Peroneal Tendonitis

Injuries > Ankle > Peroneal Tendonitis

(Also known as Peroneal Tendinopathy, Peroneal Tendinitis, Peroneal Tendinosis)

N.B. Although recent research suggest that 'peroneal tendinopathy' is the more appropriate term to describe overuse injuries to the peroneal tendon, we will use the term 'peroneal tendonitis' in this document as it is more widely known.

What is peroneal tendonitis?

There are several muscles which lie on the outside of the lower leg and are collectively known as the peroneal muscles (figure 1). These originate from the outer lower leg bone (fibula) and travel down along the outside of the leg where they insert into various bones in the foot via the peroneal tendons (figure 1). 

The peroneal muscles are responsible for moving the foot and ankle away from the midline of the body (eversion – figure 2). Whenever the peroneal muscles contract or are placed under stretch, tension is placed through the peroneal tendons. If this tension is excessive due to too much repetition or high force, damage to the peroneal tendons may occur. Peroneal tendonitis is a condition whereby there is damage to the peroneal tendon with subsequent degeneration and inflammation. 

Causes of peroneal tendonitis

Peroneal tendonitis typically occurs following excessive walking or running (especially on slopes or uneven surfaces) or during sporting activities requiring frequent change of direction and or jumping such as dancing, basketball, football or volleyball.

Signs and symptoms of peroneal tendonitis

Patients with this condition typically experience pain at the outer aspect of the ankle, foot or lower leg during activities placing stress on the peroneal tendons (or after these activities with rest, especially upon waking in the morning). The pain associated with peroneal tendonitis tends to be of gradual onset which progressively worsens over weeks or months with the continuation of aggravating activities. Patients with this condition may also experience pain on firmly touching the peroneal tendons (figure 1).

Diagnosis of peroneal tendonitis

A thorough subjective and objective examination from a physiotherapist may be all that is necessary to diagnose peroneal tendonitis. Diagnosis may be confirmed with an MRI scan or ultrasound investigation.

Treatment for peroneal tendonitis

The vast majority of patients with peroneal tendonitis heal well with an appropriate physiotherapy program. The success rate of the physiotherapy program is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.

Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Once chronic, healing slows significantly resulting in markedly increased recovery times. Immediate appropriate treatment in all patients with this condition is vital to ensure an optimal outcome.

Following the R.I.C.E. Regime with regular icing and anti-inflammatory medication may help to significantly reduce inflammation in the initial phase of this condition. A graduated flexibility, balance and strengthening program under direction from a physiotherapist is vital to ensure an optimal outcome.

Contributing factors to the development of peroneal tendonitis

There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a physiotherapist and may include:

• poor flexibility
• inappropriate training
• poor foot biomechanics
• inappropriate footwear
• muscle weakness

Physiotherapy for peroneal tendonitis

Physiotherapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of injury recurrence. Treatment may comprise:

• soft tissue massage
• electrotherapy (e.g. ultrasound)
• anti-inflammatory advice
• stretches
• joint mobilization
• taping
• bracing
• the use of crutches
• ice or heat treatment
• exercises to improve strength, flexibility and balance
• education
• activity modification advice
• biomechanical correction
• footwear advice

Prognosis of peroneal tendonitis

Most patients with this condition heal well with an appropriate physiotherapy program. This, however, can be a lengthy process and may take several months in patients who have had their condition for a long period of time. Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Early physiotherapy treatment is vital to hasten recovery and ensure an optimal outcome.

Other Intervention for peroneal tendonitis

Despite appropriate physiotherapy management, a small percentage of patients with this condition do not improve adequately. When this occurs the treating physiotherapist or doctor can advise on the best course of management. This may involve further investigation such as an X-ray, Ultrasound, CT scan or MRI, corticosteroid injection, autologous blood injection, pharmaceutical intervention or a review by a specialist who can advise on any procedures that may be appropriate to improve the condition. A review with a podiatrist for the prescription of orthotics and appropriate footwear advice may also be indicated.

Exercises for peroneal tendonitis

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.

Foot and Ankle Up and Down  

Move your foot and ankle up and down as far as possible and comfortable without pain (figure 3). Repeat 10 - 20 times provided there is no increase in symptoms.

Figure 3 – Foot and Ankle Up and Down (left leg)

Foot and Ankle In and Out 

Move your foot and ankle in and out as far as possible and comfortable without pain (figure 4). Repeat 10 -20 times provided there is no increase in symptoms.

Figure 4 – Foot and Ankle In and Out (right leg)

Lunge Stretch 

With your hands against the wall, place your leg to be stretched in front of you as demonstrated (figure 5). Keep your heel down. Gently move your knee forward over your toes as far as possible and comfortable without pain. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided there is no increase in symptoms.

Figure 5 – Lunge Stretch (right leg)

Find a Physio for peroneal tendonitis

Find a physiotherapist in your local area who can treat this condition.

Other ankle exercises

View more ankle flexibility exercises.

View ankle strengthening exercises.

View balance exercises.

Physiotherapy products for peroneal tendonitis

Some of the most commonly recommended products by physiotherapist for patients with peroneal tendonitis include:

1. Crutches
2. Ice and Heat Packs
3. Ankle Braces
4. Ankle Supports
5. Sports Tape (for protective taping)
6. Wobble Boards (for rehabilitation)

To purchase physiotherapy products for peroneal tendonitis click on one of the above links or visit the PhysioAdvisor Shop.

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