If you’ve felt pain or swelling on the outer side of the ankle after doing sports, running, or walking on a trail then you may be experiencing peroneal tendonitis. It’s a commonly ignored injury. If treated poorly, it can cause problems with your daily movement, and sports performance. This article is targeted to beginners, and it explains the condition, causes and symptoms of peroneal tendonitis, as well as the available treatment and preventive measures.
Understanding the Peroneal Tendons
We can start to understand the injury by explained what the peroneal tendon is.
You have two peroneal tendons, which are each located on the lower part of your leg, and behind the lateral malleolus. This is the lump on your ankle. The lower leg muscles that are called peroneus longus and peroneus brevis, hold the tendons, and the muscles are attached to your foot.
They are meant to:
- Help your ankle and feet during foot movement.
- Prevent your ankle from rolling inward.
- Help you balance when walking, running, or jumping.
If these tendons are not treated poorly, it can lead to peroneal tendonitis which is cause by overuse and stress of these tendons.
What Is Peroneal Tendonitis?
Peroneal tendonitis (other references call it Peroneal tendinitis) Is an inflammation of one or both tendons in the group located in the outer part of the leg called the Peroneal Tendons. This condition occurs from overuse of the tendon, excessive repetitive motion, and sudden increases in physical activity.
Peroneal tendonitis is more common with runners, some athletes, and hikers, BUT it can occur in anyone and in finds people of weak muscle tone around the ankle. and Biomechanical issues such as poor footwear. Treated will tendonitis tend to be more chronic and progressive, bordering to Peroneal tendinopathy. This is why, improvement or treatment of the tendon injury in the early stages is crucial.
Common Causes of Peroneal Tendonitis
There is not really one single origin of the condition, but there are several and multiple risk factors and activities that can disproportionally increase one’s risk of developing the condition.
Here are the most common activities or risk factors
- Overuse or Repetitive Motion – Tendons will be strained over a period of time with excessive running or repeated jumping.
- An Increase of Activity – This can be increasing running distance too quick or changing a workout to a more aggressive regimen.
- Improper Footwear – This is an apparent lack of ankle support shoes.
- Ankle Instability or Old Sprains – Old injuries diminish the strength of the ankle’s tendons and surrounding muscles.
- High Arches (Cavus Foot) – The shape of your foot will put additional strain on your peroneal tendons.
- Uneven Surfaces – Running off road and uneven terrain can result in repetitive stress.
- Tight Calves – Decreased flexibility will impact your gait and will put additional stress on the outer ankle.
Friction, strain, and repetitive loading on tendons will cause inflammation in the tendon.
What does peroneal tendonitis feel like?
Peroneal tendonitis will develop gradually and will not happen in a matter of days. The early signs can be mild, and get increasingly painful over time if not addressed.
- Pain on the outer side of the ankle (behind the bony bump)
- Swelling and/or warmth in the area
- Pain on the side of the ankle that is tender to the touch
- Pain that is worse with activity, but will get better with rest
- Weakness and/or instability with standing or walking
- A SNAP or CLICK around the ankle in some cases.
Pain can spread to the foot and/or up the leg, and will make walking/sports participation harder if it is untreated.
Diagnosis: How Is Peroneal Tendonitis Recognized?
Diagnosing peroneal tendonitis usually involves a combination of the following methods:
- Physical Examination – Looking for inflammation, tenderness, and range of motion deficits.
- Medical History – Gathering information around activity levels, prior injuries, and symptoms.
- Imaging Tests –
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Ultrasound can reveal tendon inflammation or small tears.
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MRI (Magnetic Resonance Imaging) provides detailed images of tendon structure and surrounding tissue.
These tests help rule out other possible conditions, such as ankle sprains, stress fractures, and arthritis.
Recommended Treatment for Peroneal Tendonitis
The good news is that the majority of peroneal tendonitis cases can be managed non-operatively. This is aimed at restoring the tendon to normal function and the alleviation of inflammation and pain.
The primary treatment methods that can be beneficial include:
1. Rest and Activity Modification
Relieve pain by stopping running, jumping, or any other activities that cause pain. Switching to low-impact activities, such as swimming or cycling, can help. This will allow the tendon to heal.
2. Ice Therapy
Use a pack of ice for 15-20 minutes at a time. Do this repeatedly throughout the day to help with any swelling and pain.
3. Compression and Elevation
Using an ankle brace or some type of compression wrap can help keep the area supported. Elevating the affected foot can help reduce swelling.
4. Anti-Inflammatory Medications
Using over-the-counter NSAIDs like ibuprofen or naproxen helps with pain and swelling.
5. Physical Therapy
A physical therapist can help with rehabilitation by including:
- Stretching the calves and ankles.
- Strengthening the peroneal muscles.
- Re-injury prevention with balance and proprioception.
6. Footwear or Orthotics
Shoes with good support or custom orthotic inserts can help biomechanics and lessen the stress on tendons.
7. Immobilization (Severe Cases)
In more extreme or chronic situations, a doctor may prescribe a walking boot or cast for a few weeks so the tendon can rest fully.
8. Surgery (Last Resort)
When there’s a type of tendon tear, or a tendon doesn’t respond to conservative treatment, they will likely suggest tendon repair and/or debridement of the injured tissue. Rarely, it will be the last option reserved for long-standing injuries.
Recovery and Prevention Tips
Treating this appropriately will allow most people to recover in 6 to 8 weeks, with longer recovery times for more severe cases. To help avoid setbacks, remember to:
- Warm up for your workout.
- Use shoes with good support.
- Increase the intensity of your training slowly.
- Regularly stretch your calves and ankles.
- Build up those foot and ankle muscles.
Wearing the right shoes and attending regular therapy will go a long way in helping you avoid foot tendon issues.
Summary
Peroneal tendonitis affects the tendons in the outer ankle and is often a consequence of overuse, poor footwear, bad biomechanics, and if left untreated, becomes chronic. The good news is that you can fully recover with the right lifestyle changes, physical therapy, and rest.
Listening to the body is best in avoiding chronic conditions. Healthy tendons allow athletes and recreational walkers to move freely.
Peroneal Tendonitis FAQs
1. What is the fastest way to heal peroneal tendonitis?
Rest and ice will enhance recovery, stay off high-impact exercise to allow the tendons time to heal and it is recommended to do physical therapy.
2. How long will it take to heal peroneal tendonitis?
Depending on treatment and care, mild cases can take 2 to 4 weeks while moderate to severe might take 6 to 12 weeks.
Q3. Can you walk with peroneal tendonitis?
You can walk a little. But do not walk far or on uneven ground. And definitely stop if walking increases the pain.
Q4. Does peroneal tendonitis require surgery?
In most cases, no. Surgery is only required if a tendon tears or if conservative treatments have been ineffective for months.
Q5. What exercises help with peroneal tendonitis?
Once the pain decreases, calf stretches, ankle circles and peroneal muscle exercises with a resistance band will be useful.
Q6. How can I prevent peroneal tendonitis?
To prevent peroneal tendonitis, wear proper shoes, strengthen the muscles around your ankles, and prevent abrupt increases in your training or running distance.
