Peroneal Tendonitis

What is peroneal tendonitis?

Peroneal tendonitis is inflammation of the peroneal tendons in the foot. The Peroneal tendons are responsible for stabilising the foot and ankle in order to minimise the risk of sprains.

Diagram showing peroneal musclesA tendon is a flexible cord of tissue that connects a muscle to the bone. Tendons are flexible and quite strong, however they are inelastic which means they cannot stretch.

Peroneal tendonitis usually causes pain along the outside of the foot, ankle or lower leg. Pain may be present with activity such as walking or standing. People with peroneal tendonitis often also have ankle instability and may have suffered an ankle sprain or multiple sprains.

Discomfort due to peroneal tendonitis will usually occur gradually, increasing over time if aggravating activities are continued. In the initial stage of the condition, pain is present with activity, but as the condition progresses pain will be felt even when resting.

Over time the condition may progress to the point where the tendon begins to break down. The collagen fibers become disorganized and the tendon may become prone to micro-tears. Continued degeneration is known as “tendonosis” and may ultimately lead to rupture.

If you suspect that you are suffering from peroneal tendonitis or you have been diagnosed and you need treatment, please don’t hesitate to contact us online immediately or call us on (08) 9304 1898.

The Peroneal Muscles

The peroneal muscles provide stability to the ankle during load bearing activites or movements. Each time the Peroneal muscles contract, tension and load is placed on the tendons.

There are two peroneal muscles on the outside (lateral aspect) of your leg. Their tendons travel down around the ankle and connect to the foot. The peroneus longus is longer and starts up near the knee. The peroneus brevis tendon is shorter, starting about halfway between the ankle and the knee.


Repetition and/or high forces can put excess tension on the peroneal tendons leading to damage and inflammation. Activities that are typically related to peroneal tendonitis are walking or running (particularly on uneven ground) or sports that involve frequent change of direction and lateral movement – such as basketball, netball, tennis.

People with high arched, supinated feet (feet that roll outward) can be prone to peroneal tendonitis due to tension on the peroneal tendons.

Some people with a certain type of “flat feet” or those whom have suffered ankle sprains may also be at risk of developing peroneal tendonitis. If you are taking steroids (prednisone) or flouroquinalone antibiotics (Cipro, Levaquin) you may be at elevated risk of tendon rupture.

Symptoms of Peroneal Tendonitis

  • Pain: Tenderness and/or soreness running down the back and/or around the outside of the foot during or after activity.
  • Swelling/Inflammation of the outside of the foot.
  • Area is warm to the touch.

Symptoms of Acute Peroneal Tears

  • Pain.
  • Swelling/inflammation.
  • Weakness and/or instability of the foot and ankle.

If left untreated and overuse contiunes, acute tears can lead to a change in the shape of the foot in that the arches can become higher than normal.

Degenerative Peroneal Tears

These tears can occur after years of overuse which causes the peroneal tendon to become stretched until it is thin, weak and begins to fray.

This can lead to:

  • Frequent pain on the outside of the foot or ankle
  • Feebleness and/or instability in the foot or ankle
  • An increase in the height of the arch

Treatment of Peroneal Tendonitis

Diagnosis of peroneal tendonitis is usually made on clinical examination, however referral for an MRI scan or ultrasound may be recommended to confirm the diagnosis

Treatment can include:

  • Rest and anti-inflammatory medication
  • Exercises and stretching
  • Ultrasound, heat or ice (depending on the injury)
  • Footwear advice and orthotics to reduce tension on the peroneal tendons and prevent recurrence of the problem
  • In some cases, a walking cast boot is necessary to take pressure off the injured tendon, while allowing it to heal
  • Extra-corporeal Shock Wave Therapy
  • Surgery is rarely necessary for this condition. In some cases however, the tendon will not repair without surgery.

Book a consultation and speak to the experienced podiatrists at Preston Podiatry for treatment options. We have clinics located in Currambine and West Perth, call (08) 9304 1898 today.

Prevention of Peroneal Tendonitis

There are a few things that you can do to lower your risk of suffering from a peroneal tendinopathy including:

  • Wear supportive footwear or find out more about custom orthotics.
  • Stretching the calf and peroneal muscles.
  • Gradually increase your exercise efforts or training loads.
  • Cross train in your off-season.
  • Work on improving your balance.

It is important to complete a full cycle of your rehabilitation activities before returning to sport/activity. This will greatly lower your risk of repeat injury and also aid in the prevention of further problems associated with peroneal pain.