Peroneal Tendonitis (Tendinopathy)

Peroneal tendonitis

Peroneal tendonitis (tendinopathy) is an overuse injury causing inflammation or degeneration of the peroneal tendons on the outside of the ankle.

Peroneal Tendonitis Symptoms

Symptoms of Peroneal tendonitis/tendinopathy include:

  • Pain and swelling on the outside of the ankle just below the bony bit or lateral malleolus.
  • Pain is often worse during activity but gets better with rest.
  • You may have pain when pressing in on the outside of the ankle, where the peroneal tendons pass.
  • Pain may be recreated by stretching the peroneal muscles. This is done by inverting the foot or turning it inwards.
  • You may also feel pain when trying to straighten your foot against resistance from an inverted position.

What is Peroneal tendonitis?

Peroneal tendonitis

The Peroneal muscles consist of the Peroneus longus (long) and Peroneus brevis (short) at the back & outside of the lower leg. The bony bit on the outside of the ankle is called lateral malleolus. The peroneal tendons pass down the back and underneath the lateral malleolus. Overuse causes the peroneal tendons to rub on the bone and become inflamed.

Peroneal tendon

The peroneal muscles

The peroneus longus tendon runs around the back of the lateral malleolus and under the foot. It attaches to the outside of the first metatarsal and cuneiform bones.

The peroneus brevis also passes around the back of the lateral malleolus. It attaches to the outside of the foot at the base of the 5th metatarsal. The muscles act to plantarflex the foot (point foot downwards) and evert the foot or turn it outwards.

Tenonitis or tendinopathy?

The term Peroneal tendinopathy rather than Peroneal tendonitis may be more appropriate, especially in chronic cases. This is because it describes degeneration of the tendon as opposed to just acute inflammation. If your injury is quite recent, for example a few days old, then you may have acute inflammation (tendonitis).

However, in chronic cases, acute inflammatory cells are unlikely to be present. Therefore, degeneration (tendinopathy) of the tendin is a more accurate description.

What causes Peroneal tendinopathy?

Overuse is the primary cause, however there are a number of factors which can increase your risk of injury.

  • If you run on along slopes which cause excessive inversion (rolling out) of your foot then you are more susceptible. This is because the peroneal tendon is stretched more across the bone, therefore increasing friction.
  • Tight calf muscle will increase the tension in the peroneal tendon, so causing it to rub more.
  • Overtraining is also a contributory factor, particularly in dancers or basketball players.
  • Biomechanical factors such as overpronation, or oversupination are factors, increasing friction between your tendon and ankle bone.

Peroneal Tendonitis Treatment

Cold pack over outside of the ankle

Rest is important when treating peroneal tendonitis. As it is an overuse injury, continuing to train will now allow time for healing to take place. However, may be possible to do other activities such as swimming or cycling to maintain fitness. The rule is if it hurts or makes the injury worse, immediately or the following day then don’t do it!

Apply an ice or cold therapy wrap to the painful area for 10 minutes every hour until symptoms reduce. Following the PRICE principles of protection, rest, ice, compression, and elevation. This will help reduce swelling, pain, and inflammation (read more on the PRICE principles). A peroneal tendonitis brace can be worn to protect the area and keep the tendon warm. A simple neoprene ankle wrap is ideal.

Taping for peroneal tendonitis can provide a great deal of support and protection to the ankle. It can be done in the same way as an ankle sprain taping technique.

NSAID’s (non-steroidal anti-inflammatory drugs) may be prescribed to reduce pain and inflammation. Always consult a doctor as some drugs such as Ibuprofen should not be taken by asthmatics.

Peroneal Tendonitis exercises

Stretching your calf muscles and peroneal muscles are important. Tight peroneal muscles will increase the friction between the peroneal tendon and the bone. Gently stretching the muscles over time will reduce the tension in your muscle.

Calf muscle stretches

If you simply rest without stretching or addressing the initial causes, pain will go. However, it is likely to return once you resume normal training.

Peroneal muscle stretch

A specific stretch to target the Peroneal muscles is done by stretching your foot into an ‘inverted position’. This is more easily done in a sitting position.

Sports massage

Deep tissue sports massage to the peroneal muscles can help to reduce tension in the muscle. As a result the the muscles relax, which in turn reduces the tension in the tendon. In severe cases, surgery may be required. Massage techniques will be similar to those for a calf strain.

This article has been written with reference to the bibliography.