Introduction

Inflammation or irritation of the tendons that run along the outside of the ankle and/or foot is known as peroneal tendonitis. It is usually caused by overuse of the muscles from excessive activity or sport. It usually recovers within a few weeks if proper rest and care is taken but untreated tendonitis can lead to a tear or worse conditions.³ If you present with any of the common symptoms of peroneal tendonitis, there are many natural treatments and home remedies available which will be covered in this article. 

Home remedies are an affordable and convenient option for many people, and prevent the need for a visit to the doctor’s office. This article will cover what tendons are, the difference between tendonitis and tendinosis, an overview of peroneal tendonitis specifically, and some home remedies found online. It will end with a couple of causal factors of the condition.

What are tendons

Tendons can be found throughout the body and connect muscle and bone, transmitting force and aiding mobility to the limbs. They are essential anatomical components that prevent injury by absorbing force while running, jumping, or performing any exercise that places a lot of pressure on the limbs and joints.¹ Tendons have multiple layers composed of different structures that allow them to carry and absorb the bulk of a force upon impact.

Tendonitis vs tendinosis

Tendonitis and tendinopathy are terms commonly confused with one another and used together but describe different conditions. Tendonitis is acute (short-term), and is a result of micro-tears in the collagen fibres when the tendon unit is overloaded with force that’s too heavy or comes on too fast. Tendinopathy is any condition affecting the tendons.

Tendinosis, however, is a complete degradation (destruction) of the collagen from chronic stress, overuse, or repetitive injury. It can occur in any tendon, anywhere in the body and can sometimes lead to further injuries.²

Peroneal tendonitis 

Now coming to peroneal tendonitis. It is tendonitis specifically of the hindfoot and lateral foot which sometimes leads to ankle instability. It tends to affect younger people, especially athletes, and pre-existing conditions or injuries may increase the likelihood of developing tendonitis in that area.^4,5

Common symptoms

A list of common symptoms includes:

• Pain and swelling on the outside of the ankle – this includes above and below the ankle area
• Pain on the border of your foot
• Instability while walking and struggling with uneven surfaces
• Feelings of instability/falling to one side
• Activity or exercise makes the symptoms worse and increases the pain

Home remedies for peroneal tendonitis

As mentioned before, home remedies are convenient and quick treatment options to alleviate pain and prevent further injury. Here are a few strategies listed below:⁶

Rest and immobilisation

Resting the foot and reducing movement as much as possible for 2 to 3 days helps heal the affected area. This includes avoiding exercise and strenuous movements for the foot. While resting, ice therapy to the ankle/foot may help reduce inflammation. This can be done by wrapping ice, or anything frozen, around in a towel and placing it on the foot. Avoid making direct contact with the ice and skin. While resting the foot at home, wrapping it in an elastic bandage and creating a brace may provide further help. If opting for a brace, be sure to remove it before sleeping. 

Ice therapy

Here are a few recommendations for how to apply ice to the inflamed area: 

• Wrap ice in a towel/cloth/rag/old t-shirt to avoid ice burns
• Place it on the inflamed area for 10-20 minutes at a time
• Repeat 2-3 times per day for the first week of a flare-up
• Stop application if symptoms become worse, or the area appears more inflamed 

Stretches

There are also stretches and exercises you can do at home to manage pain onset and speed up your recovery time:

• Calf wall stretches– place the unaffected foot facing forwards towards a wall, and the affected leg behind, keeping the legs straight 
  • Place your hands on the wall and push 
  • Keeping the back leg straight, bend the front knee until you feel a stretch in the back of your affected leg
  • Hold this stretch for 15 to 30 seconds and repeat 2 to 4 times 
• Calf wall stretches with both knees bent – start similarly to the previous stretch 
  • In this one, once both feet are apart, bend both knees until you begin to feel a stretch 
  • Hold for 15 to 30 seconds 
  • Repeat 2 to 4 times
• Hamstring wall stretch – you will need to lie on your back by a doorway for this stretch
  • Lie on your back facing the open doorway with the unaffected leg lying on the ground passing through the door 
  • The affected leg goes up the wall, creating a 90-degree angle to the ground
  • Keep the legs straight and you will feel a stretch along the affected leg
  • Hold the stretch for at least 1 minute, and with repetition gradually increase the time to 6 minutes 
  • Repeat this 2 to 4 times
  • Reminders –do not bend the knees and do not arch the back
• Shin muscle stretch – this stretch requires a chair 
  • Sit upright in the chair with both feet flat on the ground
  • Bend the affected leg behind you so that the toes are bent/curved on the ground and pointed away from the body
  • Hold for 15 to 30 seconds, feeling the stretch in the lower leg, particularly the area around the shin
  • Repeat 2 to 4 times

Footwear

While it may be tempting to continue wearing normal shoes and footwear, some types of shoes can exacerbate your symptoms and prolong the recovery time. During the first couple weeks, right after injury, it’s advised to wear an ankle brace. It decreases the amount of force absorbed by the tendon allowing it to rest and recover much quicker. If the tendonitis persists, first consult your physician, but it may also help to wear a walking boot. Follow your doctor’s recommendations regarding the boot. 

While outside the home, consider using arch support that can be placed inside of shoes. Arch supports work similarly to a brace by absorbing force to give the tendons in your foot a break. There are arch supports that can be placed in flats, high heels, and more if you are looking for wider options. Until the swelling and pain subside, consider wearing sandals rather than house slippers as they provide more support and transfer force away from the ankle.⁷ 

Massage therapy

Another option to consider is massages. Often recommended for sports injuries, massages can be both relaxing and therapeutic. Massages target tendons to work the injured or inflamed fibres and surrounding tissue. This releases tension, loosening the muscles and allowing blood to flow through while also promoting collagen production. A sports massage combines different massage techniques to stretch and stimulate the muscles by applying sustained pressure and friction.⁷

When to seek medical attention

See your normal physician if the symptoms do not improve or get worse. But seek immediate medical attention if you experience severe, unmanageable pain and/or you think you have ruptured a tendon.⁷

Causes of peroneal tendonitis

Lastly, here are a few causes of peroneal tendonitis to minimise injury in the future and know what to look out for if you have any of the following conditions:

• Intense physical activity – increased pressure on the feet and ankles
• Smoking
• Lack of recovery time between physical activities 
• Prolonged use of corticosteroids and antibiotics 
• Wearing unsupportive footwear
• Poor exercising techniques (poor form) which results in overloading of the muscles 
• Previous foot and ankle injury/trauma
• Diabetes
• Tightness in the back of the leg
• Inflammatory conditions (eg. rheumatoid arthritis) 
• Being overweight
• Increased age – weakening of the muscles over time 

FAQs

What does peroneal tendonitis feel like?

You may feel unstable while walking, and a pain on the outside or outer edge of the ankle.

What is the fastest way to cure tendonitis?

Rest, ice, and anti-inflammatory medication.

Can you walk with peroneal tendonitis?

If the symptoms are mild, walking is fine as long as there’s no pain associated with it. If experiencing more severe symptoms, it is best to rest for as long as possible. 

How long does peroneal tendonitis last?

Approximately 6-8 weeks.

What happens if you ignore peroneal tendonitis?

You may have persistent ankle pain and functional problems. 

Does tendonitis ever fully heal?

Most cases recover fully without the need for medical attention. 

Can tendonitis be seen on an X-ray?

Tendonitis is a condition of the soft tissues in the body, and since X-rays focus on bones, tendonitis may not be picked up by X-ray. 

What can be mistaken for tendonitis?

Muscle strains often present with similar symptoms as tendonitis so it is best to monitor symptoms carefully and report any changes. 

What kind of pain is tendonitis?

It is a dull but constant soreness type of pain. 

Summary

This article covered a few home remedies for treating peroneal tendonitis as well as common causes and symptoms of the condition. It also looked at the difference between tendonitis and tendinosis and gave a brief overview of what tendons are. Many home remedies encourage resting the ankle/foot and taking a break from physical activity but continuing to stretch the muscles to relieve some of the tension.