Peroneal tendonitis involves inflammation of the tendons that track along the outer side of the lower leg, passing behind the ankle bone and into the foot. These two tendons, the peroneus longus and peroneus brevis, stabilize the foot and ankle, particularly during movements that prevent ankle sprains. The condition often develops from repetitive overuse, such as running or sudden changes in activity, leading to pain and tenderness on the outside of the ankle. Achieving a full recovery requires a structured approach that progresses from acute pain management to rebuilding the tendon’s resilience and preventing the issue from returning.
Immediate Pain Reduction and Stabilization
The initial stage of managing peroneal tendonitis focuses on calming the irritated tendons and stabilizing the ankle joint. Reducing the load on the affected tendons is necessary for controlling the inflammatory response, which involves a period of relative rest. Activities that cause pain or stress the ankle, such as running or jumping, should be avoided.
Applying cold therapy reduces localized swelling and provides temporary pain relief. Ice packs should be applied to the outer ankle area for 15 to 20 minutes several times a day during the first 48 to 72 hours. To manage swelling, an elastic compression bandage can be wrapped snugly around the ankle, and elevating the foot above the heart assists in draining excess fluid.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be used temporarily to target pain and inflammation. Consult with a healthcare professional before beginning any medication regimen, especially for prolonged use. For stabilization, a supportive device like an ankle brace or a walking boot may be used in the short term to immobilize the joint and reduce mechanical stress on the tendons.
Therapeutic Stretching and Mobility Restoration
Once the acute pain phase has settled, the focus shifts toward gently restoring the tendon’s flexibility and the ankle’s full range of motion. Tightness in the calf muscles, which connect to the peroneal tendons, can place excessive strain on the ankle structures. Therefore, targeted stretching of the posterior leg muscles is a necessary step in the recovery process.
The seated towel stretch is performed by sitting with the leg extended and looping a towel around the ball of the foot. Gently pull the towel back until a light stretch is felt along the calf and arch. Hold this position for 30 seconds and repeat multiple times daily to encourage tissue flexibility. Another method is the standing calf stretch, placing the affected leg behind the other and leaning forward until a stretch is felt in the calf.
To restore specific ankle joint movement, incorporate gentle active range-of-motion exercises. Ankle alphabet exercises involve moving the foot to “draw” the letters of the alphabet in the air, ensuring the movements are slow and controlled. This helps mobilize the joint in all directions without placing significant resistance on the healing tendons. These mobility exercises should only improve the tendon’s capacity for movement before strengthening begins.
Progressive Strengthening for Tendon Resilience
Rebuilding the capacity of the peroneal tendons to withstand daily loads is essential for long-term recovery and preventing recurrence. Strengthening should progress systematically, beginning with movements that introduce minimal stress and gradually increasing the challenge. A fundamental starting point involves using resistance bands for ankle eversion, which is the motion of turning the sole of the foot outward.
This exercise is performed while seated, looping a resistance band around the foot and anchoring the other end to a stable object or the opposite foot. The foot is slowly moved outward against the band’s resistance, focusing particularly on the controlled return phase. This controlled return, known as eccentric loading, is beneficial for promoting tendon healing and organization.
Eccentric training can also be applied to calf raises, which strengthens the lower leg muscles supporting the peroneal tendons. By standing on a step and focusing on the slow, controlled lowering phase of the heel, the tendon experiences beneficial eccentric stress. As strength improves, introduce single-leg stance exercises and balance drills on unstable surfaces, such as a foam pad, to enhance neuromuscular control and ankle stability. Resistance and repetitions should be increased gradually, and any exercise causing sharp pain must be modified or stopped immediately.
When to Seek Professional Medical Care
While many cases of peroneal tendonitis respond well to home-based care, professional medical evaluation is sometimes necessary. If the pain does not subside after seven to ten days of consistent home treatment, or if symptoms worsen despite rest and ice, a doctor’s visit is warranted. Immediate attention is necessary if there is sudden, sharp pain, an inability to bear weight on the foot, or a sensation of snapping or popping in the ankle, which may indicate a more severe tear or acute injury.
A physician can confirm the diagnosis and rule out other conditions, such as a stress fracture or a complete tendon tear, which require different treatment paths. Professional treatments often begin with a referral for formal physical therapy, where a therapist guides a patient through a customized rehabilitation program. Other interventions may include:
- Custom-molded orthotics to correct foot mechanics.
- Prescription-strength anti-inflammatory medications.
- Specialized bracing.
- Corticosteroid injections or, rarely, surgical evaluation to repair severely damaged tendons for chronic cases.