Peroneal Tendonitis: Symptoms, Causes, Treatment, Exercises

Key Takeaways

• Peroneal tendonitis is commonly caused by overuse and repetitive ankle motions, especially in athletes and runners.

• Symptoms include pain around the back and outside of the foot, swelling, and ankle instability.

• Treatment often involves a combination of rest, physical therapy, and specific exercises to strengthen the tendons.

• At MSK Doctors, we use specialised ultrasound imaging to assess tendon integrity and inflammation levels, allowing for more targeted interventions and close monitoring of your healing process.

Brief Overview on Peroneal Tendonitis

Understanding peroneal tendonitis begins with recognising the role of the peroneal tendons in foot movement. These tendons help control the eversion of the foot, which is the outward rolling motion. When inflamed, they cause pain and can severely impact your ability to walk or run (image courtesy of Range Physiotherapy).

Tendonitis, in general, refers to the inflammation of a tendon, which is the fibrous tissue that connects muscle to bone. In the case of peroneal tendonitis, the inflammation occurs in the tendons located on the outer side of the ankle. 

This condition is often the result of repetitive stress or overuse, which is why it's frequently seen in athletes who engage in sports that require extensive running or quick changes in direction.

Impact on Lifestyle and Activities

Living with peroneal tendonitis can significantly affect your daily life. The pain and discomfort can make it challenging to engage in regular activities, especially those that involve walking or running. 

Athletes may find themselves sidelined, unable to participate in their sports, which can be frustrating and emotionally taxing.

Recognising Symptoms

Pain Location and Intensity

The pain associated with peroneal tendonitis typically occurs around the back and outside of the foot. It's often described as a sharp or aching pain that intensifies with activity. You might notice the pain increasing when you stand on your toes or turn your foot inward.

Swelling and Instability

In addition to pain, you might notice swelling around the affected area. This swelling can lead to a feeling of instability in the ankle, making it seem as though your ankle might give way. This can be particularly concerning for those who need to be on their feet for extended periods or who engage in sports.

Activity-Induced Symptoms

Symptoms of peroneal tendonitis often become more apparent during or after physical activity. If you notice that your ankle feels sore or swollen after a run or a game, it might be time to consider peroneal tendonitis as a possible cause. Resting and monitoring the symptoms can help determine if they improve with reduced activity.

Identifying Causes

Overuse and Repetitive Motion

Most cases of peroneal tendonitis are due to overuse. Activities that require repetitive ankle movements - such as intensive sports that involve moving around a lot like soccer or rugby - put excessive strain on the peroneal tendons. Over time, this strain can lead to microtears and inflammation. 

Wearing improper footwear that doesn't provide adequate support can also cause peroneal tendonitis.

Pre-Existing Conditions

Pre-existing conditions like high arches or flat feet can also contribute to the development of peroneal tendonitis. These conditions can alter the mechanics of your foot, increasing the strain on your tendons and making them more susceptible to inflammation.

Exploring Treatments

Conservative Approaches

Rest is the first and most crucial step. By reducing activities that exacerbate the condition, the tendons have a chance to heal. Applying ice to the affected area can help reduce swelling and numb the pain.

Over-the-counter anti-inflammatory medications, such as ibuprofen, can also be beneficial in managing pain and swelling. However, use these medications as directed and consult with a healthcare provider if you have any underlying health conditions.

Physical Therapy Benefits

A physical therapist can design a personalised exercise program that focuses on strengthening the muscles around the ankle, improving flexibility, and restoring balance. This specified approach aids recovery and also helps prevent future injuries.

When Surgery is Necessary

Surgical intervention typically involves repairing the damaged tendon and possibly addressing any structural issues in the foot that contributed to the condition. Recovery from surgery can take several weeks, and physical therapy is often required post-surgery to regain full function.

Effective Exercises

Stretching Techniques

Stretching is essential for maintaining flexibility and preventing stiffness. One effective stretch is the towel stretch.

To perform this exercise:

1. Sit on the ground with your legs straight out. 

2. Loop a towel around the ball of your foot and gently pull back until you feel a stretch in your calf. 

3. Hold for 15-30 seconds and repeat several times.

Strengthening the Tendon

Strengthening exercises focus on the muscles around the ankle to provide better support for the tendons. An example is the ankle eversion exercise. To perform this exercise:

1. Sit with your leg straight and place a resistance band around the ball of your foot.

2. Slowly turn your foot outward against the resistance, then return to the starting position. 

3. Repeat 10-15 times.

Another beneficial strengthening exercise for the tendon is calf raises. To perform this exercise:

1. Stand with your feet hip-width apart and slowly rise onto your toes, 

2. Then lower back down. 

3. This exercise strengthens the calf muscles and supports the peroneal tendons.

Balance and Stability Drills

Improving balance and stability is crucial for preventing further injuries. Simple balance exercises can be done at home. 

Try standing on one leg for 30 seconds, gradually increasing the time as your balance improves. You can make this exercise more challenging by closing your eyes or standing on an unstable surface, such as a pillow.

Another effective drill is the single-leg hop. Stand on one leg and perform small hops forward, backward, and side to side. This exercise helps enhance ankle stability and proprioception.

Gradual Increase in Activity

When starting a new exercise program or increasing your activity level, do so gradually. Sudden increases in intensity or duration can put undue stress on your tendons, leading to injury. Follow the 10% rule: increase your activity level by no more than 10% each week.

Incorporate rest days into your routine to allow your body to recover and adapt to the increased demands. Listening to your body and recognising signs of fatigue or pain can help prevent overuse injuries.

Monitoring Overtraining

As overtraining is a common cause of peroneal tendonitis make sure you balance your workouts with adequate rest and recovery. Pay attention to any signs of overtraining, such as persistent fatigue, decreased performance, or recurring injuries.

Maintain a training log to track your workouts, including intensity, duration, and any symptoms you experience. This can help identify patterns and prevent overtraining. If you notice any warning signs, consider adjusting your training schedule or seeking guidance from a coach or trainer.

Path to Recovery with MSK Doctors

Peroneal tendonitis represents more than just ankle pain—it's a complex condition affecting the critical stabilising structures on the lateral aspect of your foot and ankle. 

At MSK Doctors, we understand how these seemingly small tendons play an outsized role in your mobility and quality of life. Our approach combines detailed musculoskeletal assessment with advanced diagnostic capabilities to identify the specific factors contributing to your tendon inflammation - footwear issues, training errors, or anatomical predispositions like a high-arched foot. 

What differentiates us from generalised treatment specialists, is that we develop personalised rehabilitation programmes that address both the immediate symptoms and the underlying causes, preventing the frustrating cycle of recurring inflammation. 

Our specialists are adept at distinguishing peroneal tendonitis from other lateral ankle conditions that present similarly but require different management strategies. 

With our comprehensive care model—incorporating targeted manual therapy, progressive loading techniques, and gait retraining when necessary—we've successfully returned countless patients to their desired activities, from competitive sports to comfortable daily walking.

Ready to bring back the spring in your step? Book your first peroneal tendonitis consultation with MSKDoctors today and we will develop a personalised treatment plan for you.

Frequently Asked Questions (FAQ)

What is the main cause of peroneal tendonitis?

Overuse and repetitive motion, especially in athletes, inadequate footwear that lacks proper support and underlying foot conditions like high arches or flat feet.

How long does recovery typically take?

Recovery time varies depending on the severity of the condition and the individual's adherence to treatment. Generally, with proper care, most people recover within 4 to 6 weeks. 

Can exercises worsen my condition?

When done incorrectly or prematurely, exercises can aggravate peroneal tendonitis. Follow a structured program designed by a healthcare professional. Avoid exercises that cause pain and focus on those that enhance flexibility and strength without overloading the tendons. 

Is surgery always required for treatment?

Surgery is rarely needed for peroneal tendonitis. Most cases respond well to conservative treatments like rest, physical therapy, and exercises. Surgery is considered only when these methods fail, or if there is significant tendon damage.

How can MSK Doctors assist in treatment?

At MSKDoctors, we offer comprehensive care catered to specific needs. Our team of experts will evaluate your condition, design a personalised treatment plan, and guide you through each step of your peroneal tendonitis recovery.