Peroneal Tendonitis And How To Treat It

Foot and ankle injuries are common among distance runners. There are many different afflictions that can affect this region including plantar fasciitis, achilles tendonitis and posterior tibial tendonitis. If you feel pain just behind the outside of your ankle, though, there is a good chance you may be suffering from a lesser known injury called peroneal tendonitis.

Quick side note regarding terminology: Peroneal tendonitis is technically the inflammation of one or both peroneal tendons while peroneal tendonosis is caused by degenerative tears in the tendon. For this article, we will refer to both as tendonitis as the causes and methods of treatment are similar for both injuries.  

The two peroneal tendons, the peroneal longus and the peroneal brevis, sit outside the ankle and serve the purpose of stabilizing the foot and preventing sprains. Peroneal tendonitis often afflicts those who are new to running or veteran runners who have recently increased mileage or intensity.

If you treat peroneal tendonitis in its early stages, it is typically a straightforward injury to cure. The first step is to cut back mileage or stop running entirely to allow the tendons to recover. Ice and anti-inflammatory medication can help reduce inflammation and alleviate pain.

At this point, one should consider whether the cause of the injury is simply improper footwear. Often, peroneal tendonitis is related to high arches and if you are not wearing the proper pair of running shoes, the problem could be exacerbated. If your shoes are old or worn out, it is time to head to your local running store to be fitted for the proper pair of shoes.

If the injury does not subside in a few days, seeing a medical professional to receive physical therapy is necessary. The therapist will likely work with you to determine the exact cause of the injury. They will also assign exercises to strengthen the area around the tendon to prevent another strain in the future.

Here are some examples of exercises to increase the strength and flexibility of the peroneal tendon region.

  1. Standing Calf Stretch: This is the calf stretch that everyone knows. You stand facing a wall. Outstretch your arms against the wall and put one leg forward in a bent position and one back, keeping it straight. Lean into the wall until you can feel a stretch in the calf of the straight leg. Hold for 30 seconds and repeat on the other leg. Do 2 sets of 30 seconds on each leg.
  2. Achilles stretch on stair: Find a step and stand facing up the stairs. Inch towards the edge of the step, until only the ball of your foot remains on the step. Lower yourself until you feel the stretch in your achilles. Hold 20-30 seconds. Repeat 3 times.
  3. Resisted ankle eversions: Tie a small loop in the end of a resistance band and put it around the arch of your foot. Hold the other end of the band for tension and move your foot slowly up and out, feeling the exercise in your lower leg. Then return to starting position. Do 2 sets of 15.
  4. Wobble board exercises: You can utilize a wobble-board for many useful stability exercises such as moving back and forth, side to side or rotating clockwise and counter-clockwise.