You have many tendons in your body that connect muscle to bone. The two peroneal tendons are located in the foot, and both run next to each other behind the outer ankle bone. One of these tendons attaches to the outside section of the midfoot, and the other runs beneath the foot, attaching to the inside arch. The primary purpose of the peroneal tendons is to provide stability to your feet and protect you from sprains. These tendons are strong, but they’re not very flexible or stretchy, and it’s easy for them to become strained. The area where the tendon attaches to the bone is where most injuries occur. These injuries are often due to overuse and “microdamage” that happens over time. The tendon may rupture, tear, or split. Our skilled podiatrists discuss the causes of peroneal tendonitis and the importance of treatment. 
Causes of Peroneal Tendonitis
Peroneal tendonitis occurs when the peroneal tendons become inflamed. At Austin Foot and Ankle Specialists, we often see this in athletes, particularly runners. The following are often found to be the cause of this painful condition:
- Overuse and repetitive motion
- Sudden increase in training, especially when walking, running, and jumping
- Improper training
- Footwear issues
Our Austin Podiatrist Discusses Symptoms of Peroneal Tendonitis
The primary symptom of peroneal tendonitis is swelling and pain around the ankle. This pain may get worse during activity and improve when you’re resting. Because the peroneal tendons are meant to provide foot stability and bear weight, they can sometimes become inflamed. This inflammation can lead to:
- Pain at the back of the ankle that gets worse during activity and better during rest
- Swelling in the area around the ankle
- Instability in the ankle
- Warmth in the affected area
- Pain that is worse in the morning
- Limping
- Difficulty changing direction abruptly
Risk Factors for Developing Peroneal Tendonitis
Certain people are more likely to develop peroneal tendonitis than others. You might be at greater risk if you:
- Are over 40
- Don’t stretch before engaging in physical activity
- Suffer from certain health conditions, including rheumatoid arthritis, gout, or diabetes
- Have higher than normal arches
- Are an endurance runner, ice skater, dancer, or skier
- Have misaligned heels that tilt inward or are inclined
- Have lower limb muscles and joints that don’t work well together
- Have imbalanced muscles in your lower limbs
- Had a sprain or other ankle injury and did not complete rehabilitation for it, causing it to not heal properly
Why Peroneal Tendonitis Requires Treatment
It can take approximately 6 – 8 weeks for peroneal tendonitis to improve, and if you start back into your athletic or training activity too quickly, your healing tendon will suffer a setback, and your recovery time may double. This can be very frustrating for people who live an active life. To help ensure that your tendon injury heals property and/or there is no further damage, early conservative treatment is important.
Additionally, ignoring the pain that accompanies peroneal tendonitis and hoping it will go away on its own can be dangerous. This is a condition that presents similarly to other foot problems. What you think may be peroneal tendonitis could actually be a broken ankle or bone.
The Potential Consequences of Ignoring Peroneal Tendonitis
The good news is that most people who develop peroneal tendonitis make a full recovery. This does require time and effective treatment. However, if the issue is left untreated:
- The tendon could tear
- There is an increased risk of a sprained ankle in the future
- Chronic ankle instability is possible
- The cartilage inside the ankle joint could be damaged
- Nerve damage could occur
How Peroneal Tendonitis Is Diagnosed
To properly diagnose peroneal tendonitis and rule out any other condition, our podiatrists utilize a variety of methods and techniques, including the following:
Obtaining a Medical History
We need to know your physical activity level, involvement in sports, and daily routine. This will help us understand what may have led to the injury. We also want to know if you’ve had foot or ankle issues in the past that could have contributed to the current pain you are experiencing.
Performing a Physical Exam
Our podiatrist will need to look at your foot and ankle and move them into different positions while applying pressure. This will help them better understand the specific nature of your symptoms. If you experience pain during this exam, it is important to tell the podiatrist, as this can be important information about the nature of your injury.
Using Diagnostic Equipment
Our podiatrist may use an X-ray, MRI, or ultrasound to better see if there is evidence of a break or scar tissue. This can help our team make an accurate diagnosis and determine the full extent of the injury.
Treatment Options for Peroneal Tendonitis
Once your doctor confirms that you have peroneal tendonitis and not some other condition, they will likely recommend several different treatments to be used in combination. They may include:
Rest
Because this condition typically results from overusing the tendons, giving the tendons a break can help. You will likely need to limit how much you are walking for several weeks. Failing to allow your foot the rest it needs can cause setbacks and result in a longer recovery time.
Immobilization
A cast, boot, or other support device might be used to keep the foot and ankle from moving.
Bracing
You may need to wear a brace if you’re involved in activities with repetitive motion. This type of motion can aggravate your injury.
Ice
Applying an ice pack for 10-20 minutes several times per day may relieve pain and swelling. Elevation during icing may be especially helpful. Never expose bare skin to ice, as this can damage the skin.
Over-the-Counter Medication
Ibuprofen and other anti-inflammatories are commonly used to reduce pain and swelling caused by peroneal tendonitis.
Physical Therapy
Once symptoms start to improve, some exercises can be used to strengthen the muscles and improve balance.
Cortisone Injections
Cortisone injections don’t heal the tendon injury and won’t strengthen the tendon. However, they may provide some pain relief for a short time.
Surgery
Surgery is not a commonly utilized treatment option because non-surgical methods are generally effective in treating the symptoms of peroneal tendonitis. If the tendon has torn or non-surgical options do not relieve the pain, surgery could be considered but not until less invasive options are exhausted. The recovery time from surgery is very long, and any surgery carries the risk of complications, including infection. Surgery is generally only considered as a last resort.
How the Podiatrists at Austin Foot and Ankle Specialists Can Help
The podiatrists at Austin Foot and Ankle Specialists can diagnose and treat peroneal tendonitis and help you avoid the condition in the future. We do this by:
- Using available medical technology to help ensure an accurate diagnosis
- Teaching about exercises for strong feet and stretches to avoid injuries. This might include the use of a Theraband
- Providing education about selecting proper footwear and why it must be in good condition and a good fit to reduce the chances of an injury
- Explaining the benefit of custom orthotics and bracing
- Offering regenerative medicine to help reduce symptoms and accelerate healing. This is a broad category of treatment techniques from which we can select the options most likely to benefit you
- Suggesting low-impact activities that can help patients stay fit and give their feet and ankles a break, such as:
- Swimming
- Cycling
- Yoga
- Rowing
