Peroneal Tendonitis: Symptoms, Causes & Treatments

Sarah Chen never expected a routine trail run to derail her marathon training. But a persistent ache along the outer edge of her right foot grew from a whisper to a scream, leaving the 34-year-old software engineer sidelined just weeks before her big race. She's now dealing with peroneal tendonitis.

Only 60% of patients with peroneal tendon disorders are correctly diagnosed at their initial medical visit, which means this condition is under-recognized. [1]

For Chen and others like her, the path to healing begins with recognizing the warning signs and understanding that this common injury, while frustrating, need not be a permanent setback.

» You can treat your peroneal tendonitis with custom made orthotics

What is Peroneal Tendonitis?

Peroneal tendonitis is a painful condition that affects the tendons on the outside of your ankle, whihch help you move your foot and keep your arch stable. It's important to distinguish between tendonitis and tendinopathy. Tendonitis is a sudden inflammation, often caused by overdoing it, while tendinopathy is a more chronic condition caused by long-term overuse.

People with peroneal tendonitis may also experience knee pain. [2] This is because the pain in your ankle can change the way you walk, putting extra stress on your knee joint. [3] Over time, this can lead to knee osteoarthritis. [4]

Who's at Risk for Peroneal Tendonitis?

While anyone can develop peroneal tendonitis, individuals who participate in sports that require a significant amount of ankle movement, such as basketball or tennis, are at a higher risk. Engaging in proper warm-up routines, stretching exercises, and wearing appropriate footwear can help reduce the likelihood of developing this condition.

People over the age of 40 are more susceptible to peroneal tendonitis, particularly if they are overweight, smoke, or lead a sedentary lifestyle. Those with flat feet, high arches, or foot instability are also at a heightened risk. Additionally, underlying conditions like arthritis, gout, and lupus can weaken connective tissues, increasing the chances of tendon inflammation.

» Could Crocs be good for your feet? Find out by reading our review

Symptoms of Peroneal Tendonitis

Peroneal tendonitis, an inflammation of the peroneal tendons located on the outer side of the ankle, can manifest through various symptoms. These symptoms typically arise due to overuse, injury, or mechanical abnormalities affecting the ankle.

Here are the most common symptoms associated with peroneal tendonitis:

• Localized Pain: People often experience pain along the outside of the ankle, which may worsen with activity or when you apply pressure to the area.
• Radiating Pain: The pain can sometimes radiate up the leg or down into the foot, depending on the severity of the condition.
• Swelling: There may be noticeable swelling around the ankle, particularly over the peroneal tendons.
• Warmth and Redness: The affected area can appear warm to the touch and may show signs of redness.
• Ankle Instability: You may feel a sense of instability in your ankle, especially during activities that require lateral movement.
• Pain with Activity: Engaging in activities such as running, jumping, or even walking can exacerbate symptoms.
• Clicking or Popping Sensation: Some people report a clicking or popping sound during movement.

» Are you rolling your ankle all the time? Get supination relief exercises

What Causes Peroneal Tendonitis?

• Flat Feet: When the arch of the foot collapses and the ankle rolls inward, it puts more stress on the peroneal tendons. This extra strain, combined with the increased reliance on these tendons in flat feet, can lead to overuse injuries and inflammation.
• High Arches: When the foot rolls outward (supinates), it can cause high arches. This puts extra strain on the peroneal tendons, especially when you're bearing weight. Over time, this repeated stress can lead to peroneal tendonitis.
• Plantar Fasciitis: Even though these conditions are different, they both cause changes in how you walk. To reduce pain from inflamed tissue, people often change their walking style, which can put extra strain on the peroneal tendon on the outside of the foot. If this tendon is overworked repeatedly, it can become inflamed and painful.
• Bunions: Like the other conditions we discussed, bunions can change the way you walk. This altered walking pattern can put extra stress on the peroneal tendon on the outside of your foot.

» Did you know you can get amazing benefits just by rolling your feet?

6 Ways to Treat Peroneal Tendonitis

Management of peroneal tendonitis involves alleviating repetitive strain placed on the structures and allowing the microtears to heal.

1. RICE Method: A Simple Treatment Plan

To help manage your condition, try the RICE method:

• Rest: Give your body time to heal before returning to exercise. Gradually increase your activity level over several weeks.
• Ice: Apply ice to the painful area for 15 minutes, every 2 hours. Wrap the ice in a cloth to avoid skin damage.
• Compression: Gentle compression can help reduce swelling. Be careful not to wrap it too tightly, as this can restrict blood flow.
• Elevation: Raise the injured area above your heart to help reduce swelling.

» Having pain along the bottom of your foot? It could be plantar fasciitis

2. Physical Therapy for Peroneal Tendonitis

Physical therapy can help manage and prevent peroneal tendonitis. Here are a few simple exercises you can try:

Stretches:

• Calf Stretch: Stand facing a wall with your arms extended. Step back with one leg, keeping your heel on the ground. Lean into the wall, feeling a stretch in your calf. Hold for 15-20 seconds, then repeat on the other side.
• Soleus Stretch: Similar to the calf stretch, but bend your knee slightly.

Strengthening Exercises:

• Ankle Movements: Sit down and cross one leg over the other. Slowly move your ankle up and down, then side to side.
• Single-Leg Calf Raise: Stand near a wall or chair for support. Raise one heel off the ground, then slowly lower it back down. Repeat on the other leg.

» You can get more exercises to relieve peroneal tendonitis in our library

3. Custom-Made Orthotics

Orthotics and supportive shoes can help prevent and manage peroneal tendonitis. These devices provide cushioning, stability, and arch support to reduce stress on the tendons.

Now, you might think that over-the-counter insoles provide sufficient support to help you with overpronation, but that isn't the case. These insoles are a universal solution, meant for people who want to improve comfort during everyday wear—not for addressing specific conditions.

What you need is a personalized solution.

Upstep Custom Orthotics match the unique contours of your feet, offering personalized arch support that helps distribute pressure evenly—especially useful for peroneal tendonitis. They'll help you power through everything, whether it's the daily commute or a recreational football match.

The insoles are durable, too. We make them using polypropylene, a material known for its exceptional durability. Its high tensile strength allows it to withstand repeated biomechanical stress without losing its shape or structural integrity. You won't be able to wear your Upstep Insoles out, no matter if you're into heavy workouts or just have a physically demanding job.

All you need to do is:

• Take a 3-minute test and order a custom mold
• The mold will arrive at your address in 1–3 business days
• You'll imprint your feet and return the mold to us—free of charge

4. Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain, swelling, and fever. They can be helpful in the early stages of peroneal tendonitis, improving your ability to do physical therapy exercises.

» You probably didn't know this: You can get your orthotics covered by insurance

5. Extracorporeal shock wave therapy (ESWT)

Extracorporeal shock wave therapy (ESWT) is a safe, effective, and affordable treatment for many musculoskeletal conditions, including peroneal tendonitis. It can reduce pain and improve movement, especially for people who haven't found relief with other treatments.

ESWT is a non-invasive procedure that can help reduce the need for pain medication. It's versatile and can be used to treat other inflammatory conditions in the body.

» Rome wasn't built in a day, but you could rebuild your arches in a few

6. Surgery

If conservative treatments like physical therapy and medication don't work after 7-8 months, surgery might be an option. Surgical options include:

• Debridement: Removing damaged tissue from the tendon.
• Tendon transfer: Replacing the damaged tendon with a healthy one.
• Osteotomy: Cutting and realigning a bone to improve foot alignment and reduce stress on the tendon.

Osteotomy surgery can help prevent peroneal tendonitis by improving the biomechanics of the foot.

» Feel like you have a pebble in your shoe? It could be metatarsalgia

Recover from Persistent Peroneal Pain

Peroneal tendonitis, while painful and potentially disruptive to daily activities, is a manageable condition with proper care and treatment. From conservative approaches like the RICE method and physical therapy to more advanced interventions like ESWT and surgery, there are multiple treatment options available depending on the severity of your condition.

The key to successful recovery lies in early recognition of symptoms and prompt treatment. Upstep Orthotics will help maintain proper foot mechanics so you can return to your regular activities. Plus, they are made of polypropylene, a material that absorbs shock and ensures the insoles keep their original shape—which is perfect if you're a runner.

If you're experiencing symptoms of peroneal tendonitis, don't hesitate to seek professional medical advice. With proper diagnosis and a tailored treatment plan, you can work toward reducing pain, improving mobility, and preventing future episodes of this condition.