Peroneal tendonitis is an irritation or inflammation affecting the two tendons (peroneus longus and peroneus brevis) that run along the outside of the ankle and foot. These tendons stabilize the ankle during movement and protect it from sprains. The condition often arises from overuse, such as a sudden increase in activity or repetitive ankle motion. It can also be caused by poorly supportive footwear or underlying foot structures like high arches. Successful recovery requires a structured approach to reduce inflammation and rebuild tendon strength.
Immediate Relief and Initial Steps
Immediate action should center on the R.I.C.E. protocol: Rest, Ice, Compression, and Elevation. Resting involves avoiding activities that provoke pain, allowing the irritated tendons to begin healing without additional strain. Applying ice packs to the affected area for 20 minutes every two hours helps reduce inflammation and provide localized pain relief.
Compression, using an elastic bandage or wrap, aids in limiting swelling and provides support to the ankle joint. Elevating the foot above the level of the heart minimizes fluid accumulation and swelling. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be used temporarily for managing pain and inflammation.
In the acute phase, temporary supportive measures, such as taping or an ankle brace, can reduce strain during necessary movements. For more severe cases, a healthcare provider might recommend short-term immobilization with a walking boot or soft cast. This initial focus on pain reduction and stabilization is a temporary measure, paving the way for active rehabilitation.
Rehabilitation Through Targeted Exercise
Rehabilitation requires moving toward active, corrective strengthening to address underlying tendon weakness. The core of this process involves a progressive loading program, often guided by a physical therapist, which rebuilds the tendon’s capacity to handle stress. This typically begins with low-impact exercises before advancing to more demanding movements over weeks or months.
Eccentric strengthening exercises are particularly beneficial, focusing on controlling the lengthening of the muscle-tendon unit under load. For the peroneal tendons, this involves resisting the foot’s inward movement (inversion) as the muscles slowly lower the foot back to the starting position. Resistance band work is commonly used to perform resisted ankle eversion, which directly strengthens the peroneal muscles responsible for turning the foot outward.
Balance training, also known as proprioception, is necessary to restore ankle stability and coordination. Exercises like single-leg standing drills or the use of wobble boards challenge the ankle’s ability to react to uneven surfaces. Consistent performance of these targeted exercises allows the tendon structure to adapt and become more resilient to future forces.
Advanced Medical Interventions
If conservative treatment, including several weeks of structured exercise, fails to resolve symptoms, advanced intervention may be necessary. A doctor may use diagnostic imaging, such as an ultrasound or MRI, to assess the extent of tendon damage, rule out tears, or check for mechanical issues like tendon subluxation. These images help determine if the tendinopathy has progressed beyond simple irritation to a more chronic, degenerative state.
For persistent pain, a physician may consider a corticosteroid injection, which targets inflammation within the tendon sheath. These injections carry a risk of weakening the tendon and potentially causing a tear, so they are used sparingly. Platelet-rich plasma (PRP) therapy is another option that involves injecting a concentration of the patient’s own growth factors to promote tissue healing.
Surgical intervention is reserved for a small minority of cases, typically when severe, chronic symptoms persist after six months of well-managed conservative care. Surgery may involve debridement, the process of cleaning out damaged or degenerative tissue from the tendon. For cases with longitudinal tears or if the tendon repeatedly slips out of its groove (subluxation), surgical repair or reconstruction may be necessary to restore function and stability.
Preventing Recurrence
Implementing long-term strategies reduces mechanical stress on the peroneal tendons, preventing recurrence. Ensuring proper footwear that provides adequate support and cushioning is one of the most effective preventative measures. Shoes that are worn out or lack support should be replaced promptly, especially for individuals engaging in high-impact activities.
Custom orthotics or specialized inserts can be beneficial, particularly for individuals with foot biomechanics that predispose them to the condition, such as high arches. These devices correct foot alignment, which reduces the excessive load placed on the peroneal tendons during walking and running. Incorporating a consistent routine of stretching and strengthening exercises, even after the pain has resolved, maintains flexibility and muscle endurance.
Regularly stretching the calf muscles and the peroneal tendons helps relieve tension that can pull on the ankle. Any increase in training intensity or duration should be done gradually to allow the tendons time to adapt to the new load. Maintaining a healthy body weight also minimizes the per-step forces that the ankle and its surrounding tendons must absorb.