Peroneal Tendonitis

Peroneal Tendonitis

Peroneal tendonitis is inflammation of the peroneal tendons which run behind the bony bit on the outside of the ankle (the lateral malleolus) causing pain and swelling on the outer ankle. Treatment involves reducing pain and inflammation through rest, ice and bracing then stretching tight muscles in the lower leg.

On this page:

  • Symptoms & diagnosis
  • Causes & anatomy
  • Treatment & Rehabilitation
  • Exercises

Peroneal Tendonitis Symptoms

Symptoms include pain and swelling on the outside of the ankle just below the bony bit or lateral malleolus (play video). Pain is often worse during activity but gets better with rest. There may be a pain when pressing in on the peroneal tendons on the outside of the ankle. Pain may be recreated by stretching the peroneal muscles by inverting the foot or turning it inwards as well as attempting to do the reverse against resistance.

Peroneal tendonitis causes & anatomy

Peroneal tendonitis

What is Peroneal Tendonitis? The Peroneal muscles consist of the Peroneus longus (long) and Peroneus brevis (short) at the back of the lower leg. They attach to the foot via tendons which pass down the back of the ankle, behind and under the lateral malleolus (bony bit on the outside of the ankle).

Overuse can cause the peroneal tendon to rub on the bone and become inflamed. The term Peroneal tendinopathy rather than Peroneal tendonitis may be more appropriate in chronic cases as it describes degeneration of the tendon as opposed to just acute inflammation.

Runners who run along slopes which cause excessive eversion or rolling out of the foot are more susceptible to developing symptoms. As the foot rolls outwards the peroneal tendon is stretched more across the bone, increasing the friction between the tendon and the bone.

Tight calf muscle will increase the tension in the peroneal tendon causing it to rub more. Overuse is also a contributory factor, particularly in dancers or basketball players. Overpronation of the foot or excess eversion of the foot again will cause the peroneal tendon to run against the malleolus on the ankle bone more.

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

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

Peroneal Tendonitis Treatment

Rest is important when treating peroneal tendonitis. As it is an overuse injury, then continuing to train is not going to allow the inflammation to go and the injury to heal. It 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 either 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 can 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 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

calf muscle stretching videoStretching the calf muscles (play video) and peroneal muscles is 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 the tendon. This is especially important, as what some athletes may find is simply resting alone will result in the pain and inflammation going away, but if tight peroneal muscles are the original cause of injury, then as soon as training begins again the injury may return.

Peroneal muscle stretchA specific stretch to target the Peroneal muscles (play video) themselves is done by manually stretching the foot into an 'inverted position', and is more easily done in a sitting position.

Deep tissue sports massage for the peroneal muscles can help to reduce tension in the muscle and help lengthen the muscles, which in turn reduces the tension in the tendon. In severe cases, surgery may be required.

This article has been written with reference to the bibliography.