Peroneal Tendonitis

Peroneal tendonitis occurs when there is inflammation of the peroneal tendons running behind the lateral malleolus or the bony bit on the outside of the ankle, which ultimately creates swelling on the outer ankle.

Did you know...

Contrary to what many believe, tendonITIS is very rare. You most likely have tendinosis!

Injury Overview


Most commonly, peroneal tendonitis is caused by sudden increases in training, and the use of badly designed footwear. People who also have hindfoot varus posture are more likely to experience peroneal tendonitis. In these cases, the heel is turned inwards slightly which causes the peroneal tendons to work harder than they should have to. The harder they work, to more likely it is that they will develop tendonitis. Sports can also cause overuse of these tendons, especially those that require quick pivoting movements like football, gymnastics, or basketball.

Another cause is abnormal foot positions, especially those people with high foot arches are at an increased risk of experiencing peroneal tendonitis.  If you have suffered from re-occurring ankle sprains, you may also be at a higher risk of developing peroneal problems. It’s important to practice flexibility exercises, as tightness in calf muscles and calf weakness can also lead to tendonitis.


As with any injury, it is very important to rest. Because peroneal tendonitis is an overuse injury, it is necessary to pause any sort of training routine, as this won’t allow the inflammation to go away, and the injury to heal. Swimming is a good alternative to use while healing to maintain your fitness level. The rule to always follow is if it hurts or makes the injury worse either immediately or the next day, immediately stop. To help relieve pain before going to the doctor, you can apply an ice or cold therapy wrap to the affected area 10 minutes to each hour until it helps the symptoms subside. You can also take pain medication to help ease the pain.

Usually, patients who have peroneal tendonitis, but don’t have a significant tear in their peroneal tendon, can be treated without the need for invasive surgery. Any treatment will aim to decrease the load the tendons experience, as well as lessening inflammation.

However, for patients who have a large tear or a physical irritant to the tendon like a bony protrusion, surgery may be required. Surgery aims to clean up the tendons themselves, fix any significantly torn tendons, and even smooth out the tract in which the peroneal tendons run in.


To prevent peroneal tendonitis problems, it is important to strengthen the ankle. This is because most peroneal tendonitis problems happen right at the contact phase of gait because of the increased stress at this point. Never ignore any pain in this area, it won’t go away. You can practice control over lower limb biomechanics by changing your foot position during the contact phase of gait. Wearing good shoes is very helpful, as well as practicing ankle strengthening exercises and wearing ankle support. It is important to practice preventative methods every day to ensure that your ankles continue to work to their best ability.

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