What Is Peroneal Tendonitis? A Guide to Pain, Inflammation, and Diagnosis

Peroneal tendon injury is an inflammation characterised by pain located on the outer side of the ankle or foot.¹ This also involves the degeneration of the peroneal tendons, which are the essential structures of fibres that make movement easy when you walk or do physical activities. The main cause is often misuse or trauma, which then leads to peroneal tendonitis. Understanding the root of the problem can lead to early treatment, managing the pain effectively, and avoiding further complications.²

This discomfort typically alleviates with rest but intensifies during activities like simple walking, running, and jumping. Initial management for peroneal tendonitis typically involves home-based exercises.¹

Inside the Foot: Understanding Its Structure and Function

A tendon plays an essential role within the musculotendinous unit, which is the connection between muscle and tendon, facilitating the transfer of forces from muscles to the rigid structures of bone, which permits joint movement. They possess greater strength than muscles and are capable of supporting nearly seventeen times your body weight. Tendons focus the force exerted by muscles on a limited area, helping the muscle to alter its direction and function from a distance. This approach ensures that the underside of the muscle maintains an ideal distance from the joint, eliminating the need for an excessive stretch of muscle connecting the origin and insertion. Tendons consist of a combination of loose, fatty areolar tissue, nerves, blood vessels, and collagen within a matrix outside of the cell. The tendon’s mechanical role involves facilitating its smooth movement against the surrounding tissue, which consists of 30% collagen and 2% elastin. Elastin plays a crucial role in providing flexibility to the tendon, whereas muscle is predominantly composed of fibres, which are essential for maintaining this flexibility.³

How Does Peroneal Tendonitis Start?

Peroneal tendonitis may occur from multiple causes in anyone. It can go from repetitive movements of the ankle, such as dancing, running, and intensive sports, inadequate shoe wear, to structural foot abnormalities. Specific medical disorders, including diabetes, rheumatoid arthritis, and osteoarthritis, may elevate the problem.

In addition, some other causes may be affected by:^1,2,4

• Ageing
• Excess body weight
• Muscle weakness or rigidity in the feet or legs
• Engaging in prolonged durations of standing 
• Inadequate exercise or training methods and insufficient recovery time from activities
• Extended administration of certain drugs, such as steroids
• History of surgical intervention or injury in this area
• Nicotine, which includes the practice of smoking

Recognising the Early Signs of Peroneal Tendonitis

Excessive use of the tendons can lead to inflammation of the peroneal tendons gradually. Alternatively, it may occur rapidly as a result of an unexpected ankle fracture, such as a sprain.

Common symptoms include:

• Swelling, which can impede their smooth movement
• Pain in the ankle extending through the tendon
• Discomfort that intensifies with exercise
• Inflammation may cause an increase in the temperature in the area surrounding your muscle tissue
• Haematoma in a red or purple colour
• Wider (or enlarged) tendons may manifest as a palpable mass or lump beneath the skin

Warning symptoms that indicate the rupture of the tendons:⁴

• Weakness and instability in the ankle
• Severe discomfort in the area located on the lateral aspect of the foot and ankle
• Acute and cracking sensation

Peroneal Tendonitis Recovery: What You Can Do at Home

When the peroneal is damaged, rest is essential, so minimising the movement of the tendon for 2-3 days will help with the symptoms. Also, apply a compress with ice, wrapped in a towel, to the tendon for a duration of up to 20 minutes at intervals of 2 to 3 hours. 

In mild cases, once you can move the injured area without experiencing pain, continue the exercises at home to prevent stiffness in the joint,⁵ such as:⁶

• Calf Wall Stretch: Face a wall and extend one leg back. Maintain a straight back leg, ensuring both heels remain grounded and toes are directed forward. Flex your front knee and lean forward gently until you experience a stretch in your calf muscle
• Seated Ankle Stretch: Position yourself in a chair and place your affected leg across the other. Gently use your hands to position your foot downward (toes directed towards the floor), maintaining this position for 5–10 seconds. Then, adjust it upward (toes pointing towards the ceiling) and hold once more

These exercises usually minimise the risk of additional injury or discomfort; keep in mind that if the pain persists in the next few weeks, it is advised to look for a healthcare provider.^1,5

How Non-Steroidal Anti-Inflammatory Drugs Can Help With Peroneal Tendinopathy

NSAIDs are an abbreviation for non-steroidal anti-inflammatory drugs and are the most prescribed drugs globally. These drugs act by reducing COX 1 and COX 2, which are enzymes that produce prostaglandins. Prostaglandins are hormones that affect the human body and lead to inflammation, pain, and other body functions. Therefore, these drugs decrease the local inflammation, pain, and fever, which minimises these symptoms. Although NSAIDs are typically considered safe and easily accessible from the counter, they may lead to side effects, particularly with prolonged use. Approximately 10% of the individuals who do not take these drugs frequently may not experience gastrointestinal complications, such as ulcers or cardiovascular issues. 

Healthcare specialists may also prescribe creams that might have the same efficacy on muscle and joint pain when compared to other topical options, such as diclofenac, resulting in reduced side effects relative to oral medications.⁷

These drugs act as pain relief by reducing the inflammation and swelling around joints and the ends of nerves.¹

The most common medicines prescribed by a healthcare provider in order to be effective in alleviating these symptoms include:⁸

• Aspirin
• Naproxen
• Ibuprofen
• Tylenol 

FAQs

What Are the Best Ways to Speed Up Healing from Peroneal Tendonitis?

To speed up recovery from peroneal tendonitis, it depends on the type of injury. It can include the combination of rest, elevating, compressing, and putting ice on the local area, as well as rehab, such as repeated exercises at home which involve single-leg balance and heel raise.^1,4

Summary

Medicines are essential for treating the pain and inflammation linked to peroneal tendonitis. Commonly used to alleviate inflammation and provide relief from discomfort, NSAIDs include ibuprofen and naproxen. These can be administered orally or applied directly to the affected area to improve localised pain while minimising side effects.

On the other hand, rest, ice, elevation, and rehabilitation on top of medicines boost the healing. If the tendons rupture, the healthcare provider may recommend surgery.