Peroneal Tendinopathy

Peroneal Tendinopathy

Article by John Miller

What is Peroneal Tendinopathy?

Peroneal Tendonitis

Peroneal tendonitis is the often-used term for peroneal tendinopathy. Peroneal tendinopathy is a condition characterised by structural changes of the peroneal tendon in response to load. Contrary to popular belief, it is not an inflammatory condition. Swelling is present due to irritation of the tendon and surrounding structures. However, it is not a crucial aspect of the injury. This lack of inflammation is why health practitioners refer to peroneal tendonitis as the more accurate term: peroneal tendinopathy.

More info about tendinopathy.

Peroneal tendon injuries are usually due to increased loads and overuse of the peroneal muscles. Over time, the tendon thickens to manage the increase in a tensile load more effectively. Minor structural changes are reversible and often respond well to physiotherapy management.

What are the Peroneal Muscles?

The peroneal muscles are on the outside of your lower leg. They turn the foot out and provide stability to the ankle during weight-bearing. The peroneal tendons wrap around the lateral malleolus (the bony lump on the outer ankle) and attach to different areas on your foot. Every time the peroneal muscles contract, tension is placed on the tendons.

What Causes Peroneal Tendinopathy?


Many different factors can cause peroneal tendonitis, including

  • A sudden increase in weight-bearing activities, mainly walking, running or jumping.
  • Inadequate or unsupportive footwear
  • Muscle imbalances of the lower limb
  • Poor lower limb biomechanics
  • Incomplete rehabilitation following an acute ankle injury, such as an ankle sprain

What are the Symptoms of Peroneal Tendinopathy?

People with peroneal tendinopathy may experience:

  • Gradual worsening pain over the outside of the ankle
  • Pain during or after weight-bearing activities.
  • Pain with turning the foot in or out
  • Instability around the ankle when weight bearing

How is Peroneal Tendinopathy Diagnosed?

Your physiotherapist is an expert in diagnosing peroneal tendinopathies. A variety of tests will determine the diagnosis and exclude other causes of lateral ankle pain. An ultrasound scan may also confirm the diagnosis.

Peroneal Tendinopathy Treatment

The prognosis for peroneal tendinopathy is variable, depending on the stage of the injury.

In the acute phase, you should start to notice an improvement within a couple of weeks of treatment. Treatment in this stage aims at reducing load and allowing the irritated tendon to settle. Once the pain lessens, you will be started on a home exercise programme to normalise range of motion, strengthen the lower limb muscles and improve your balance.

Chronic tendinopathies will take longer to recover. The treatment at this stage is primarily based on active rehabilitation to improve the tendon’s ability to respond to load. This rehab will include eccentric strengthening of the peroneal muscles and balance, strength, and range of motion exercises of the lower limb.

Peroneal Tendinopathy Prevention

There are several things you can do to reduce your risk of developing peroneal tendinopathy.

  • Wear correct, supportive footwear for you- this is not necessarily the most expensive or newly released shoe on the market!
  • Gradually increase your training load or exercise level.
  • Maintain a level of activity in the “off-season”-
    • Cross-training is not only great for maintaining your cardiovascular fitness, but it will also ensure your muscles stay healthy and reduce your risk of re-injury when you return to your chosen sport!
  • Improve your balance and ankle proprioception

Return to Sports with Peroneal Tendinopathy

Recovery for athletes with peroneal tendinopathy is generally good, and most people can return to their previous sporting level without any ongoing problems. You must complete your entire rehabilitation program as prescribed by your physiotherapist to prevent further issues and reduce your re-injury risk.

Common Ankle Injuries

ankle pain

Sprained Ankles

The most common ankle injury is a sprained ankle, but ankle pain can have numerous sources.

Ankle Fractures

An ankle fracture occurs when there is a break in one or more of the bones. The most common ankle fractures are avulsion fractures of your distal fibula, which can be a side effect of an ankle sprain. All suspected fractures require medical investigation and professional management by your health professional to avoid long-term foot and ankle issues. If your healthcare professional suspects an ankle fracture, you will be referred for at least an X-ray and potentially an Orthopaedic Surgeon.

Ankle Tendinopathies

While muscle strains are more common in your legs, there are essential muscles that converge into tendons that wrap around your ankle to stabilise your ankle and foot to protect them from sprains and allow you to walk and run. These muscles and their tendon vitally provide you with a normal foot arch and avoid flat feet. Your muscles or tendons can become injured or inflamed as a result of overuse or trauma. The inflammation is called tendonitis. They can also tear, completely rupture, or sublux out of place. Medically tendon injuries are known as tendinopathies, and at the ankle may include:

Ankle Arthritis

Your ankle pain and dysfunction can lead to degenerative conditions such as ankle osteoarthritis. While arthritis usually is a chronic deterioration of your ankle joint, it is crucial to slow ankle arthritis progression. Would you please seek the professional advice of your ankle and foot health practitioner, e.g. physiotherapist or podiatrist?

Biomechanical Conditions

Biomechanical disorders may result in foot deformation, painful weight-bearing and potentially nerve compression. In simple terms, this is where your foot and ankle do not have normal bone alignment and motion contr. Here are a few possible conditions related to poor ankle biomechanics.

Muscle Injuries

Nerve-Related Ankle Pain

Children & Youth Conditions

Systemic Conditions That May Cause Ankle Pain

Soft Tissue Inflammation

Other Useful Information