How to Deal With Peroneal Tendon Injuries

4 min read

Problems affecting the two peroneal tendons that lie behind the outer ankle bone are common in athletes. These problems mainly occur in the area where the two tendons glide.

What part of the ankle is involved?

The peroneals are two muscles and their tendons that lie along the outside of the lower leg bone and cross behind the outer ankle bone. Major muscles that support the outside (lateral) part of the ankle are called the peroneus longus and the peroneus brevis.

The tendons of these two muscles pass together in a groove behind the outside (lateral) ankle bone. (Tendons attach muscles to bones.) Contracting the peroneal muscles makes the tendons glide in the groove like a pulley. The pulley action causes the foot to point downward (plantarflexion) and outward (eversion).

Why do I have this problem?

Peroneal tendon problems mostly occur where the tendons glide. Their movement can cause irritation of the lining of the tendons. The irritation can also occur after an ankle injury, such as a blow to the outside of the ankle or an ankle sprain.

Repetitive ankle motions in sports, such as running and jumping, can lead to wear and tear on the tendons inside the groove. A high arch puts extra tension on the peroneal tendons within the groove and has also been found to cause peroneal tendon problems.

Peroneal tendon problems commonly occur from an ankle sprain. During the typical inversion ankle sprain, the foot rolls in. This type of injury sprains or tears the ligaments that support the ouside (lateral) part of the ankle. The forceful stretch on the peroneals when the foot rolls in can also cause a lengthwise tear in the peroneal tendons.

Peroneal tendonitis often occurs during the recovery period after an ankle sprain. Because the ankle is unstable, the peroneals may need to work harder to give needed support to the damaged lateral ankle ligaments.

In some patients, a peroneal tendon problem is caused by degenerative changes in the tendons themselves rather than by inflammation around the tendons. The tendon itself becomes abnormal.

Do You Have Tendonitis?

It is important to be aware of the common symptoms associated with this condition to prevent permanent damage.

  • Periodic or constant pain at the outside area of your ankles;
  • The tendons around and above the lateral ankle bone are tender;
  • Your outer ankle may appear to mildly swell;
  • On and off pain begins to develop;
  • Pain becomes more constant even when you take a rest; and
  • Pushing your foot outward against the resistance results in pain.

The diagnosis of peroneal tendonitis is usually made by examination of the ankle by a doctor. X-rays may be ordered to make sure there is no fracture or other problem. The physical examination helps determine where the tendons are inflamed, ruptured, or degenerated.

The doctor will move your ankle into different positions. The peroneal tendons are checked by holding your foot up and out against the doctor’s downward pressure. Stretching the foot up and in can also be used test whether the tendons hurt.

Your doctor may order an MRI scan of your ankle. These images can show if there is abnormal swelling or scar tissue in the tendons. MRI scans can also show lengthwise tears in the tendons.


Initial treatments may involve resting and protecting the sore tendons. You may need to immobilize your foot and lower leg in a short-leg walking boot for two to four weeks. In less severe cases, you may use a stirrup ankle brace, arch support, or lateral heel wedge to take tension off the sore tendons.

You will probably work with a physical therapist. The therapist may use heat, ice, and ultrasound treatments to reduce pain and swelling. Stretching, strengthening, and ankle coordination exercises are added as symptoms ease.

Your doctor may also prescribe medications. Anti-inflammatory medications can help ease pain and swelling and get you back to activity sooner. In rare cases, cortisone can be injected into the sore tendons to relieve symptoms that won’t go away.

Important Reminders

Although many would want to recover from injuries at the shortest time possible, it is vital to keep in mind that recovering properly is more important than recovering fast. Thus, the following should always be remembered:

  • Never attempt to load your injured tendons immediately;
  • Do not begin any exercises while you experience persistent pain;
  • Rehabilitation exercises should be done gradually and consistently until such time that the tendons fully recover;
  • Rest is an integral part of the road to recovery regardless of the degree of the injury;
  • Wearing stiff soled shoes that feature a wide base with high toe off can be beneficial in easing the stress experienced by the peroneal tendons; and
  • Always consult a medical professional to ensure proper recovery from your injury.

Making sure that you do proper stretching and use the right shoes before engaging in any physical activity can go a long way in protecting yourself from possible injuries.

Call into your nearest Foot Solutions store today. We can fit you with the correct footwear & arch support to help prevent tendon injuries.