Peroneal Tendonitis

Author: Chloe Wilson - BSc(Hons) Physiotherapy

Peroneal Tendonitis is a common cause of pain around the back and outer side of the foot due to inflammation, irritation or degeneration of the tendons. 

Tendons are strong, cord-like structures that link muscles to bones. In order to move, our muscles contract which pulls on the appropriate tendon which in turn pulls on the appropriate bone.  Tendonitis occurs when the tendons are over-used or placed under too much tension, usually from repetitive movements causing a strain on the tendon.

Micro-trauma from repetitive tension on the peroneal tendons causes damage to the tendons resulting in peroneal tendonitis.   

Peroneal Tendonitis

There are two peroneal muscles, peroneal longus and peroneal brevis.  They run down the back of the fibula through a groove on the outer side of the ankle behind the lateral malleolus.  The tendons then split with peroneus brevis inserting into the base of the little toe bone (fifth metatarsal) and peroneus longus crossing the sole of the foot to attach to the outer side of the big toe (first metatarsal). 

Their job is to pull the foot and toes downwards, known as “plantarflexion” and to turn the foot outwards, known as “eversion”. 

What Causes Peroneal Tendonitis?

There are four main causes of tendonitis in the peroneal muscles:

1)  Overuse

Overuse is the most common cause of peroneal tendonitis.  Sudden increases in training levels, inappropriate footwear or poor training techniques tend to be to blame.  Runners who frequently run along slopes (e.g. cambered roads or uneven surfaces) which cause the foot to excessively roll out into eversion, are more prone to peroneal tendonitis.  Sports such as basketball, football and gymnastics, or anything requiring quick pivoting movements are also commonly associated with the disease.

2)  Ankle Sprain

You may also be prone to peroneal problems if you have suffered from recurrent ankle sprains due to weakness and injury around the ankle.

High foot arches increase the risk of developing peroneal tendonitis

3)  Abnormal Foot Position

Typically if the heel is turned inwards slightly, known as “hindfoot varus”, or you have high arches, you are at increased risk of peroneal tendonitis as these makes the peroneal muscles and therefore tendons work harder.

4)  Muscle Imbalance

Tightness in the calf muscles and weakness in the calf and peroneal muscles can lead to tendonitis.  Visit the Calf Exercises section to find out the best ways to strengthen and stretch the calf muscles.

Typical Symptoms

People suffering from peroneal tendonitis tend to complain of pain around the back and outside of their foot.  It will most likely be tender to touch.  Pain tends to come on gradually over a few weeks/months, gets worse with activity and eases with rest.  The pain often tends to be worse first thing in the morning.  It may also hurt to turn your foot inwards, known as inversion. 

Treatment Options

It can take a number of months for the symptoms of peroneal tendonitis to fully settle down so effective treatment is vital. 

1)  Rest:  It is essential to avoid any activity which aggravates your symptoms, to allow the tendon to heal properly.  Failure to do so will result in longer healing time

Ice can help reduce any inflammation associated with peroneal tendonitis

2)  Ice: Use ice regularly to reduce swelling.  Find out how to safely and effectively apply ice in the Cold Therapy section.

3)  Compression: Wearing tubigrip compression bandage or a support brace can help reduce inflammation

4)  Elevation: When resting, keep the ankle elevated higher than the heart

5)  NSAIDS: Talk to your doctor about taking non-steroidal anti-inflammatories such as ibuprofen to reduce the pain and swelling

Strengthening and stretching exercises are a useful treatment tool for peroneal tendonitis.  Approved use

6)  Exercises: Doing strengthening and stretching exercises for the calf and peroneal muscles will help reduce the tension on the peroneal tendons.  This will help speed up healing and time and reduce the chances of the condition recurring

7)  Change training structure:  Don’t overdo it especially when trying to increase your activity levels.  Follow the 10% rule - only increase your training levels by a maximum of 10% per week be it intensity, frequency or distance.  If you are a runner, stick to flat, smooth surfaces

8)  Orthotics: If your tendonitis is due to abnormal foot shape, it often helps to wear inserts in your shoes to correct the deformity.  Ideally, you should see a podiatrist who can evaluate your foot and ensure you have the right insoles for you.  Using the wrong insoles may end up causing you more problems

Acupuncture can help reduce the pain and inflammation associated with peroneal tendonitis

9)  Acupuncture: Acupuncture can sometimes help to reduce pain associated with tendonitis but needs to be combined with other treatments such as exercises to stop the pain from coming back

10)  Physical Therapy: This may include joint mobilisations if there is stiffness in the bones of the foot, taping to improve foot position and ultrasound to reduce inflammation and promote healing.

What Else Could It Be?

Tendonitis can occur in a number of places around the ankle and foot.  Visit the foot tendonitis section to learn about the different types of tendonitis, including achilles tendonitis and extensor tendonitis.

There are a number of other causes of pain on the outer side of the foot.  If peroneal tendonitis isn't sounding quite like your problem, visit the Side Foot Pain section.  Alternatively, if you want help working out what is causing your pain, visit the foot pain diagnosis section.  

Go to Tendonitis Overview or Homepage

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