shin splints, and calf pain/ cramping. This one hour DVD or video provides step-by-step instructions for locating and realeasing the twenty trigger points in six muscle groups that produce lower leg pain complaints. Learn more by clicking here > Trigger Point Therapy for Lower Leg & Foot Pain.