Peroneal muscular inhibition is a concept in which some sort of inhibition of the peroneal longus muscle results in dysfunction and symptoms. This is different to a weakness of the muscle.
Muscle testing for peroneal inhibition:
The strength of peroneus longus is tested with the foot held inverted, plantarflexed with the medial side of the foot stabilized with one hand. The other hand tries to invert the foot as the patient resists with eversion. Care needs to be taken to assess if other muscles are recruited to resist the force. Typically with an inhibition, the weakness is quite noticeable and they can not resist the examiner’s force.
Cause of Peroneal Muscular Inhibition:
This is not clear unless there is obvious pain that the peroneals are inhibited because of that (this arthrogenic type of peroneal muscular inhibition was demonstrated by Dong et al 2024).
It is suggested that it may be related to the lack of the movement of the proximal tibiofibular joints allowing movement of the fibula with dorsiflexion of the talus. This possible link is based on the clinical response of those with this to the mobilization of these joints.
Clinical Features of Peroneus Longus Inhibition:
Pain about the first metatarsophalangeal joint as peroneal longus can not stabilize the first ray on the ground.
Functional hallux limitus due to the dorsiflexed position of the first ray (or more likely a limitation of first ray plantarflexion stability due to the inhibition).
Chronic symptoms following an ankle sprain.
Increased risk for Achilles tendon pain as the peroneus longus can no longer assist in heel-off during gait
Vague antero-lateral leg pains.
Patients feels as though they are walking on the outside of the foot even when the foot posture appears ‘neutral’ or ‘overpronated‘ (internal inversion compensation). This may result in ‘cuboid syndrome‘ like symptoms or exacerbate them.
There may be a substitution with the anterior tibial muscle to compensate. The anterior tibial muscle is primary a swing phase muscle that can function out-of-phase during stance, leading to overuse and a locking of the first MPJ as it tries to elevate the first ray (prevents it from plantarflexing).
Treatment of Peroneal Muscular Inhibition:
Ankle joint mobilization with mobilization of both the proximal and distal tibio-fibular joints.
Manipulation of these joints somehow activates muscular facilitation, however, the mechanism is not clear.
Muscle testing before and after the mobilization typically demonstrates a significant increase in “strength”.
Commentary:
- still somewhat a poorly developed and vague concept; still needs some clarity, further developments and explanations. It is the subject of debate because of the lack of objective scientific evidence.
- some of the descriptions and discussion of peroneal muscular inhibition by clinicians experienced in the concept can have alternative explanations. For example, the reported pain in the first MPJ area being a common symptom in peroneal muscle inhibition, could rather be the cause of the peroneal inhibition.
- the lack of a coherent explanation or mechanism linking the manipulation/mobilization of the joints to an improvement in the inhibition of the muscle is problematic. Some have likened this to the ‘magical thinking’ of unscientific alternative practices such as applied kinesiology.
External Links:
Peroneal muscle inhibition (Podiatry Arena)
Related Pages:
Muscle anatomy: Peroneal longus | Peroneus brevis | Peroneus tertius | Peroneus Quartus | Peroneus digiti quinti muscle
Muscle testing: Peroneus longus and brevis
Muscle Inhibition | Arthrogenic muscle inhibition | Abductor hallucis inhibition | Cuboid syndrome | Calcaneocuboid Fault Syndrome | Posterior Tibial Muscle Inhibition
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