Peroneus Muscles

Peroneal Tendinopathy

What is Peroneal Tendinopathy?

Peroneal tendonitis is a common term for a peroneal tendinopathy.

Peroneal tendinopathy refers to a condition of the peroneal tendon where there is structural changes in response to load. Contrary to popular belief, it is not an inflammatory condition. Swelling is common due to irritation of the tendon and surrounding structures, BUT it is not a crucial aspect of this particular condition.

This is why health practitioners now refer to peroneal tendonitis as the more accurate term: peroneal tendinopathy.

More info about tendinopathy here.

Peroneal tendon injuries are usually due to increased loads and overuse of the peroneal muscles. What happens is that when this happens repeatedly over a period of time, the peroneal tendon naturally thickens in response to manage the increase in tensile load more effectively.

Good news is that depending on the stage of the tendinopathy, these structural changes are reversible and often respond well to physiotherapy management.

What are the Peroneal Muscles?

The peroneal muscles are located on the outside of your lower leg.

What they do and function is that they turn the foot out and provide stability to the ankle during weight-bearing. The peroneal tendons wrap around the lateral malleolus (this is the bony lump on the outer side of the ankle) and attach at different areas on the foot.

Every time the peroneal muscles contract, tension is placed on the peroneal tendons.

What Causes Peroneal Tendinopathy?

There are a number of different factors which can cause peroneal tendonitis, including

  • A sudden increase in weight-bearing activities, particularly walking, running or jumping
  • Inadequate or unsupportive footwear (or new footwear)
  • Muscle imbalances of the lower limb
  • Poor lower limb biomechanics
  • Incomplete rehabilitation following an acute ankle injury, such as an ankle sprain

What are the Symptoms of Peroneal Tendinopathy?

People with peroneal tendinopathy may experience:

  • Gradual worsening pain over the outside of the ankle
  • Pain during and/or after weight-bearing activities
  • Pain with turning the foot in and/or out
  • Instability around the ankle when weight bearing

How is Peroneal Tendinopathy Diagnosed?

You can consult a

  • physiotherapist
  • podiatrist
  • sports physician or
  • orthopedic surgeon / orthopedist

A variety of tests will be performed to determine the diagnosis and exclude other causes of lateral ankle pain. An imaging ultrasound may also be used to confirm the diagnosis.

Peroneal Tendinopathy Treatment

The prognosis for peroneal tendinopathy is variable, depending on the stage of the injury.

In the acute phase, you should start to notice an improvement with a couple of weeks of treatment. Treatment in this stage is aimed at reducing load and allowing the irritated tendon to settle. Once the pain lessens, you will be started on a home exercise program to improve

  • range of motion
  • strengthen the lower limb muscles and
  • improve your balance

Chronic tendinopathies will take longer to recover. The treatment at this stage is largely based on active rehabilitation to improve the tendon’s ability to respond to load. This will include

  • eccentric strengthening of the peroneal muscles;
  • as well as balance, strength and range of motion exercises of the lower limb, ankle and foot

Peroneal Tendinopathy Prevention

There are several things you can do to reduce your risk of developing peroneal tendinopathy.

  • Wear correct, supportive footwear for you- this is not necessarily the most expensive or newly released shoe on the market
  • Gradually increase your training load or exercise level
  • Maintain a level of activity during down time or off seasons – consider cross-training which is not only great for maintaining your cardiovascular fitness, it will also ensure your muscles stay strong and reduce your risk of re-injury when you return to your chosen sport
  • Improve your balance and ankle proprioception

Return to Sports with Peroneal Tendinopathy

Recovery for athletes with peroneal tendinopathy is generally good and most people are able to return to their previous sporting level without any ongoing problems. It is important that you complete your full rehabilitation program as prescribed by your physiotherapist to prevent further problems and reduce your risk of re-injury.