When it comes to lower extremity function I think the peroneals have to be one of the most important muscles besides the Gluteal group, who often steal the show.
The peroneal group, in particular peroneus longus, is a vital muscle as it helps descend the first ray onto the ground. As I posted about on Facebook yesterday, having good contact with your big toe on the ground while maintaining proper position of your ankle, knee, hip, pelvis and torso is hugely important. It sounds simple, but it is an extremely common”tug-a-war” that I have to work on with a majority of patients daily.
They put their big toe securely on the ground, but to do so their knee is caving in, their foot is collapsed, their hip is jutting out to the side etc. We then try to correct those compensations and the patient will struggle mightily to keep that big toe down while everything else is corrected. This is rehab, this is function, this is LIFE! The ability to have this function is so important in everything that we do. It helps us stay grounded throughout the day and building strong foot to hip connections and it’s important during toe off in gait/running otherwise we are going to be moving off the outside of our foot and not utilizing full lower extremity potential. Controlling this tug-a-war and coming out on the winning side where we can get our toe down and everything else in as best of a position as possible is really what a lot of lower extremity dysfunctions come down to. It is often a missing link I find in people that have constantly been working on their hip alignment without much success.
Typically there isn’t a vast array peroneal “specific” exercises besides the classic Theraband eversion exercise. The peroneals are an important muscle to work on in closed chain, but below is a simple exercise you can do in open chain that is a twist on the more commonly used eversion exercise.
Key points to this exercise:
- You do an EVERSION movement of the ankle. Note, this means ZERO external rotation of the tibia/femur which for a lot of people is going to be very challenging. Try to keep a neutral shin position as best you can and don’t compensate out of that plane throughout any of the range
- Spreading the toes can be helpful.
- I often cue people to lead into dorsiflexion with the PINKY TOE and lead into planter flexion with the BIG TOE. By leading plantar flexion with the big toe it is really going to fire up peroneus longus (eversion and plantar flexion), while so many of us would want to lead plantar flexion with a slight inversion bias. Also, I liked leading dorsiflexion with the pinky toe because so many times when people dorsiflex they will try to get “more” dorsiflexion by jamming up the medial aspect of the foot and thus it’s really more of a midfoot flexion than a true dorsiflexion. By doing this, it almost helps keep the talocrural joint in neutral.
- As with every exercise you must do it with INTENT!! You can’t just go through the motions with this one or there is no real benefit. There should be quivering, shaking, muscle burning etc.
Let me know what you guys think. I really enjoy this exercise much more than classic inversion/eversion band exercises as it has a bit more of a functional purpose to really work on peroneal’s motor control. And yes, don’t worry people, lots of closed chain “functional” exercises are done on top of this. Thanks for reading everyone!