Peroneal Tendonitis

Author: Chloe Wilson - BSc(Hons) Physiotherapy

Peroneal Tendonitis: Causes, Symptoms and Treatment options

Peroneal tendonitis is a common cause of pain around the back and outer side of the foot, 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?

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 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, while the peroneus longus tendon crosses under the sole of the foot attaching to the big toe.

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.

Common Causes

There are a number of different causes of tendonitis in the peroneal muscles:

  • 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 disease

  • 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 tendonitis

  • Injury: You may also be prone to peroneal 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

Typical Symptoms

People suffering from peroneal tendonitis tend to complain of pain and tenderness around the back and outside of their foot and ankle.  

The pain from peroneal tendonitis tends to come on gradually over a few weeks or months, gets worse with activity and eases with rest. 

Symptoms often tends to be worse first thing in the morning, easing once you are up and about.  It may also hurt to turn your foot inwards, known as inversion, as this movement stretches the tendons. 

Treatment Options

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

  • 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
  • Ice: Applying ice regularly to the outer ankle can help to reduce pain and inflammation.  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
Strengthening and stretching exercises are a useful treatment tool for peroneal tendonitis.  Approved use www.hep2go.com
  • Exercises: Regularly doing strengthening and stretching exercises for the calf and peroneal muscles will help reduce the tension on the peroneal tendons. This helps to speed up healing and reduces the chances of peroneal tendonitis 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 tendonitis 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.

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.

Page Last Updated: 11/12/18
Next Review Due: 11/12/20

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