Peroneal Tendonitis

Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

Peroneal Tendonitis: Causes, symptoms, diagnosis and treatment

Peroneal tendonitis is a common cause of foot pain, particularly around the ankle.

Frequently affecting runners or athletes who have upped their training, peroneal tendonitis usually develops slowly, gradually getting worse and worse.

Repetitive overloading or stretching of the peroneal tendons can cause small tears in the tendons which leads to inflammation, irritation, weakening and degeneration. The result is pain on the outer ankle which gets worse with activity.

What Is Peroneal Tendonitis?

Peroneal tendonitis is when there is inflammation and degeneration of the peroneal tendons on the outer side of the foot.

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.  

Peroneal Tendonitis causes pain on the outer side of the ankle due to inflammation and degeneration of the peroneal tendons

There are two peroneal muscles, peroneal longus and peroneal brevis

They work to pull the foot and toes downwards, known as “plantarflexion” and to turn the foot outwards, known as “eversion”. 

The peroneal tendons run down the back of the fibula (outer shin bone) through a groove on the outer side of the ankle behind the lateral malleolus.  

  • Peroneus Brevis attaches to the base of the little toe
  • Peroneus Longus tendon crosses under the sole of the foot attaching to the big toe.

Foot 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 overuse or repetitive tension on the peroneal tendons, or an ankle injury such as a sprain, damages the tendons which can lead to peroneal tendonitis.

What Causes Peroneal Tendinitis?

There are a number of different causes of peroneal tendinopathy:

  • Overuse: This the most common cause of peroneal tendonitis. Sudden increases in training levels, inappropriate footwear or poor training techniques tend to be to blame. Sports such as basketball, football and gymnastics, or anything requiring quick pivoting movements are also commonly associated with the peroneal tendonitis tears

  • Running: 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 tendinitis

  • Injury: You may also be prone to peroneal tendon problems if you have injured your ankle or suffered from recurrent ankle sprains. Repeatedly damaging the ligaments that support the foot and ankle leads to weakness and instability which can put more strain on the peroneal tendons

  • 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

  • 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

Symptoms Of Peroneal Tendinopathy

The symptoms of peroneal tendonitis symptoms tend to present as:

  • Foot & Ankle Pain: People suffering from peroneal tendonitis tend to complain of pain and tenderness around the back and outside of their foot and ankle

  • Gradual Onset: The pain from peroneal tendinopathy tends to come on gradually over a few weeks or months

  • Worse With Activity: peroneal tendonitis pain usually gets worse with activity and eases with rest.

  • Worse In The Morning: Peroneal tendonitis tear symptoms often tend to be worse first thing in the morning, easing once you are up and about

  • Pain With Inversion: It may also hurt to turn your foot inwards, known as inversion, as this movement stretches the tendons. 

Treating Peroneal Pain

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

  • Rest: It is essential to avoid any activity which aggravates your peroneal pain 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
  • Ice: Applying ice regularly to the outer ankle can help to reduce pain and inflammation from peroneal tendinopathy.  You can find out how to safely and effectively apply ice in the Cold Therapy section

  • Compression: Wearing a tubigrip compression bandage or a support brace can help to reduce inflammation and instability

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

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

  • 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 to help avoid peroneal pain
Strengthening and stretching exercises are a useful treatment tool for peroneal tendonitis.  Approved use
  • Exercises: Regularly doing strengthening and stretching exercises for peroneal tendonitis will help reduce the tension on the peroneal tendons. This helps to speed up healing and reduces the chances of peroneal pain recurring

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

  • 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.

10 Second Summary

Peroneal Tendonitis is caused by inflammation, tearing and degeneration of the peroneal tendons on the outer foot. Running, sports, footwear, muscle imbalance and foot injuries are usually to blame.

Peroneal tendinopathy can be treated following PRICE principles, changing activity regimes and orthotics, and exercises for peroneal tendonitis are a must!

What Else Could It Be?

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.  

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.

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Page Last Updated: 10/11/20
Next Review Due: 10/11/22