Peroneal tendonitis involves irritation or inflammation of the tendons located on the outside of the ankle and foot. This condition is common among active individuals, particularly those involved in sports that require repetitive ankle movements. It often develops from overuse but can also result from an acute injury like an ankle sprain.
Understanding Peroneal Tendonitis
The peroneal tendons, specifically the peroneus longus and peroneus brevis, are strong bands of tissue that connect muscles in the lower leg to bones in the foot. These tendons run side-by-side behind the fibula, the smaller bone in the lower leg, and wrap around the outside of the ankle. Their primary function is to stabilize the ankle during weight-bearing activities, help turn the foot outward (eversion), and protect against ankle sprains.
Peroneal tendonitis arises from excessive repetitive forces on these tendons. Common causes include overuse from activities like running or jumping, sudden increases in physical activity, and improper training techniques. Inadequate footwear or certain foot biomechanics, such as high arches, can also contribute by stressing the tendons. Symptoms include pain along the outside of the ankle and foot, worsening with activity and improving with rest. Swelling, redness, warmth, and tenderness are also common.
The Healing Process: What to Expect
Peroneal tendonitis resolves with appropriate care. The healing timeline varies depending on the inflammation’s severity, adherence to treatment, and individual responses. Most people experience significant improvement within a few weeks to a few months with conservative treatments. Pain and swelling often subside within three to four weeks with consistent non-operative measures.
Complete recovery and return to full activity might take longer, sometimes up to three months or more, especially if the condition is chronic or associated with other injuries. Pushing through pain can worsen the condition and potentially lead to a tendon tear. If surgery becomes necessary, recovery extends, often requiring several months before resuming usual activities.
Effective Treatment Strategies
Initial treatment for peroneal tendonitis focuses on conservative approaches to reduce pain and inflammation. The RICE method—Rest, Ice, Compression, and Elevation—is a common starting point. Resting the affected foot and avoiding painful activities aids healing. Applying ice packs to the outside of the ankle for 10-20 minutes several times daily reduces swelling and numbs the area. Compression with an elastic bandage helps control swelling, while elevating the foot above heart level reduces fluid accumulation.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) manage pain and inflammation; consult a healthcare provider for proper dosage. In some cases, a doctor might recommend immobilization using a soft cast or boot to take weight off the tendons. Physical therapy is important for treatment, guiding individuals through exercises to restore strength, flexibility, and balance in the ankle and foot. These exercises may include:
Calf stretches
Ankle circles
Resistance band exercises for eversion
Single-leg balance drills
For persistent symptoms, medical interventions may be considered. Corticosteroid injections, administered around the tendon or into the tendon sheath, reduce inflammation and pain. These injections are used cautiously due to a potential risk of tendon rupture. Surgery is reserved for severe cases where conservative treatments have failed, especially if there are tendon tears or dislocations. Surgical procedures can involve cleaning out damaged tissue or repairing torn tendons, with recovery timelines extending significantly.
Preventing Recurrence
Preventing peroneal tendonitis recurrence involves long-term strategies focused on proper mechanics, supportive habits, and listening to the body. Gradually increasing activity levels is important, especially after an injury or rest. Avoiding sudden increases in activity intensity or duration allows tendons to adapt.
Wearing appropriate and supportive footwear is important, as shoes with good arch support and cushioning reduce strain on the peroneal tendons. For athletes, sport-specific shoes may offer additional benefits. Incorporating regular stretching and strengthening exercises for the calf and peroneal muscles maintains flexibility and muscle balance, including calf raises, towel stretches, and resistance band exercises. Paying attention to body signals and resting when pain or discomfort arises prevents overexertion and re-injury. If symptoms reappear or worsen, consulting a healthcare professional promptly ensures timely intervention.