What Is Peroneal Tendonitis?

Peroneal Tendonitis is a common cause of pain around the back, and outer side of the foot, due to inflammation, irritation, or degeneration of the tendons. Tendons are strong, cord-like structures, that link muscles to bones. In order to move, our muscles contract, which pulls on the appropriate tendon, which in turn pulls on the appropriate bone.

Micro-trauma from repetitive tension on the peroneal tendons causes damage to them, resulting in peroneal tendonitis. There are two peroneal muscles, peroneal longus and peroneal brevis.  They run down the back of the fibula, through a groove on the outer side of the ankle, behind the lateral malleolus.  The tendons then split with the peroneus brevis inserting into the base of the little toe bone (fifth metatarsal), and the peroneus longus, crossing the sole of the foot, to attach to the outer side of the big toe (first metatarsal).  Their job is to pull the foot and toes downwards, known as “plantarflexion”, and to turn the foot outwards, known as “eversion”.

What Causes It?

There are four main causes of tendonitis in the peroneal muscles:

1)  Overuse

Overuse is the most common cause of peroneal tendonitis.  Sudden increases in training levels, inappropriate footwear, or poor training techniques are usually to blame.  Runners who frequently run along slopes (e.g. uneven surfaces), which cause the foot to excessively roll out into eversion, are more prone to peroneal tendonitis.  Sports such as basketball, football and gymnastics, or anything requiring quick pivoting movements are also commonly associated with the disease.

2)  Abnormal Foot Position

Typically if the heel is turned inwards slightly, known as “hindfoot varus”, or you have high arches, you are at increased risk of peroneal tendonitis, as these make the peroneal muscles and therefore the tendons, work harder.

3)  Ankle Sprain

You may also be prone to peroneal problems if you have suffered from recurrent ankle sprains, due to weakness and injury around the ankle.

4)  Muscle Imbalance

Tightness in the calf muscles, and weakness in the calf and peroneal muscles, can lead to tendonitis.  Foot exercises and stretches are the best ways to strengthen and stretch the calf muscles.

Typical Symptoms

People suffering from peroneal tendonitis tend to complain of pain around the back and outside of their foot.  It will most likely be tender to touch.  Pain tends to come on gradually over a few weeks/months, gets worse with activity, and eases with rest.  The pain often tends to be worse first thing in the morning.  It may also hurt to turn your foot inwards, known as inversion.

Treatment Options

It can take a number of months for the symptoms of peroneal tendonitis to fully settle down, so effective treatment is vital. 

1)  Rest:  It is essential to avoid any activity which aggravates your symptoms, to allow the tendon to heal properly.  Failure to do so will result in longer healing time.

2)  Ice: Use ice regularly to reduce swelling.  Safe and effective application of ice is critical.

3) Compression: Wearing tubigrip compression bandage, or a support brace, can help reduce inflammation.

4) Elevation: When resting, keep the ankle elevated higher than the heart.

5) NSAIDS: Talk to your doctor about taking non-steroidal anti-inflammatories such as ibuprofen, to reduce the pain and swelling.

6)  Exercises: Doing strengthening and stretching exercises for the calf and peroneal muscles will help reduce the tension on the peroneal tendons.  This will help speed up healing and time, while reducing the chances of the condition recurring.

7) Change training structure:  Don’t overdo it, especially when trying to increase your activity levels.  Follow the 10% rule – only increase your training levels by a maximum of 10% per week, be it intensity, frequency or distance.  If you are a runner, stick to flat, smooth surfaces

8) Orthotics: If your peroneal tendonitis is due to abnormal foot shape, it often helps to wear inserts in your shoes to correct the deformity.   Ideally, you should see a podiatrist who can evaluate your foot, and ensure you have the correct insoles.  Using the wrong insoles may end up causing you more problems

9) Acupuncture: Acupuncture can sometimes help to reduce pain associated with tendonitis; but it should be combined with other treatments, such as exercises, to stop the pain from recurring.

10) Physical Therapy: This may include joint mobilisations, if there is stiffness in the bones of the foot; taping, to improve foot position; and ultrasound therapy to reduce inflammation and promote healing.

Your feet mirror your general health . . . cherish them!