Peroneal Tendonitis: Causes, Symptoms & Treatment

Medically Reviewed By : Dr Sravya, MBBS, MS

So, are you dealing with a nagging pain on the outside of your foot or leg and do you want to know what it is? Well, it’s called peroneal tendonitis/tendinitis. But, before we dive into peroneal tendonitis, let’s get into some basics first!

Do you know what a tendon is? A tendon is a string of strong, flexible tissue which is similar to a rope. It connects our muscles to our bones. Today, we move our limbs so freely because of these tendons. But, sometimes these tendons can be strained too.

Now, peroneal tendons come into action! They stabilize the foot and ankle and protect us from sprains. But, once they get inflamed, it will be painful to move our foot.

What is peroneal tendonitis?

Tendonitis is the inflammation of tendons (-itis means inflammation) and peroneal tendonitis or peroneal tendinopathy is defined as the inflammation of the tendons of muscles which occurs on the outside of your lower leg.

It usually occurs when one or both the peroneal tendons swell resulting in an intense pain. Most often, it occurs due to overusing the tendons but it can also be the result of a sudden injury or a fall and aging can also be a reason sometimes. As you grow older, blood supply to your tendons gradually decreases, resulting in thinning and making it easier for you to injure.

In This Article

What are peroneal tendons?

There are two muscles, peroneus longus & peroneus brevis in each leg. They make up the peroneal muscles and they turn into tendons around the ankle.

Peroneus longus runs underneath the foot & attaches to the arch on the inside. While, peroneus brevis attaches to the outside of the foot to the little toe’s base. These peroneal tendons help stabilize the foot and ankle and also protects it from sprains. It also helps stabilize our feet and legs while walking.

How common are peroneal tendonitis injuries?

Peroneal tendon injuries are quite rare. It mostly occurs in athletes, long-distance runners or someone who spends a lot of time on their feet.

Even though peroneal tendon injuries are rare, it causes aggravating pain outside of the foot which doesn’t let you do your favorite activities. But fear not, it is a treatable condition and can be prevented by following a few simple steps.

What exactly causes peroneal tendonitis?

It’s a known fact that our feet and ankles do a lot of work for us everyday and of course they will ask for a break at some point of time.

In case of peroneal tendinopathy, your feet and ankles may take a break for several reasons. Some of the causes of peroneal tendonitis are here as follows:

Overuse: This is one of the most common causes of peroneal tendonitis. Sports like basketball, football, gymnastics or anything that may require quick actions are commonly associated with peroneal tendon injuries/tears. Spending more time on training than usual, using inappropriate footwear are to be blamed for overusing tendons.
Injury: You are at greater risk for peroneal tendonitis if you have experienced any sudden falls or injury to your ankle or repeatedly hurting your ankle may lose balance and put more pressure on the peroneal tendons.
Running: Peroneal tendinitis is more common among runners who frequently run on slopes such as uneven or cambered roads which can lead your foot to turn inside out.
FrozHigh arches: People with high arches or a slightly inward (towards inside) bent heel are at more risk of developing peroneal tendinopathy. Because these conditions put more strain on the peroneal muscles and tendons.en Shoulder: It is uncertain what causes a frozen shoulder. But it often happens during a period of binding, a mistake, or specific illnesses. The pain grows with time as the shoulder becomes harder and harder, reducing movement. But it often happens during a period of binding, a mistake, or specific illnesses. The pain grows with time as the shoulder becomes harder and harder, reducing movement
Other peroneal tendonitis causes may include:

Weakness and tightness of the calf muscles (back of your lower leg)
Having poor circulation
Joints and muscles in the lower limb not working together
Conditions such as arthritis or diabetes
Previous ankle injuries

What does peroneal tendinitis feel like?

Peroneal tendinitis can come suddenly or it can develop over time. In both cases, there are a few common symptoms of peroneal tendonitis and they may include:

A sharp aching sensation on the outside of your foot
Pain at the back of the ankle
Instability of ankle when bearing more weight
Changes in temperature (warm to the touch)
Limping
Swelling on the outside of the leg
Pain usually gets worse with activities and eases with rest
It may hurt when you turn your foot inwards

The symptoms of peroneal tendonitis usually develop gradually over a few weeks or months and these symptoms tend to be worse in the morning and eases once you are up.

How is peroneal tendonitis diagnosed?

The best way to determine if you have peroneal tendinopathy is to visit an orthopedic nearby.

They will collect your medical history first, which includes:

They will ask you if you’ve increased your physical activity suddenly
If you’ve changed your training techniques recently
Any recent surgeries, falls or any injuries
Lifestyle factors
Sports and hobbies
Level of activity

Next step, they will perform various physical examinations which are as follows:

Recording symptoms which are noticeable.
Gait assessment– it’s called walking or motion analysis which is used to assess how the individual stands and walks. It helps in analysing any muscle, nerve or skeletal problems. In this test, they will ask the patient to close their eyes & then to turn 360 degrees. Observes how the patient walks (any hesitancy or multiple attempts), foot clearance, step height for both feet, checking if the right & left steps are symmetrical and analysing the speed of gait (one’s way of walking).
Range of motion (ROM) assessment– It is used to assess how mobile your joints are compared to an average person’s joint movement. Simply put, it will determine how far or little a part of the body can be moved around a joint or a fixed joint.
Strength assessment– it shows the decreased strength of peroneal muscles. The peroneal muscles can be separated and checked if any of the tendons is affected.
Joint assessment– it is used to assess the stability, flexibility and the quality of the joint movement.
Palpation– The doctor will touch and feel your body with fingers or hands by applying different types of pressure to examine the size, texture, location and tenderness of a body part or an organ.
Other imaging tests include– MRI, ultrasound, an X-ray can be used to rule out other possibilities and further helps with diagnosis.

Always go for an early diagnosis so that you can reduce your risk for the condition which helps you for a speedy recovery.

How can peroneal tendinopathy be treated?

People who suffer from peroneal tendonitis are more active, spend a lot of time running, high-intensity training, etc. I know it’s really difficult to slow down your way of life even though the pain is severe, but the best way to treat the condition is to slow down, rest and stay off your feet.

Some of the non-surgical peroneal tendonitis treatment options are available and they include:

‘RICE’ is a short-cut for:-

‘R’ stands for rest: It’s very crucial to avoid all the activities which aggravate your symptoms so that it can heal faster.

‘I’ stands for ice: Apply ice on your ankle regularly, it can help reduce your pain and inflammation of peroneal tendonitis.

‘C’ stands for compression: Wear a support brace or a compression bag, it can help reduce inflammation and instability of your foot or ankle.

‘E’ stands for elevation: Keep your ankle elevated higher than your ankle while resting. It can help reduce the pressure on your foot or ankle.

Few best stretches to manage and heal peroneal tendonitis:

Some of the best stretches which are recommended commonly by the physiotherapists for treating peroneal tendinitis are as follows:

1. Calf stretch:

This is one of the most common stretches which can be done in many different ways. You can follow the steps below to ensure you are doing it right

Firstly, face towards the wall and take a step behind.
Now, step back with the leg you want to stretch. Place your hands on the wall for support.
Bend the leg which is forward and keep the back leg straight.
Now, try to keep the heel of your back foot on the ground in the same position.
Hold this stretch for a whole 1 minute for 3 sets. Do it thrice a day.

2. Towel stretch:

Stretching the muscles above and below the affected area is very important. It can help decrease the neural tension and tightness. Follow the steps below to do the exercise:

You need a large bath towel.
Now, place the towel around the toes of the leg you want to stretch.
Lie down and lift the leg you are stretching while pulling on the towel.
The other leg should lie flat and the leg you are stretching should be straight.
Hold this stretch for half a minute for 3 sets. You can perform this everyday.

3. Golf ball massage:

It’s not mandatory to use a golf ball for this technique, you can also use any hard round object. You can follow the instructions below to perform this technique:

Sit straight while placing your feet flat on the floor.
Now, place the golf ball or any hard round object underneath the arch of your foot.
Apply firm (stable) pressure into the golf ball with the help of your foot.
Now, roll the ball back and forth on the sole of the foot while maintaining the same pressure.
Do this technique for at least 1-2 minutes or the longer you can tolerate. Do it thrice a day.

Most of the cases are resolved with physical therapy, but few people may require surgery. Surgery is for those who had this condition for a longer time, so get an early diagnosis and treatment to avoid this situation.

Don’t endure it, just cure it!

As we all know, peroneal tendonitis is a common condition and it is treatable. So all you have to do is, get a right diagnosis followed by treatment and some stretches at home. With the right treatment and instructions, you should be able to return to do your favourite activities within two weeks.

But, if the symptoms persist longer, don’t just endure it and visit your doctor, get an early diagnosis followed by treatment to be cured from the condition.