PERONEAL TENDONITIS
Dr. Masci has experience in managing peroneal tendonitis
in the ankle and mid-foot
Dr Masci has extensive experience managing peroneal tendonitis in the ankle and mid-foot. So what is peroneal tendonitis, how do we diagnose it, and what’s the best treatment?
This is the dedicated page for peroneal tendonitis. For peroneal tendon tears and instability, see our overview of peroneal tendon problems.
What is peroneal tendonitis?
Peroneal tendonitis, also called peroneal tendinopathy, is an injury of the peroneal tendons at the ankle, and it’s common. The tendons arise from the peroneal muscles on the outside of the leg, forming two tendons — the peroneus longus and peroneus brevis — that run around the outside of the ankle and attach to the foot. Their main action is to evert the ankle, rocking it outward.
The most common peroneal tendon problem is inflammation — peroneal tendonitis. (Peroneal tendons can also tear or become unstable; we cover those on the peroneal tendon problems page.)
How do specialists diagnose peroneal tendonitis?
Peroneal tendonitis results from repetitive overuse or an acute injury, such as an ankle sprain. Typical symptoms include pain at the back of the outer ankle when walking or running, swelling, weakness, and tenderness on the outside of the ankle. The pain is reproduced by pulling the foot downwards and inwards, which stretches the tendons.
Ultrasound or MRI shows thickening of the peroneal tendons and inflammation of the tendon sheath. Ultrasound is also effective at detecting a peroneus brevis tear or peroneal tendon subluxation, which can occur alongside or be mistaken for tendonitis.
Peroneal tendonitis treatment
Simple treatments are often very effective.
- Rest and offloading — ice, relative rest, and a walking boot in more painful cases.
- Medication — anti-inflammatories such as ibuprofen reduce pain and inflammation, and GTN patches can help with tendon pain.
- Physiotherapy — strengthening the peroneal tendons, calf muscles, and small muscles of the foot.
- Orthotics—supporting flat or high-arched feet—reduce the load on the peroneal tendons.
Injections for peroneal tendonitis
Injections help in more difficult cases. Cortisone injections are used sparingly because of the small risk of tendon damage. A carefully placed cortisone shot into the tendon sheath (not the tendon) can help severe cases that don’t improve. We use ultrasound guidance to ensure accuracy and safety. Where there’s a tear, we consider PRP rather than cortisone.
Surgery
We only consider surgery if simple measures fail. Options include peroneal tendon repair, or tenodesis (stitching the damaged tendon to the normal one), and sometimes reshaping the heel to reduce the load on the tendon. Recovery after surgery takes up to four months.
Frequently asked questions about peroneal tendonitis
What does peroneal tendonitis feel like?
Pain and swelling on the outside of the ankle, behind the bony bump, are brought on by walking or running and eased by rest. The pain is often reproduced by turning the foot down and in, which stretches the tendons.
How long does peroneal tendonitis take to heal?
Like most tendon problems, it’s often slow, typically several weeks to a few months, with a consistent strengthening and load-management programme. Reducing the aggravating activity early speeds recovery.
Can I run with peroneal tendonitis?
Often with modification — reducing volume and uneven surfaces while you build strength. If pain escalates, scale back and get it assessed, since persistent tendonitis can be slow to settle. Swimming and cycling keep you fit in the meantime.
Is my outer ankle pain tendonitis or a tear?
You can’t always tell from symptoms — both cause outer-ankle pain and swelling. Ultrasound or MRI distinguishes them, which matters because a tear changes treatment (we avoid cortisone and consider PRP or surgery).
Do orthotics help peroneal tendonitis?
Often, yes. Supporting a flat or high-arched foot redistributes the load away from the peroneal tendons, which can meaningfully reduce pain — particularly where foot shape is contributing.
Final word from Sport Doctor London about peroneal tendonitis
Peroneal tendonitis is a common tendon injury on the outside of the ankle, with pain and swelling over the tendons. Simple treatments — ice, medication, physiotherapy, and orthotics — help most cases, and we reserve injections or surgery for particularly challenging ones.
To book a one-stop ankle assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.