Peroneal Tendinitis: Causes, Treatments, and Exercises for Healthy Ankles

If you experience pain on or near your ankle, you may assume that it’s a sprain, or that you’re having an issue with your Achilles tendon. But there are other tendons in that area that can get irritated and inflamed: your peroneal tendons. “Unlike your Achilles tendon, which is on the back side of your ankle along your heel, the peroneal tendons run along your outer ankle bone and the side of your foot,” explains Mijo Cotic, PT, DPT, a physical therapist at Hinge Health. They have an important job: They connect the muscles in your lower leg to your foot bones, which helps keep you stable and balanced.

Both Achilles tendinitis (tendonitis) and peroneal tendinitis (tendonitis) can take a toll on your foot mobility and function. If your feet and ankles hurt or feel unsteady, it’s understandably trickier to do your usual daily routine and activities.

Thankfully, tendinitis in the ankle can often be managed with at-home treatment, especially exercises that increase ankle strength and range of motion. As one Hinge Health member recently told us, doing regular stretching and strengthening exercises is giving them more confidence to walk further. “I took a three-mile walk yesterday [on vacation] with minimal discomfort,” they said. “I can really feel the stability and strength in my ankle. Was able to enjoy something that I didn’t think I could three months ago.”

Here, learn more about what peroneal tendinitis is, what causes it, and tips and exercises that can help you feel better so you can get back to the activities you love or need to do.

What Is Peroneal Tendinitis?

Here’s a crash course on your peroneal tendons: You’ve got two of them in each ankle, and they run side by side behind your outer ankle bone. One attaches to the outer part of the midfoot; the other one runs under your foot and attaches near the inside of your foot’s arch. Their mission is to keep your foot and ankle stable and help prevent ankle sprains.

Most of the time, they do their job very well. But if you’re doing more activity than these tendons can handle at the moment, they can get irritated, triggering peroneal tendinitis, says Dr. Cotic. This condition can also occur if you’ve recently picked up a sport where there are a lot of quick lateral movements and changes of direction, such as football, basketball, or soccer. 

This is not to say that you should avoid playing new sports or increasing your activity level. Quite the opposite: You should be comfortable and confident using and moving your feet and ankles and trying new things. But doing some targeted stretches and strengthening exercises can help keep your body healthy and prepared for taking on more activity.

Symptoms of Peroneal Tendinitis

Peroneal tendinitis isn’t as common as other types of ankle tendinitis, such as Achilles tendinitis. One study of several thousand runners, for example, found that there were only 13 cases — less than one percent — of peroneal tendonitis. But since it is so rare, it can sometimes be misdiagnosed (usually as a lateral ankle sprain).

“With peroneal tendinitis, it’s pretty common to have some type of pain around the foot or ankle, although the nature of the pain can vary a lot from person to person. It can be sharp, dull, or even just achy,” says Dr. Cotic. “You may even notice a pinch-like pain, as if something’s impinged.” Other symptoms that accompany peroneal tendinitis often include:

• Pain that worsens with activity.

• Swelling and/or redness around the tendons. “You may notice it looks puffier compared to the area around it,” explains Dr. Cotic.

• A “mass” that moves with your tendon (this is due to your tendon or tendons thickening temporarily because of inflammation). 

• A popping or clicking sound when you put weight on the affected foot. 

Sometimes, peroneal tendonitis can lead to subluxation, which means one or both tendons have slipped out of position. If this happens, you may feel a snapping sensation of your tendon around your ankle bone. You’ll likely feel pain and may not be able to put weight on your ankle. If you notice this, see a physical therapist or foot doctor right away. Untreated, it can lead to a peroneal tendon tear.

Causes of Peroneal Tendinitis

Anyone can develop peroneal tendinitis, especially if they do sports that involve a lot of ankle movement, like running or playing soccer or basketball. Here are some of the most common contributors:

• Repetitive activities. When pain develops gradually, it’s usually due to repeatedly doing too much of an activity, or doing something that requires a lot of repetitive motion, without doing the right strengthening exercises to prepare your body for those activities, says Dr. Cotic. “We often see it from walking or running on an uneven surface or a hilly terrain,” he adds. Again: This does not mean running or uneven terrain is bad or something to be avoided. It just means that if you do these activities and they’re affecting your foot health, therapeutic exercises can help your body handle them.

• High arches. While all foot types can be susceptible to peroneal tendinitis, those with stiffer, more rigid feet (common in people with high arches) might be more at risk.

• Ankle sprains. Ankle sprains can put more stress on peroneal tendons. An ankle sprain means you’ve experienced some damage to your ankle ligaments, a form of connective tissue similar to tendons. If you are recovering from an ankle sprain, or you have recurrent ones, you might be more susceptible to peroneal tendinitis, says Dr. Cotic. 

• Tight calf muscles. “When your calves are tight, it's harder for your main ankle joint to move through its normal range of motion. This can cause changes to your ankles and feet that can stress your peroneal tendons,” says Dr. Cotic.

Treatment and Recovery Recommendations

Most cases of peroneal tendinitis should start to improve within a few weeks. While you recover, you may want to take a temporary break from activities that significantly increase your pain. But some discomfort is okay and normal during regular activities and movement, and it’s a good idea to stay as active as feels comfortable for you. 

“You want to keep your ankle joint moving, to increase blood flow to the area and promote healing,” explains Dr. Cotic. You can do this through movement like walking, biking, and swimming, as well as the suggested exercises in the section below. Here are some other recommended treatments for peroneal tendonitis:

• Ice and heat. Ice tends to be useful periodically throughout the day, especially after activity, to help with swelling, says Dr. Cotic. Apply it 10 to 20 minutes at a time. You can also rotate it with heat if that feels good for you. 

• Bracing. You may benefit from taping your ankle (a physical therapist can show you how) or wearing a compression brace when doing certain activities to reduce extra strain on your peroneal tendons.

• Over-the-counter medication. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol) can be helpful for ankle tendinitis pain and swelling. It’s important to make sure that you are safely able to take these medications, based on your medical history.

• Physical therapy. “Your ankles are part of a ‘kinetic chain’ that’s connected not just to your feet, but to your knees and hips, as well,” explains Dr. Cotic. A physical therapist can work with you on appropriate ankle stretching and strengthening exercises, which will help treat peroneal tendonitis and help prevent potential tendon or joint problems down the line. They may also work with you on exercises that target your hips and knees. “Our goal is to build strong, healthy ankles, so that you can get back to doing what you love,” stresses Dr. Cotic. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

Most people respond well to conservative measures within a few weeks. In very rare situations, where you don’t respond to more conservative measures like physical therapy, tendon surgery may be recommended. 

These exercises recommended by Hinge Health physical therapists can help to effectively treat and prevent peroneal tendonitis.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Update Your Footwear

If you have very high arches, and you notice peroneal tendonitis cropping up, it might be worth visiting your local sneaker store. “Many people automatically think that they need a sneaker that provides arch support, but if you have high arches the reverse is true: You actually benefit from a more neutral type shoe,” explains Dr. Cotic. “Wearing a shoe that is too stable or supportive can cause your peroneal tendons to engage more than you actually want.” The proper shoe — the one with the right amount of support for you — helps make each joint more efficient and improves your ability to heal and go about your activities without pain, he adds. 

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Peroneal Tendon Injuries. (n.d.). American College of Foot and Ankle Surgeons. Retrieved from https://www.acfas.org/

2. Davda, K., Malhotra, K., O’Donnell, P., Singh, D., & Cullen, N. (2017). Peroneal tendon disorders. EFORT Open Reviews, 2(6), 281–292. doi:10.1302/2058-5241.2.160047

3. Walt, J., & Massey, P. (2020). Peroneal Tendon Syndromes. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544354/

4. Draper, T. R. (2022, November). Non-Achilles Ankle Tendinopathy. UpToDate. https://www.uptodate.com/contents/non-achilles-ankle-tendinopathy

5. Taunton, J. E. (2002). A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine, 36(2), 95–101. doi:10.1136/bjsm.36.2.95