Ankle Pain: Peroneal Tendinitis

The 26 Review

  • What is Peroneal Tendinitis Inflammation and injury to the tendons on the outside of the ankle
  • Causes Repetitive running on sloped streets, long-distance running, tight calf muscles, and recurrent ankle sprains
  • Symptoms Ankle pain, pain that worsens with physical activity, swelling, instability when walking
  • Diagnosis Physical examination, X-rays, MRIs, and Ultrasounds
  • Treatment Bracing, immobilization, OTC medication, physical therapy, surgery

Let’s take a closer look…

Peroneal tendinitis is a condition that creates pain around the outside and back of the foot due to injury or damage to the peroneal tendons. The peroneal tendons are strong, cord-like structures that link peroneal muscles in the calf to the bones within the feet. Tendinitis occurs when microtears cause damage and inflammation in the tendon. This can lead to pain and difficulty walking. People often experience pain and swelling around the back and outside of the feet, among other symptoms. The pain felt with peroneal tendinitis typically worsens with activity, coming on slowly and progressively worsening over time. This condition is seen in runners and athletes most commonly.


There are a wide array of things that can cause peroneal tendinitis, but generally it boils down to repetitive motions involving the legs, ankles, and feet. Runners who frequent sloped streets can develop peroneal tendonitis, because the foot rolls outward, causing increased friction between the tendon and the bone. Marathon runners or long-distance runners commonly get this condition due to the repetitive motion of running long distances. Not stretching and in turn having tight calf muscles increases the tension on the tendons, causing them to rub more. Individuals who have recurrent ankle sprains are more likely to develop this ailment, because their ankle is weaker.


When struggling with peroneal tendinitis, there are a few symptoms one is most likely to notice. Typically, the most immediate symptoms include pain and swelling in the ankle. Other symptoms of peroneal tendonitis include the following:

  • Pain at the base of the 5th metatarsal
  • Tenderness behind the ankle
  • Pain first thing in the morning
  • Pain that worsens with physical activity
  • Redness or warmth around the tendon
  • Thickening tendons with a nodule or mass that moves with the tendon.


To diagnose this condition, your podiatrist will begin with a discussion of a patient’s full medical history of injuries. Following the discussion, a full physical examination will be conducted. During the physical examination, the doctor may press on certain parts of the foot and ankle to check for tenderness or swelling. Patients should be aware they may be asked to perform certain ankle movements to evaluate the range of motion in the joint. At times, advanced imaging may be necessary to make sure an individual doesn’t have a foot fracture, osteoarthritis, cartilage damage, or torn tissue. Those advanced imaging tests may be an X-ray, MRI, CT scan, or Ultrasound.


The best thing a person can do with peroneal tendinitis is to rest, ice, and take anti-inflammatory medications to moderate their symptoms. Bracing can support and stabilize the ankle, if walking, running, or jumping is a part of your daily routine. Immobilization may be called for to take the weight off of the tendons so they can heal. In certain cases, steroid injections around the tendon itself can alleviate pain. Physical therapy can guide a patient through stretches and exercises to regain flexibility, mobility, and strength within the foot and ankle. If peroneal tendinitis doesn’t improve with conservative treatments, surgery may be recommended. Surgery will consist of cleaning out any damaged outer layers of tissue. To figure out what the best treatment plan is for you, contact your podiatrist.

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