When doing any sport, especially running, there’s an amount of risk we need to accept regarding possible injuries. As runners, we know that the chances are high that we’ll end up injured at some stage, most likely with Achilles tendonitis, runner’s knee, and IT band syndrome. But what happens when your symptoms don’t fit the usual running injuries?
You may have peroneal tendonitis.
Also known as peroneal tendinopathy, this aggravating (yet uncommon) injury causes pain in the outer part of the lower leg and foot. If you have peroneal tendonitis (or suspect you do), you may be wondering what you can do to get rid of it. Luckily, we have the answers you’re looking for. Let’s jump right in.
What Is the Peroneal Tendon?
While peroneal tendonitis is fairly uncommon, especially compared to other tendon-related running injuries, it’s still incredibly frustrating. The main reason is that it’s hard to pinpoint the pain source.
With peroneal tendonitis, the source is the peroneal tendon. We have two of these tendons in each leg – the peroneus brevis and the peroneus longus. They are parallel to one another and connect the outside part of your foot to your lower leg.
These tendons work together to allow your foot to roll outwards and help your calf muscles flex your foot. They also help stabilize your ankles when doing weight-bearing or high-intensity activities like running.
As with all tendonitis cases, the issue is related to damage and degeneration rather than inflammation. This is where the “tendinopathy” name comes in. But since “tendonitis” is the more common term, that’s what it’s typically called.
How Common is Runner’s Peroneal Tendonitis?
As with most tendon-related injuries, your peroneal tendons can get injured due to overuse. But unlike Patellar or Achilles tendon injuries, peroneal tendon injuries are uncommon.
A 2013 study categorized injuries of over 2,000 runners and found that just 13 participants had peroneal tendonitis, of which 9 were men. Based on this study, only 0.6% of running injuries are peroneal tendonitis, showing just how rare it is. However, more studies would need to be done for a more accurate conclusion.
So, while it’s unlikely that the injury you have is peroneal tendonitis, you shouldn’t dismiss it. If the symptoms fit, consult your doctor or trainer for an accurate assessment.
What Are the Symptoms of Peroneal Tendonitis?
The main symptom of peroneal tendonitis is an aching or sharp sensation on the outside of your foot or along the length of your tendons on the outside of your lower leg. It can occur along the outside of the ankle, along the edge of your 5th metatarsal bone, or at the insertion point of your tendons.
Running will be quite painful, as will rolling, flexing, or pointing your foot. You may also have soreness and stiffness when doing ankle circles or if you passively stretch the tendon. You shouldn’t experience any pain when pushing on the injured area or when standing.
Some of the most common symptoms include:
- Pain that worsens with physical activity
- Pain along the tendons
- Redness, warmth, or swelling around the tendons
- Thickened tendons with a nodule or mass that moves with the tendon
NOTE: if you have pain when standing or while non-weight-bearing or your foot is tender to the touch, you may have a fracture and should seek medical advice immediately.
While peroneal tendonitis is uncommon, it can cause plenty of trouble if you don’t address it quickly. A frequently asked question is how to know which of the peroneal tendons has the injury. However, studies have found that the treatment doesn’t change based on which tendon it is and that 33% of peroneal tendonitis cases saw both tendons affected anyway.
Can You Rupture Your Peroneal Tendon?
If you don’t treat peroneal tendonitis, it can progress to a rupture. Ruptures occur if the tendon partially or fully tears. Weakened or damaged tendons can lead to subluxation – a dislocation of the tendons. Ruptures and subluxation may cause:
- Intense pain on the outside of your ankle and foot
- Ankle instability and weakness
- Snapping or sharp feeling in your tendons
How To Diagnose Peroneal Tendonitis
Unfortunately, peroneal tendonitis is challenging to diagnose as the symptoms are much like those of most ankle and foot issues, like fractures, sprains, and arthritis. One study suggests that out of everyone diagnosed with peroneal tendonitis, around 60% are first misdiagnosed.
When getting diagnosed, your doctor will review your symptoms and perform a physical exam. They’ll press on different parts of your ankle and foot and check for tenderness or swelling. Your doctor may also ask you to do ankle movements to assess your range of motion.
You may also undergo imaging, such as an MRI, X-ray, ultrasound, or CT scan, to check you don’t have torn tissue, cartilage damage, osteoarthritis, or a fracture.
Causes of Runners’ Peroneal Tendonitis
As peroneal tendonitis is so uncommon, there aren’t any studies on the risk factors or causes of the issue. But there is one risk factor that stands out. A review of 22 cases of peroneal tendonitis found that more than 80% of the patients had high-arched feet. The higher arches place more tension on the peroneal tendons, increasing their risk of injury.
When we think about it, this makes complete sense as having low-arched feet is a risk for posterior tibial tendon injuries – these tendons are on the inside of your foot and leg.
Studies have also shown that running faster places additional stress on your peroneal tendons. Faster running creates significant activity in your peroneus brevis muscle. The intensity of the contraction doubles when comparing race pace to easy recovery jogging.
Sometimes, peroneal tendonitis is precipitated by an ankle injury or sprain. Given the peroneal tendon’s location on the foot, we can see how an ankle injury could provoke tendonitis or tendon damage. If you’ve got lingering pain after spraining your ankle, you may also have a peroneal tendon injury.
Risk Factors for Peroneal Tendonitis
While anyone can get peroneal tendonitis, it occurs more frequently in those who engage in activities that require lots of ankle movement, such as running and basketball. You’re also at a higher risk of developing peroneal tendonitis if you:
- Are older than 40
- Have previous tendon injuries
- Don’t stretch before exercising
- Have health conditions like gout, diabetes, rheumatoid arthritis, or osteoarthritis
- Are overweight
- Have high arches
- Smoke
How To Get Rid Of Peroneal Tendonitis
Conservative treatment options normally aim to relieve tendon inflammation and pain within four weeks. Recovery may take longer if your peroneal tendonitis results from a sprain or injury.
Some of the typical treatments used to get rid of peroneal tendonitis include:
Immobilization: You may need a noot or soft cast to help immobilize your ankle and foot to take the weight off the tendons and prevent them from moving so they can repair.
Bracing: You can use an ankle brace to stabilize and support your ankle when doing certain activities, like jumping or running.
Physical Therapy: You may need a physical therapist to work with you on stretches and exercises to regain flexibility and strength in your ankle and foot. Your PT may also recommend using heat, ice, or ultrasound therapy.
Medication: Your doctor may recommend using a non-steroidal anti-inflammatory drug to reduce inflammation and pain. You may need a steroid injection in the tendon sheath.
RICE Method: Often, the first port of call is to use the RICE method – rest, ice, compression, elevation. Avoid strenuous activities and apply cold compresses or ice packs for 20 minutes every 2 to 4 hours. Wrap the ankle in a compression bandage and keep it elevated to reduce swelling.
Does Peroneal Tendonitis Require Surgery?
If your peroneal tendonitis doesn’t show improvement with the above treatments, you may require surgery. This surgery will clean out the damaged layers of tissue from the peroneal tendons. This procedure is called a synovectomy.
Depending on your level of damage, you may only require a minimally invasive synovectomy. This surgery has a faster recovery as it involves using smaller incisions.
Before opting for this option, you need to understand the risks of ankle surgery. Some of the risks include the following:
- Blood clots
- Bleeding
- Nerve damage
- Infection
- Ankle pain
- Recurring tendonitis
- Scar tissue buildup
How to Prevent Peroneal Tendonitis
If you’ve been feeling a few twinges and niggles in your outer foot or leg, there are a few things you can do to minimize the risk of it developing into peroneal tendonitis. These include:
- Maintain a healthy weight
- Slowly build up the intensity of physical activity
- Don’t push through ankle or foot pain
- Rest between workouts
- Quit smoking and drinking
- Wear supportive shoes and ankle braces
- Stretch the ankles and feet before running
- Consult your doctor about orthotics for high arches
What Is The Expected Recovery Time?
Most runners fully recover from peroneal tendonitis within 4 to 6 weeks when allowing proper time for recovery using the conservative options. If you’ve had peroneal tendonitis surgery, you’ll have a cast on your ankle or lower leg for around 6 weeks.
You’ll likely use crutches for mobility during this time. Once the cast is removed, you may need the crutches for a further 2 to 4 weeks. Your surgeon will advise you on when it’s safe to put weight on your foot and ankle again.
Almost everyone who undergoes peroneal tendonitis surgery requires physical therapy after the cast is removed to regain stability and strength in their ankle.
When to Seek Medical Advice for Peroneal Tendonitis
If you experience any of the following symptoms or problems, contact your doctor immediately:
- Can’t rotate the ankle in any direction
- Unable to put weight on the ankle or foot
- Can’t walk
- Have a popping or snapping sensation in the ankle or foot
- Notice discoloration or swelling in the ankle or foot
- Have sudden, severe pain in the ankle or foot
Best Exercises for Peroneal Tendonitis
As the saying goes – prevention is better than cure. Taking the time to strengthen your peroneal tendons will reduce your risk of developing tendonitis. They’re simple to do and take only a few minutes. These exercises also positively impact your running training and strength overall.
These exercises should be done three times each week, and each day should include 3 sets of 10 reps per exercise.
- Ankle eversions with a resistance band
- Ankle inversions with a resistance band
- Weighted calf raises
See more: our guides to injury rehab and prevention for runners.
