Peroneal tendinopathy

There are two peroneal tendons that pass on the outside of the ankle. Together they help stabilise the ankle and foot, especially when walking on uneven ground or standing on one leg.

What causes this problem?

The peroneal tendons are commonly injured during an ankle sprain, but they can also be injured through overuse. Walking or running on uneven ground, especially in worn shoes or trainers, can cause the problem.

What are the symptoms?

The more common symptoms are pain and sometimes swelling on the outside of the ankle. On ultrasound examination, the tendon itself is often thickened. Compared to the other foot, weakness may also be observed when pushing an object with the outside of the foot.

What should I do if I have this problem?

If possible, rest or at least reduce activity to allow symptoms to settle naturally. Change footwear to those more supportive of the ankle, such as boots. If you wear arch support, it may help to remove it because it pushes your foot outwards too much.

What treatments can help?

The first treatment is usually an insole, which supports and assists the peroneal tendons. Exercises on a flat surface to strengthen the tendon are necessary to promote healing. Simple painkillers such as paracetamol can be used to dull the pain, but they do not cure the problem. Anti-inflammatories such as Ibuprofen can also be effective. It is best to consult your GP or pharmacist if you have not taken these before, as these medications can have side effects. In extreme cases, a supportive boot or ankle brace may be used for a short period to allow symptoms to settle.

Will I need surgery?

Mostly, it can be successfully treated without surgery. However, if the problem does not get better then surgery may need to be considered, but only after an ultrasound scan. Surgery may be necessary if the tendon repeatedly slips out of its groove behind the ankle; if it does this, you will experience a clicking sensation over the outside ankle.

Exercise programme for peroneal tendonitis

Calf wall stretch

• Stand facing a wall with your hands on the wall. Take a step back with your affected leg.
• Keeping your toes pointed forward and both heels on the floor, bend your front knee and shift your weight forward. Keep your back leg straight.
• Hold the stretch for 15 to 30 seconds, or longer if you can.
• Repeat three times.

Standing stretch

• Stand facing a wall with your hands on the wall. Take a step back with your affected leg.
• Keeping your toes pointed forward and both heels on the floor, bend both knees and lean forward.
• Hold the stretch for 15 to 30 seconds, or longer if you can.
• Repeat three times.

Ankle stretch

• Sit in a chair with your affected leg crossed over your other knee.
• Hold the bottom of your foot and slowly tilt the sole of your foot toward the floor. Hold for five to 10 seconds.
• Then pull your foot toward you, tilting it to the ceiling. Hold for five to 10 seconds.
• Repeat 10 times.

Resisted ankle stretch

• Ensure that you only rotate your foot outwards and not your lower leg. Your knees should remain stationary. Stop the strengthening exercise if you start to experience pain.

Warning

These exercises should not be done on a step. This will not help and may make the problem worse, as it increases the compression between the tendon and the lateral malleolus.