Condition, Peroneal tendonitis

What Is Peroneal Tendonitis? Causes, Symptoms, and Treatment Options


While many of us are familiar with common injuries such as ankle sprains, much less common conditions such as peroneal tendonitis can be equally painful and debilitating. The condition is characterized by inflammation or irritation of the peroneal tendons. This can lead to loss of range of motion in the foot and ankle joints, pain, and stiffness that worsens with time.

In the human body, a tendon is a belt of tissue that holds muscle to the bones. There are four peroneal tendons in the leg, with each leg having two. The peroneal tendons run side by side behind the bony lump on the lateral malleolus and the lower leg bone (fibula). On each leg, one peroneal tendon is attached to the inside arch and goes under the foot while the other tendon is attached to the outside foot at the base of the smallest toe (fifth metatarsal). The peroneal tendon protects the ankle from sprains and also helps provide stability when the ankle is bearing weight.

What is Peroneal Tendonitis?

Peroneal tendonitis is a condition when the peroneal tendon in the ankle is injured or inflamed; with time, this condition can develop into a more severe condition called tendinosis. This condition is common among athletes, more especially those involved in a high-impact landing sport like running. Pivoting, jumping, twisting, and sprinting with a sharp stop. 

Peroneal tendonitis is usually caused by repetitive friction and stress on the tendons due to overuse or muscle imbalance. This pain is easily ignored at the early warning stage because the pain minimizes when one does a warm-up before an action. Unfortunately, this can cause more severe pain and injury in the ankle.

Causes of Peroneal Tendonitis

Individuals who engage in sports that involve high-impact landing and repetitive ankle motion are more prone to Peroneal Tendonitis. Factors that can cause Peroneal Tendonitis include;

  • Overuse of the ankle
  • A sudden increase in training; especially training that involves you slamming your weight on your feet, like jumping, running, and walking
  • Poor training techniques
  • Improper, bad fitting, or unsupportive footwear
  • Failure to complete a rehabilitation program after an ankle injury
  • Using the ankle when during the healing process
  • Poor running or jumping techniques
  • Lack of enough warm-up time

Other factors that can increase the risk include;

  • Having a high foot arch
  • If your joints and lower limb muscle are not and working and functioning well together
  • If the muscle in the lower limbs is imbalanced or under-developed.


Symptoms of Peroneal Tendonitis

Peroneal Tendonitis can either develop over time (chronic) or happen suddenly (acute). In both cases, the following are the common symptoms;

  • Pain that worsens during activity and reduces during rest
  • Pain or discomfort at the back of the ankle
  • Swelling at the back of the ankle
  • Unstable ankle when bearing weight
  • The swollen area is warm when touched
  • Pain when turning the foot
  • Pain along the outside part of the ankle and foot; and in some cases, the pain affects the whole leg.
  • Pain in the foot when walking, standing, sitting, or even when there is no weight exerted on the foot
  • Pain when exercising

Diagnosis of Peroneal Tendonitis

Peroneal Tendonitis is most times misdiagnosed and gets worse because of wrong treatment; to diagnose Peroneal Tendonitis, proper evaluation by a doctor is advised. To diagnose Peroneal Tendonitis, the doctor will examine the foot, looking for warmth, swelling, pain, weakness, instability on the outer side of the ankle.

Furthermore, an X-ray, MRI scan, or Ultrasound test may be required to fully examine the injury. The doctor would also examine the ankle and foot to ascertain the pain caused is from Peroneal Tendonitis and to check for other related injuries that come with a peroneal tendon injury. Proper evaluation and diagnosis are very important because if the pain continues for long, a simple sprain may add other problems.

Prevention of Peroneal Tendonitis

To avoid getting or developing Peroneal Tendonitis, try the following preventive measures:

  • If you need to increase the workload of your training, do it gradually. Never increase your workload at once.
  • During the recovery period, maintain the level of activity. These measures should be taken more seriously by people involved in sport, especially during the off-season
  • Stretch only the calf and peroneal muscles during recovery. Patients should wait until the pain and inflammation are fully gone before they resume training.
  • Wear proper footwear that appropriately supports the ankle and foot.

Treatment of Peroneal Tendonitis

Just like other tissues and tendonitis injuries, the first treatment is to stop or limit any activity that can cause pain. Individuals treatment procedure varies based on the pain, symptoms, and injury. Below are the general treatments for Peroneal Tendonitis

1. Usage of Pain Medications

Patients can get over-the-counter pain relievers and non-steroidal anti-inflammatory medications based on the doctor’s prescription. These medications include Naproxen and Ibuprofen which can reduce swelling and pain

2. Wearing of Ankle Bracelet for Peroneal Tendonitis

Patients can get an Ankle Bracelet for Peroneal Tendonitis which will help support and protect the ankle from getting injured during the recovery process. Patients can also get ankle boots to support the bracelet or tap the ankle for more support

3. The RICE Method

The RICE method is an acronym for the first stage of treatment procedure for most injuries. RICE stands for Rest, Ice, Compress, and Elevate the affected part. Using this procedure helps reduce inflammation and pain, especially in the initial stage of the condition.

4. Physical Therapy

Physical therapy is a very important procedure where the ankle is strengthened with Peroneal Tendonitis massages, exercises, or heat therapy. Physical therapy will also allow the patient to learn better performance techniques for whatever caused the problem.

5. Cortisone Injections

These are powerful steroidal anti-inflammatory medications, usually recommended by the doctor. Although it is slightly invasive and painful, it will reduce the pain and swelling. It may also weaken the tendons in the peroneal and may cause a tear of the soft tissues later in the future.

6. Shockwave Therapy for Peroneal Tendonitis

EPAT therapy, alternatively known as Extracorporeal Shock Wave Therapy (ESWT) is a painless and non-invasive treatment procedure that brings faster healing by increasing blood flow while producing proteins that can enhance tendon repair and allowing the growth of new blood vessels.

A tool called a Shockwave device is used to deliver high-pressure impulse waves deep into the soft tissues in the ankle on short sessions. This procedure works faster than traditional therapies and is mostly used on athletes so that they can return to action quickly.

7. Surgery

If after trying all these treatment methods the problem remains, Peroneal Tendonitis surgery will be the last resort. Surgeons will have to repair or remove the damaged tendons. There are risks associated with this procedure; patients need to know about the risks before using this treatment. 



Peroneal tendonitis is usually caused by repetitive friction and stress on the tendons due to overuse or muscle imbalance. At first, people tend to ignore the symptoms because the pain comes and goes.

When you feel pains in your ankle, it is important you talk to your doctor for proper examination and diagnosis.