Peroneal tendonitis is a common source of pain for runners, characterized by irritation or inflammation of the tendons located on the outside of the ankle and foot. The pain arises from repetitive strain and overuse, often leading to a nagging ache that worsens with activity. Continuing to run while experiencing pain from peroneal tendonitis is generally ill-advised and can significantly prolong recovery. Immediate modification or complete cessation of the activity is necessary to prevent the condition from worsening.
Understanding Peroneal Tendonitis
The peroneal tendons are two strong cords, the peroneus longus and peroneus brevis, that run along the outside of the lower leg bone (fibula) and behind the ankle bone. Their primary function is to stabilize the foot and ankle, especially during weight-bearing activities, and to control the ankle’s outward movement, known as eversion. Runners often develop this issue due to specific training errors or biomechanical factors that overload the tendons.
Sudden increases in weekly mileage, intensity, or frequency place excessive stress on the tissue, exceeding its capacity to adapt. Running on cambered roads or uneven surfaces forces the ankle into an excessive outward roll, demanding more work from the peroneal muscles to maintain stability. Improper footwear or a naturally supinated foot posture, where weight is borne on the outer edge of the foot, also increases the strain placed on these tendons.
The Direct Answer: Running While Injured
When the peroneal tendons are symptomatic, continuing to run converts an acute, inflammatory injury into a chronic, degenerative issue called tendinosis. This shift involves a breakdown of the collagen fibers within the tendon structure rather than simple inflammation. Ignoring the discomfort risks causing micro-tears to coalesce into larger tears, which can eventually lead to a complete tendon rupture.
This level of damage may require surgical intervention to repair, transforming a temporary running break into a multi-month recovery. The constant, repetitive impact of running, which can be two to three times body weight, prevents the necessary rest for the inflammatory cycle to break.
Immediate Management and Non-Running Activities
The first step after recognizing peroneal tendon pain is to follow the R.I.C.E. protocol to manage the acute symptoms:
- Rest involves stopping all painful activities, including running, to allow the tendon’s load capacity to recover.
- Ice for 15 to 20 minutes several times a day can help reduce local pain and swelling.
- Compression using an elastic bandage or supportive brace helps minimize swelling and provide gentle support to the ankle.
- Elevation of the foot above the heart assists with fluid drainage from the ankle area.
While rest from running is required, maintaining cardiovascular fitness is possible through non-impact activities. Swimming, especially using a pull buoy to minimize ankle movement, is an excellent choice for full-body conditioning. Cycling at a low resistance, or using an elliptical machine, also provides a safe way to keep moving while the tendons heal.
Safe Return to Running Protocol
A safe return to running should not begin until the ankle is completely pain-free during normal daily activities, including walking, and has achieved full range of motion. The initial phase of rehabilitation focuses on rebuilding the strength and stability that the peroneal tendons provide. Specific exercises, such as resistance band ankle eversion, are performed to target the injured muscles directly.
Eccentric calf raises, focusing on the slow, controlled lowering phase, help strengthen the tendon under load and improve its tolerance for running forces. Once pain-free walking and strengthening exercises are successfully tolerated, a structured run-walk protocol can begin.
The standard progression involves increasing running volume by no more than 10% each week to allow the tendon to adapt to the rising load gradually. A helpful guideline is the “48-hour rule,” which states that if pain increases during a run, it must return to its baseline level within 48 hours to be considered tolerable load. Any pain that persists past this window indicates the load was too high and must be reduced in the next session.