Peroneal Tendonitis

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Training smarter helps to boost performance and reduce the risk of injuries. As athletes we’re more predisposed to injuries – it comes with the territory especially when continue to push ourselves forward. There’s a little known and often misdiagnosed injury that’s not as common as Achilles tendonitis, but it can be just as aggravating. If you’ve Googled around and can’t quite pinpoint exactly what’s causing your pain, then maybe it’s time to find out more about peroneal tendonitis.

A peroneal injury is oftentimes difficult to diagnose because the symptoms mimic as other conditions such as plantar fasciitis or an ankle sprain. But it can actually be a more serious condition like a peroneal tendon tear. If the tendon injury is left untreated it can lead to a rupture!


Peroneal Tendonitis: A Common Sports Injury

A large percentage of sports-related injuries are related to overuse and involve a tendinopathy, like a peroneal injury. The peroneal tendons work to keep the foot stable and bear our weight. Peroneal tendonitis is typically an injury due to the degeneration of the tendon tissue from repetitive movements rather than inflammation. It can be a chronic overuse condition or as a result of acute trauma from ankle instability.

Most people who have peroneal injury will feel pain on the outside of their ankle or foot when they walk or run as opposed to patients with low arches who pronate increasing the risk of injury on the inside of their ankles [1][2]. So it makes sense that higher arches seem to place more tension on the lateral tendons as peroneal tendinopathy is often also found in patients with chronic instability on the outside of their ankles [3].

Peroneal tendinopathy may occur in one leg only, but the muscle group is susceptible to degenerative overuse with too much load. When a runner’s speed increases from a jog to a faster pace, more demand is placed on the peroneus brevis muscle to compensate for the demand as the ankles work harder to stabilise the load [4] [5]. The ongoing microtraumas lead to the overuse injury as orderly collagen strands become dishevelled. This causes the area to swell, become red and feel warm.


What Does a Peroneal Tendon Tear Feel Like?

Peroneal tendonitis ankle symptoms include:

  • Pain along the side of the foot near the bottom of your malleolus ankle bone
  • Inflammation or swelling around this area
  • Bruising that may appear underneath the skin
  • Tenderness along both sides of your lower leg just above footwear

If left untreated for an extended period of time, it may lead to further instability or problems with walking.


Peroneal Tendonitis Treatments

So how can a podiatrist balance the stress on the peroneal tendons to adjust for the increase load? To avoid misdiagnosis, first the patient should describe how the injury happened so that our team can make a proper diagnosis. Our specialised podiatrist at The Foot Practice in Singapore may recommend conservative peroneal tendonitis treatments to reduce pain, including:

  • Custom Made Orthoses to correctly support the structures of the foot. This helps to address arch height to adjust misalignments like overpronation to help rehabilitate an existing peroneal tendon injury.
  • Foot Mobilization Therapy to improve the function and joint mobility in the foot ankle stability or knees.
  • Podiatric exercise program to strengthen, improve flexibility and correct biomechanical imbalances.
  • Shockwave Therapy to induce the formation of new blood vessels through neovascularization. This creates new growth factors like protein release to stimulate tissue healing.

In addition to the treatment options above, selecting the right footwear can also speed your recovery. Also, our podiatrist may recommend peroneal tendonitis recovery exercises as part of your overall treatment protocols. Through a Footwear Assessment, our podiatrist can also help you select the shoes to limit pronation and abduction.

Our Sports Podiatrist in Singapore can help to rehabilitate the injured peroneal tendon. Understanding peroneal tendonitis tear symptoms and what causes it may help you to identify the overuse injury before more serious complications happen. The more information you have on how to manage this condition, the quicker you can get back to your sport. Contact us today to make an appointment.




[1] Brandes CB, Smith RW. Characterization of patients with primary peroneus longus tendinopathy: a review of twenty-two cases. Foot Ankle Int. 2000 Jun;21(6):462-8. doi: 10.1177/107110070002100602. PMID: 10884103.

[2] Rabbito M, Pohl MB, Humble N, Ferber R. Biomechanical and clinical factors related to stage I posterior tibial tendon dysfunction. J Orthop Sports Phys Ther. 2011 Oct;41(10):776-84. doi: 10.2519/jospt.2011.3545. Epub 2011 Jul 12. PMID: 21765219.

[3] Park HJ, Cha SD, Kim HS, Chung ST, Park NH, Yoo JH, Park JH, Kim JH, Lee TW, Lee CH, Oh SM. Reliability of MRI findings of peroneal tendinopathy in patients with lateral chronic ankle instability. Clin Orthop Surg. 2010 Dec;2(4):237-43. doi: 10.4055/cios.2010.2.4.237. Epub 2010 Nov 5. PMID: 21119941; PMCID: PMC2981781.

[4] Reber L, Perry J, Pink M. Muscular control of the ankle in running. Am J Sports Med. 1993 Nov-Dec;21(6):805-10; discussion 810. doi: 10.1177/036354659302100608. PMID: 8291630.

[5] Konradsen, L. & Højsgaard, C.. (2007). Pre‐heel‐strike peroneal muscle activity during walking and running with and without an external ankle support. Scandinavian Journal of Medicine & Science in Sports. 3. 99 – 103. 10.1111/j.1600-0838.1993.tb00369.x.

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