Introduction

This article will introduce peroneal tendonitis, provide an overview of causes and symptoms, and give you advice on how to manage and prevent the condition. 

Definition of peroneal tendonitis

Peroneal tendonitis describes a condition that causes pain around the outside of your ankle or foot.¹ The pain usually improves with rest and worsens with physical activity, for example with running, walking, or jumping.¹ 

Importance of prevention

It can take a long time for peroneal tendonitis to get better.² Once you have had the condition once, it may also come back regularly.² Therefore, it is better to prevent it from occurring in the first place.² This article will introduce you to ways to help prevent peroneal tendonitis from occurring. 

Understanding peroneal tendonitis

This section will explain how peroneal tendonitis may arise. 

Explanation of peroneal tendons

The peroneals are muscles that travel down the back and outside of your lower leg.³ There are two peroneal muscles with tendons that run behind your ankle to attach to your foot.³ 

The peroneal tendons provide stability to your ankle when walking or running.³ They help prevent you from turning over on your ankle when moving and help to provide mobility to your ankle.³  

It is these peroneal tendons that become damaged and inflamed in peroneal tendonitis.  

Causes of peroneal tendonitis

There are several causes of peroneal tendonitis which are outlined below.^1,4,5 

Overuse

The most common cause of peroneal tendonitis is overuse of the muscles and tendons. Overuse results in small injuries to the tendons leading to pain and inflammation. 

Poor footwear

Wearing poor or unsupportive footwear may also lead to peroneal tendonitis. 

Muscle imbalance

Conditions which cause an imbalance between your muscles, or if you have weakness or tightness in your muscles, may predispose to the development of peroneal tendonitis. Muscle imbalance may originate from previous surgery or trauma, poor exercising technique, or the presence of an inflammatory condition. Various strengthening exercises may help resolve this and are outlined below. 

Biomechanical factors

Biomechanical factors describe how you move, or position your body. In the case of peroneal tendonitis, this refers to force, motion or body position of your ankles and feet. Therefore, spending long periods of time standing, running or jumping, with sudden alterations to the duration of these activities may lead to peroneal tendonitis. Sudden ankle injuries, sprains or instability may also lead to inflammation and tendonitis of the peroneal muscles. 

Other causes

Several other causes alongside those outlined above of peroneal tendonitis exist and include: 

• Being overweight 
• Older age
• Diabetes⁶ 
• Inflammatory conditions, such as rheumatoid arthritis⁷
• Prolonged use of specific drugs, including oral corticosteroids and fluoroquinolone antibiotics¹ 
• Smoking 

Signs and symptoms

The signs and symptoms of peroneal tendonitis are outlined below: 

Pain along the outside of the foot and ankle

The most common symptom of peroneal tendonitis is pain along the outside of the foot and ankle.¹ It may occur above, behind or below the outside of the ankle.¹ The pain tends to get worse with activity and improves with rest.⁴ 

Swelling

The pain from peroneal tendonitis may be associated with swelling around the foot and ankle.¹ 

Weakness and instability in the foot and ankle

Many individuals with peroneal tendonitis may struggle with weakness in the foot and ankle.⁵ Weaknesses may lead to instability, especially when walking on uneven surfaces.⁵ You may also feel increasingly unbalanced when standing on the affected leg.⁵  

Prevention strategies

Peroneal tendonitis can take a very long time to heal.² It may also come back once you have had the condition once.² Therefore, it is important to prevent the condition from occurring in the first place.² This section will outline several ways to prevent peroneal tendonitis from occurring. 

Proper footwear

One of the causes of peroneal tendonitis is poor and unsupportive footwear.^1,4,5 Therefore, choosing proper footwear is important to prevent the condition from occurring. 

Choosing supportive shoes

To avoid peroneal tendonitis, try to avoid flat, hard, unsupportive footwear. Soft, flexible shows will also provide you with little to no support. 

It is well known that choosing supportive and comfortable shoes can be very beneficial in treating ankle conditions, including peroneal tendonitis.⁸

When buying new shoes make sure they fit correctly. Importantly, they should not be too tight on your toes and fit comfortably around your heel. The NHS provides a detailed summary of how to choose supportive shoes. 

Avoiding worn-out shoes

In peroneal tendonitis, it is also important to avoid worn-out shoes as these will also provide you with little support. 

Strengthening and stretching exercises

One of the causes of peroneal tendonitis is muscle imbalance.^1,4,5 Therefore, strengthening the muscles around your foot and ankle can prevent the condition from occurring. 

Below we provide some limited examples of exercises you may do to help strengthen your muscles. The NHS provides a breakdown with pictures of how to complete more strengthening exercises and examples of exercises for ankle pain. 

Calf raises

1. Stand and hold the back of a chair
2. In a slow and controlled manner, lift your heels off the floor to a comfortable point

Repeat this a couple of times. 

Ankle circles

1. Sit down on a chair and make sure you are comfortable
2. Move both your ankles in small circles in one direction 
3. Repeat this in the other direction 

Repeat this a couple of times. 

Towel stretch

1. Sit comfortably on the floor or  a chair
2. Loop a towel around the underside of your foot
3. Slowly and gently pull the towel towards you 

Hold this position for a couple of seconds before repeating on the other side. 

Gradual increase in activity

Peroneal tendonitis can often be caused by a sudden change in activity levels.² Instead, try to gradually increase the intensity and duration of any physical activity to prevent strain and overuse of the peroneal muscles and tendons.² 

Warm-up and cool-down routines

When starting exercise, make sure you begin by warming up your muscles.² At the end of your workout, run or walk, make sure to cool down with stretching.² This prevents suddenly putting strain onto your muscles and tendons and causing any injury.² A cool down helps to stretch out muscles and tendons at the end of the exercise.² 

The NHS provides a concise summary of how to warm up and cool down before and after exercise, respectively. 

Proper technique

To prevent injury during exercise it is important to keep a proper technique.² This will prevent strain or minor muscle and tendon injuries, which may lead to peroneal tendonitis.² You can find several resources online to teach you proper techniques, for example running or other sports techniques. 

Rest and recovery

 While building up exercise slowly helps to prevent peroneal tendonitis, resting and allowing your muscles to recover is equally important.² Try not to overuse your muscles and stop exercising if you feel any pain or tension. 

Lifestyle modifications

Peroneal tendonitis may also be prevented through several lifestyle modifications.² 

Healthy weight management

Maintaining a healthy weight is important to prevent peroneal tendonitis.² The NHS provides useful information on healthy weight management. 

Hydration

It is also important to drink plenty of water and keep hydrated to prevent muscle and tendon injury.² The NHS recommends drinking between 6 to 8 glasses of fluid each day. 

Balanced diet

Alongside maintaining a healthy weight and hydration, you must eat a balanced diet.² Further information can be found on the NHS website on consuming a balanced diet. 

When to seek medical help

If you have any of the following factors it is important to seek medical help and advice from your healthcare professional. 

• Persistent pain
• Severe swelling
• Difficulty walking

They may provide further support on how to deal with your condition or suggest it is due to another diagnosis. 

Summary 

Peroneal tendonitis occurs when the peroneal tendons in the ankle and foot become injured and inflamed from overuse, a muscle imbalance, poor footwear, instability or trauma. The condition can take a very long time to heal so it is important to try and prevent it from occurring in the first place. To do this make sure you wear proper and comfortable footwear, engage in physical activity including strength exercises, and keep a healthy weight and diet. If you are concerned, contact your healthcare professional for further information and advice. 

FAQs 

What does peroneal tendonitis feel like?

Peroneal tendonitis causes pain along the outside of your ankle and foot.¹ It may also cause swelling and instability.¹ 

What is the fastest way to treat peroneal tendonitis? 

Treatment for peroneal tendonitis includes rest, putting ice on the affected area, and taking anti-inflammatory medications.¹

How long does peroneal tendonitis last? 

Peroneal tendonitis may take up to 4 to 6 months to completely heal.¹