Peroneal Tendonitis

Overview

What is peroneal tendonitis?

Peroneal tendonitis is inflammation in the tendons that run along your outer ankle bone and the side of your foot. These tough bands of tissue connect the muscles in your lower leg to the bones in your foot. They help stabilize and balance your foot and ankle, protecting them from injuries.

This type of foot tendonitis is usually the result of overuse, but it can also happen suddenly if you fall or injure your foot.

Who gets peroneal tendonitis?

Anyone can get peroneal tendonitis, but it’s more common in people who play sports that involve a lot of ankle movements. You’re also more likely to develop peroneal tendonitis if you:

How common is peroneal tendonitis?

Peroneal tendonitis isn’t as common as other types of foot tendonitis, such as Achilles tendonitis. In one study of several thousand runners, there were only 13 cases (less than 1%) of peroneal tendonitis.

Symptoms and Causes

What causes peroneal tendonitis?

Peroneal tendon inflammation can develop over time with repetitive overuse of the tendons. Or it might happen suddenly due to an acute ankle injury like a sprain. The tendons or the lubricated sheath that surrounds the tendons can swell, making it hard for them to move smoothly.

What are the symptoms of peroneal tendonitis?

Symptoms of peroneal tendonitis may include:

  • Ankle pain along the length of your tendon.
  • Pain that gets worse with physical activity.
  • Swelling, redness or warmth around your tendon.
  • Thickened tendons, with a mass or nodule that moves with your tendon.

Can your peroneal tendon rupture?

Left untreated, peroneal tendonitis can progress to a tendon rupture. This occurs if your tendon partially or completely tears. Damaged or weakened tendons can also lead to subluxation, which dislocates the tendons. Ruptures or subluxation can cause:

  • Ankle weakness or instability.
  • Intense pain along the outside of your foot and ankle.
  • Sharp, snapping feeling in your tendons.

Diagnosis and Tests

How is peroneal tendonitis diagnosed?

Peroneal tendonitis can be difficult to diagnose. The symptoms are similar to those of other foot and ankle problems, like sprains, arthritis and fractures. One study suggests that out of 40 people with peroneal tendonitis, about 60% were initially misdiagnosed.

Your healthcare provider will perform a physical exam and review your symptoms, though. They may palpate (press) on certain parts of your foot and ankle to check for swelling or tenderness. Your provider might also ask you to perform certain ankle movements to evaluate the range of motion in the joint.

Sometimes imaging is necessary to make sure you don’t have a foot fracture, osteoarthritis, cartilage damage or torn tissue. Your provider might recommend an X-ray, MRI, CT scan or ultrasound, as well.

Management and Treatment

How is peroneal tendonitis treated?

Conservative treatments usually help relieve tendon pain and inflammation within three to four weeks. Recovery might take longer if tendonitis is the result of another injury, such as a sprain.

Common treatments for peroneal tendonitis include:

  • Bracing: An ankle brace can support and stabilize your ankle if you have to perform certain movements, like running or jumping.
  • Immobilization: You might need a soft cast or boot to immobilize your foot and take weight off your tendons so they can heal.
  • Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce pain and inflammation. In some cases, your provider might recommend steroid injections around the tendon itself, into the tendon sheath.
  • Physical therapy: Physical therapists guide you through exercises and stretches to regain strength and flexibility in your foot and ankle. Your therapist might also recommend ice, heat or ultrasound therapy.
  • RICE method: You can perform RICE (rest, ice, compression and elevation) at home. Rest by avoiding strenuous activities. Apply an ice pack or cold compress to your ankle for 20 minutes every two hours. Wrap your ankle in a compression bandage to reduce swelling and keep your ankle elevated, preferably above the level of your heart.

Will you need surgery for peroneal tendonitis?

If peroneal tendonitis doesn’t improve with conservative treatments, you might need surgery. Surgery consists of cleaning out the damaged outer layers of tissue from your peroneal tendons during a procedure called a synovectomy. Some people may be candidates for a minimally invasive synovectomy, which involves smaller incisions (cuts) and a faster recovery.

What are the risks of peroneal tendonitis surgery?

Like all surgeries, ankle surgery for peroneal tendonitis does carry some risks such as:

  • Bleeding.
  • Blood clots.
  • Infection.
  • Nerve damage.
  • Recurring tendonitis or ankle pain.
  • Scar tissue formation.

Prevention

How can you prevent peroneal tendonitis?

Tips for preventing peroneal tendon pain include:

  • Gradually work up to intense physical activity.
  • Maintain a healthy body weight.
  • Never push through foot or ankle pain.
  • Quit smoking.
  • Allow for rest between workouts, games or other physical activity.
  • Stretch to warm up your feet and ankles before physical activity.
  • Use ankle braces, supportive shoes or other appropriate protective equipment.
  • Wear orthotics if you have high arches, but only if recommended by your healthcare provider.

Outlook / Prognosis

What’s the prognosis (outlook) for people with peroneal tendonitis?

Most people recover fully from this condition in about a month. Talk to your healthcare provider before getting back to full activities or your sport. Your recovery time from peroneal tendonitis will be longer if you have surgery. After surgery, you'll wear a cast on your lower leg for four to six weeks. You might need crutches for the first few weeks, as well. Your provider can tell you when it’s safe to put weight on your ankle again. Most people need physical therapy after surgery to regain strength and stability in their ankle.

Living With

When should you contact your healthcare provider?

Contact your healthcare provider if you:

  • Are unable to walk or put any weight on your foot or ankle.
  • Can’t rotate your ankle in any direction.
  • Experience a snapping or popping sensation in your foot or ankle.
  • Have severe, sudden pain in your foot or ankle.
  • Notice swelling or discoloration in your foot or ankle.

A note from Cleveland Clinic

Peroneal tendonitis is irritation or inflammation in the tendons that run along the outside of your ankle and foot. It’s usually due to overexertion and typically heals with a few weeks of conservative treatments. But untreated tendonitis can get worse, leading to a tendon tear. Never try to push through foot or ankle pain. Remember to give your body the rest it needs between periods of intense physical activity.

Last reviewed by a Cleveland Clinic medical professional on 10/27/2021.

References

  • American Academy of Orthopaedic Surgeons. Smoking and Musculoskeletal Health. (https://orthoinfo.aaos.org/en/staying-healthy/smoking-and-musculoskeletal-health/) Accessed 10/27/2021.
  • Davda K, Malhotra K, O'Donnell P, Singh D, Cullen N. Peroneal tendon disorders. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508858/) EFORT Open Reviews. 2017 Jun;2(6):281-292. Accessed 10/27/2021.
  • Foot Health Facts. American College of Foot and Ankle Surgeons. Peroneal Tendon Injuries. (https://www.foothealthfacts.org/conditions/peroneal-tendon-injuries) Accessed 10/27/2021.
  • Walt J, Massey P. Peroneal Tendon Syndromes. (https://www.ncbi.nlm.nih.gov/books/NBK544354/) [Updated 2021 May 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Accessed 10/27/2021.

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