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 and turn the foot outward (eversion). The condition most often arises from repetitive overuse, such as running, which causes friction and swelling as the tendons rub against the bone. Foot structures, like high arches, can increase the repetitive forces on these tendons, making a person susceptible to injury. Recovery focuses on calming the initial inflammation and then restoring the full function and strength of the ankle to prevent recurrence.
Immediate Steps for Pain Reduction
Initial management focuses on immediately reducing pain and inflammation using the R.I.C.E. protocol. Rest means avoiding activities that cause pain, potentially requiring minimized walking or a temporary walking boot if pain is severe.
Applying an ice pack for 15 to 20 minutes every two hours helps reduce local swelling and numb the pain. Compression, using an elastic bandage, provides support and controls swelling; ensure the wrap is snug but does not impair circulation. Elevation involves raising the foot above the level of the heart to promote fluid drainage and decrease swelling.
Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen or naproxen can provide temporary relief. These medications inhibit the body’s inflammatory response, decreasing both pain and swelling. Always consult a healthcare provider before starting any medication to confirm the correct dosage and ensure there are no contraindications.
Restoring Function Through Movement
Once acute pain subsides, rehabilitation shifts toward controlled movement to restore the tendon’s capacity to handle load. This begins with gentle stretching to improve flexibility in the surrounding calf muscles, which can pull on the peroneal tendons.
Stretching Techniques
A simple wall stretch, keeping the back leg straight and the heel on the ground, lengthens the calf muscles and alleviates tension.
The towel stretch is performed while seated; loop a towel around the ball of the foot and gently pull it toward the body.
Perform stretches slowly, holding for approximately 30 seconds, and never push into a sharp, painful range. Consistent stretching prepares the tendons for strengthening.
Strengthening Exercises
Strengthening focuses on the muscles that stabilize the ankle, especially the peroneal muscles responsible for eversion. Resisted eversion exercises use a resistance band looped around the foot to push the ankle outward against the tension. Begin with low resistance, focusing on controlled movements, performing two to three sets of 10 to 15 repetitions.
Standing heel raises strengthen the lower leg musculature and improve the foot’s ability to absorb shock. Eccentric strengthening, focusing on the slow, controlled lowering phase of the heel raise, is beneficial for tendon health. The return to activity must be gradual, and any exercise that increases pain should be immediately modified or stopped.
Long-Term Support and Protection
Long-term support measures are crucial for preventing recurrence, especially when returning to sports or high-impact activities. Supportive footwear is a primary preventative step, as unstable shoes place undue stress on the peroneal tendons. For individuals with high arches or specific gait patterns, custom or over-the-counter orthotics can be highly beneficial.
Orthotic inserts correct biomechanical alignment, helping to distribute forces more evenly across the foot and reducing tendon strain. Temporary ankle bracing or taping can also provide external support during rehabilitation or when engaging in activities that require quick changes in direction. A figure-eight taping technique is often used to stabilize the ankle joint.
Maintaining muscle balance is essential for long-term protection, ensuring that the strength gained in rehabilitation is not lost. Continued use of strengthening exercises helps the peroneal tendons withstand the dynamic forces of daily life. Gradually increasing the intensity and duration of exercise, rather than sudden spikes in activity, allows the tendons to adapt to the increasing load and prevents future overload injuries.
When Professional Medical Help is Necessary
While many cases respond well to home care, professional medical evaluation is necessary if pain does not improve after two weeks of consistent R.I.C.E. and rest. Immediate attention is required for “red flag” symptoms, including the inability to bear weight, a visible deformity, or a sudden, sharp, or “snapping” sensation, which may indicate a tear or subluxation. A healthcare provider can perform diagnostic imaging, such as an X-ray or Magnetic Resonance Imaging (MRI), to rule out bone fractures or assess tendon damage.
Physical therapy is often prescribed for supervised rehabilitation, offering tailored strengthening and stretching programs. If conservative treatment fails, a physician may consider advanced interventions.
Advanced Interventions
Corticosteroid injections around the tendon sheath can provide localized anti-inflammatory relief, though they are avoided directly into the tendon due to the risk of weakening the tissue.
Platelet-rich plasma (PRP) therapy involves injecting a concentration of the patient’s own healing growth factors into the injured area to promote tissue repair.
For chronic cases lasting three to six months or those involving significant tendon damage, surgical intervention may be required. Surgery typically involves cleaning out the damaged tissue (debridement or synovectomy) and may include repairing significant splits to restore the tendon’s integrity.