Your Guide to Treating & Preventing Peroneal Tendonitis

Tired fitness woman in sports bra on nature trail takes break with hands on knees.

Peroneal tendonitis, as the name implies, is an inflammation of the peroneal tendons.

This not-so-common injury is caused by excessive or prolonged training and usually develops over a long period of time.

In today’s post, I’m sharing with you the runner’s guide to treating and preventing peroneal tendonitis so you can return to running strong and pain-free.

Let’s lace up and dig in.

What is Peroneal Tendonitis?

To understand the underlying causes of peroneal tendonitis, let’s first discuss some anatomy.

The peroneal tendons, a band of fibrous tissue located on the outside of the ankle just behind the fibula, attaching muscle to bone.

These consist of powerful, cord-like structures that connect the peroneal muscles to the calf and the bones of the foot.

Each leg contains two peroneal tendons—peroneal, meaning related to or located on the outer side of the calf.

They run side by side down the fibula and behind the lateral malleolus, which the bony lump on the outside of your ankle, and attach the foot in two different spots.

Peroneal tendonitis is injury or damage to these tendons, and it’s a common cause of pain around the back and outside of the foot in runners.

This condition happens when microtears cause tendon inflammation and damage.

This condition is especially common in runners as we’re more likely to roll our feet outwards when running, resoling in friction between the tendon and bone.

Ignored, the peroneal tendons will thicken in an attempt to endure the excessive stress as it tries to repair the damaged area.

This compromises the tendons, making them more prone to tearing.

The end result? The tendons eventually disrepair and break down.

Symptoms

Peroneal tendinopathy manifests as a progressively growing pain on the outer aspect of the ankle, especially when turning in the ankle (inversion) as well as when turning the ankle out (eversion).

You may also feel unstable at the ankle joint while walking or running.

You may also experience pain when pushing off the ball of your foot.

Causes of Peroneal Tendonitis in Runners

There are many causes of peroneal tendinopathy in runners.

As I have already explained, the main cause is overuse.

When an extra load is put on the tendons, it forces them to rub on the bones, causing swelling and pain.

Other culprits that may contribute to the onset of the condition include:

  • Bad running form
  • Improper running shoes
  • Increased running speed
  • Muscles imbalances in the lower legs that limit ankle mobility.
  • Having a history of ankle injuries, such as ankle sprains
  • Foot abnormalities, such as having a high foot arch. The higher the arch, the higher the risk.
  • Sudden change in running surface, especially the road to trails that requires a lot of ankle strength

Can You Yun With Peroneal Tendonitis?

This really depends on the severity of your condition, but all in all, I won’t recommend running with peroneal tendonitis.

The best thing you can do is to take a few days off and let the tendons recover.

You’ll bounce back more quickly with rest.

The affected limb needs time to recover, and, in time, the pain will fade.

Still want to keep on running? Keep your ego in check.

As a rule, slow down and reduce your overall mileage.

Stop running if the pain starts getting worse or is affecting your gait.

In advanced cases, you may also want to avoid walking or any other weight-bearing activities that may aggravate your injury.

running injury
runer woman with knee injury and pain

Consult Your Doctor

If you’re coming down with any of the above symptoms, consult your doctor to perform a tendonitis diagnosis.

That way, you’ll know for sure what you’re dealing with so you can take the right measures to start the healing process.

Your doctor may recommend an X-Ray or an MRI scan to rule out any abnormalities or fractures.

Treatment

Your treatment options for dealing with peroneal tendon injury depends on the severity of your condition.

Options include:

Medication

To help soothe pain and inflammation, consider oral or injected anti-inflammatory drugs, such as ibuprofen and cortisone.

Brace

Use a brace for a short time or during physical activity to provide more support.

In fact, braces might be needed until the foot is completely healed.

Immobilization

Another measure to assist with your recovery is immobilization.

Keeping your foot immobile during the acute phase helps limit foot and ankle movement, speeding up recovery in the process.

You can either use a splint or cast to keep the affected limb from moving and let it heal faster.

When Surgery is Needed

In case the pain persists despite non-surgical measures, surgery might be needed to fix the tendon or tendons as well as the supporting structures of the foot (in some cases, but not all).

For example, if the tissue around the tendon is behind the pain, the surgeon may perform a procedure known as “tendon release” to remove it.

A “tendon repair” can also be performed in case there’s a tear or rupture in one of the peroneal tendons.

Following surgery, rest and physical therapy are key parts of rehabilitation.

How To Prevent Peroneal Tendonitis

There are many measures you can take to prevent peroneal tendonitis in the future.

These include:

Improving Flexibility

Runners are notoriously prone to tight calves.

When the calves are tight, they can pull on the muscles around your ankles, causing pain.

Regular stretching to rescue.

It can help you improve collagen synthesis as well as muscle fiber organization.

This leads to developing stronger muscles and tendons.

This is why, for many cases, a doctor may recommend a set of home exercises that include stretching exercises.

Consult your doctor to determine if any stretching can help you soothe symptoms and keep flexibility in the ankle and surrounding region following peroneal tendonitis.

Here are three stitches to help you prevent peroneal tendonitis.

  • Towel Stretch
  • Stretch 2
  • Stretch 3

Choose The Right Shoes

As I touched upon earlier, improper footwear can contribute to peroneal tendonitis.

This is especially the case if you have a high arch, what’s known as under pronation.

So what should you do here?

Simple: Choose running shoes that offer more supports, support and stability to help your foot from rolling inward.

You can also consider using insoles to make your current shoes more supportive.

The Conclusion

Peroneal tendonitis is a common overuse injury in athletes doing high impact sports—runners are no exception.

But by taking the right treatment measures, you can often return to running after peroneal tendonitis without surgery.