Do you have peroneal tendinitis? Here's how to fix it (2023)

Do you have peroneal tendinitis? Here's how to fix it (1)

John Davis

As runners, we accept that our sport involves some risk. When we're good at oursMarathon-Trainingsplan,Addicted to trail running, or a first 5k, we hear from the high injury rates. And do you know there's a good chance we'll end up as one of many injured runners.

We anticipate that we might end up withrunner kneeorAchilles tendonitis. But what if your pain doesn't seem to fit into any of the usual categories? And when you're looking for running injuries, the sore spot and tender area just don't seem to mix.

Peroneal tendonitis, also known as peroneal tendinitis, is a rare but aggravating injury. It can cause pain on the outside of your foot. And when running on the outside of your lower leg.

Do you have peroneal tendinitis? Here's how to fix it (2)

What are the peroneal tendons?

While peroneal tendonitis isn't as common as the other forms of tendon pain, it doesn't make it any less frustrating. Especially when we cannot pinpoint the exact source of the pain.

There actually istwoperoneal tendons. The peroneus longus and the peroneus brevis, which run parallel to each other. Connect the outside of your foot to the peroneus longus and brevis muscles in your lower leg.

These tendons work together to evert (roll outward) your foot and also help your calf muscles plantar flex your foot. They also help stabilize your ankle during weight-bearing activities like running.

As with all cases of "tendonitis," the problem is really degeneration and damage, not inflammation. A more appropriate term would be "peroneal tendinopathy" or "peroneal tendon dysfunction".

However, since the term tendonitis is still more commonly used, this article will use that.

How common is peroneal tendinitis in runners?

Like any tendon, both peroneal tendons can be injured from overuse.

In contrast to injuries to the Achilles tendon orPatellarsehne, which are fairly common and well understood, peroneal tendon injuries are fairly rare.

A study by Taunton et al., which categorized the injuries suffered by over two thousand runners at a sports injury clinic, found only thirteen cases of peroneal tendonitis.1This means that peroneal tendinitis accounts for only about 0.6% of all running injuries. With such a small number of cases, it is difficult to draw too many conclusions, but Taunton et al. noted that nine of the thirteen cases occurred in men.

It is difficult to say whether peroneal tendinitis is actually more common in men than in women. Or if this is just random statistical noise. However, injuries to the Achilles tendon and the patellar tendon are also more common in men. So there might be something to this trend.

(Video) How to Treat Peroneal Tendonitis with Seattle Podiatrist Larry Huppin

Do you have peroneal tendinitis? Here's how to fix it (3)

What Does Peroneal Tendonitis Feel Like?

Peroneal tendonitis presents as a sharp or painful sensation along the length of the tendons or on the outside of your foot.

It can occur at the insertion point of the tendons. Along the outside edge of your fifth metatarsal. Or further up along the outside of your ankle.

Running will be painful, as will trying to flex and evert the foot, especially against resistance. Stiffness and pain can also occur when "knuckle-circling" or even passively stretching the tendon.

There should not be much pain when standing or when gently pressing on the injured area. However, if the outside of your foot feels very tender and you experience severe pain while standing or even without weight bearing, you can use insteadHave a fracture in your fifth metatarsal.

These are uncommon but can cause a lot of trouble if not addressed immediately. So if you're unsure if you have peroneal tendinitis, see your doctor as soon as possible.

Does it matter which of the two peroneal tendons you injured? The relatively sparse scientific literature on peroneal tendonitis indicates that this is not the case.

In fact, about 33% of all cases of peroneal tendinitis appear to be involvementbothtendons anyway. Therefore, any rehabilitation program must address both the peroneus longus and the peroneus brevis.2

Common causes of peroneal tendinitis in runners

Because peroneal tendinitis is so rare, there are no large studies of risk factors. The only reports that exist in the medical literature analyze a relatively small number of cases.

However, one risk factor seems to stand out.

A review of twenty-two cases of peroneal tendonitis by Clayton B. Brandes and Ronald W. Smith found that over eighty percent of these patients had a high arched foot. According to the authors, feet with higher arches put more tension on the peroneal tendons, predisposing them to injury.2

That makes sense, because with alowAn arched foot appears to be a risk factor for posterior tibial tendon injury (the tendon at thewithinof the ankle).3We've already gone into more detailHow your arch height affects your shoe choice and the type of injury you are most at risk for.

Research published in 1993 also suggests that higher running speeds may put additional stress on the peroneal tendons.

Lyle Reber, Jacquelin Perry, and Marilyn Pink of the Centinela Hospital Biomechanics Laboratory in California studied how muscle activation patterns in the muscles around the ankle changed with running speed in a group of healthy, injury-free long-distance runners.4

The researchers found that higher running speeds led to a significant increase in the activity of the peroneus brevis muscle. Muscle contraction intensity doubled when comparing a light jog to a running pace.

Reber, Perry, and Pink hypothesized that forces are rapidly transmitted to the midfoot when running at high speed. And the associated increase in the need for a stable ankle is responsible for the increased demands on the peroneus brevis.

As a result, faster runners and runners who engage in high-intensity interval training sessions are at greater risk of peroneal tendonitis.

Maybe it's best to stay away from thatTraditional forms of quick workif much of what we have said so far applies to you.

Some cases of peroneal tendon injuries are triggered by an ankle sprain. We have already told youHow to sprain your ankle while trail running. However, given the location of the tendons on your foot, it's easy to see how an inversion sprain can lead to tendon damage.

A 1993 report by Mark Sobel, Mark Geppert, and Russell Warren of the Hospital for Special Surgery in New York linked ankle instability from previous ankle sprains to damage to the peroneal tendons.5This was confirmed by a 1998 article inFoot & Ankle Internationalby researchers at the Mayo Clinic.6

If you have persistent pain after an ankle sprain, you may have injured one of your peroneal tendons as well. In some cases it even broke. This can be detected on an MRI.


Download the Peroneal Tendonitis Treatment Exercises and Plan.

It is a PDF detailing the conservative and aggressive treatment options for runners suffering from peroneal tendinitis.


How can I treat my peroneal tendinitis?

Even with treatment, the rarity of the injury complicates treatment. There are no controlled clinical trials that establish a rehabilitation program to be followed.

Still, we can draw some conclusions from what we know about the injury. And follow the recommendations of scientists and doctors with clinical experience.

According to Daniel S. Heckman and others at the University of North Carolina, treatment should include rest (obviously), stretching, and strengthening. And proprioceptive exercises to restore proper tendon function.7

From what we know about peroneal tendon function, it follows that any strengthening program should focus on eversion of the foot against resistance, probably using an elastic band.

A similar strengthening program is proposed forTendonitis of the posterior tibiavon Alvarez u.8

The customized program includes doing200 repetitions of the eversion exercise daily.Start with a very weak resistance band and take breaks if you must.

Over time, you should make progress to be able to do all 200 reps in a row and use a stronger resistance band.

When stretching, it's best to focus on thatStretch your calf muscles.This is because tense calves could lead to faster load transfer to the metatarsus when running, which would increase the stress on the peroneal tendons.

you can dostraight kneeAndbent kneeWade reaches outthree sets of 30 seconds each, three times a day.

One-leg balance exercises are the best wayto improve proprioception and restore proper peroneal tendon function.

As with other single leg balance programs for running injuries, you can start with simple one leg balance and then add more complex movements. For example, reach forward, left and right with your upper body. Or work on a wobble board or foam balance mat.

These balance exercises should be done in a structured and gradual manner to improve proprioception.

In the beginning, work on improving your one-leg balance until you cantwo and a half minutes of one-legged balancingconstant.

(Video) Peroneal Tendonitis: Causes, Diagnosis, and Treatment

After that, you can increase the difficulty by closing your eyes, doing directed body leans, or using a wobble board.

What other possible treatment options are there?

As with any tendon injury, you may find freezing or contrast baths helpful for peroneal tendinitis. Although there isn't any solid research to support any of these options.

If rest and some basic balancing, stretching, and strengthening exercises don't fix the problem, you should see a physical therapist.

It's possible that you have some unique biomechanical issues that are contributing to your case of peroneal tendonitis. Or you may need a different set of exercises to get back on track.

If this is one of several injuries, your running form may be to blame.

Our running form course analyzes this for youto make sure injuries become a rare occurrence rather than being healthy is rare. One of the main reasons runners get injured is because they go too far. Be sure to read oursCrossing, cadence and heel strikepost for more on that.

Both Heckman et al. and Selmani, Gjata and Gjika proposeget individual orthosesto relieve the peroneal tendons.7, 10

Unlike many other injuries, ittutApparently, there should be a difference between custom orthotics and standard over-the-counter orthotics like SuperFeet or PowerStep.

Typically, the goal of an orthotic is to provide arch support, thereby transferring the load to the outside of the foot.

This can be very helpful in the event of injuries such asPlantarfasziitisorShin Splints. But in the case of peroneal tendinitis, this could be onebadThing. Keep in mind that over eighty percent of people who get peroneal tendinitis have high arches.

Building even more arch support and shifting the load to the outside of the foot (where the peroneal tendons reside) could actually be causing the problemworse!

Custom orthotics can change this equationby keeping the arch height of the insert lower and adding a "wedge" under the outside of your heel. This can take pressure off the outside of your midfoot.

If your case of peroneal tendinitis does not respond to rest and physical therapy exercise, a custom-made orthosis might be worth trying.

If conservative treatments fail, you should see an orthopedist and have an MRI done to check for a tendon tear.

Especially when a peroneal tendon injury coincides with an ankle sprain, there's a chance that what feels like tendonitis is actually a tendon rupture that needs surgical repair.

Fortunately, MRI appears to be an effective method to determine the extent of peroneal tendon damage.7If you tear a tendon or if there is very severe tendon damage, you may need surgery to fix it.

Outline of Treatment

conservative treatments

These are methods that are fairly easy and inexpensive and can be done even at home.

  • Wadendehnung
  • Everversion exercise with a resistance band
  • balance exercise

Aggressive treatments

These are treatments with higher costs and less certainty of results, but they can prove useful in recalcitrant cases.

  • A... seepodiatrist or orthopaedistand ask for a customized orthosis. In the case of peroneal tendinitis, standard over-the-counter orthoses are unlikely to be of much help due to the biomechanics of the injury.
  • Consider dry needling. Some runners find it works very well for peroneal tendon problems. If you're desperate, it might be worth trying.
  • See a physical therapist familiar with running injuries to make sure you don't have weakness, tightness, or gait abnormalities that are causing your tendon problems.
  • If conservative treatments are still not working after several weeks or months, see an orthopedic surgeon you trust so you can get an MRI to check for a tendon rupture or severe tendon damage and to discuss the possibility of surgery.

When can I return to running?

Avoiding walking on the tendon while it's injured seems like the right idea.

A 1994 case study describes a 49-year-old runner who suffered an acute peroneus longus tendon tear in the middle of a 10-mile road race after running for several months with chronic tendon pain. This runner recovered and returned to training. But only after an operation and a year of rehab!11

As with any injury, your return to running should be gradual and patient.

Research on Achilles tendon and patellar tendinitis suggests that mild pain upon restarting running is not a cause for concern as long as the pain does not progressively worsen.12

This “pain monitoring” approach (theBrad Beer spoke about it in a recent podcast interview) has not been tested on injuries to the minor tendons of the feet. However, when in doubt, use caution and wait for your tendon to heal before returning to full training.

The good news is that peroneal tendons are not known to be particularly resistant to healingPosterior Tibiasehneor the plantar fascia. With a little patience and the right rehab program, you should be able to get back into training soon.

And please do us a small favor and share this guide with others because there's a good chance it's the guide they're looking for with this frustrating injury!

Do you have peroneal tendinitis? Here's how to fix it (4)

Do you have peroneal tendinitis? Here's how to fix it (5)

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Do you have peroneal tendinitis? Here's how to fix it (6)

(Video) Peroneal Tendinopathy / Tendinitis: Causes & Treatment (Education | Strengthening | Stretching)


Taunton, J.; Ryan, M.; Clemens, D.; McKenzie, D.; Lloyd-Smith, D.; Zumbo, B., A 2002 retrospective case-control analysis of running injuries. British Journal of Sports Medicine 2002, 36, 95-101.

Brandes, C.B.; Smith, R. W. Characterization of patients with primary peroneus longus tendinopathy: A review of twenty-two cases. Foot & Ankle International 2000, 21(6), 462-468.

Rabbito, M.; Pohl, M.B.; Modest, N.; Ferber, R., Biomechanical and clinical factors associated with stage I posterior tibial tendon dysfunction. Journal of Orthopedic & Sports Physical Therapy 2011, 41(10), 776-784.

Reber, L.; Perry, J.; Pink, M., Muscular control of the ankle during running. The American Journal of Sports Medicine 1993, 21(6), 805-810.

Sobel, M.; Geppert, M.J.; Warren, R., Chronic ankle instability as a cause of peroneal tendon injury. Clinical Orthopedics and Related Research 1993, 296, 187-191.
Clarke, H.D.; Kitaoka, H.B.; Ehman, R.L., Peroneal tendon injuries. Foot & Ankle International 1998, 19 (5), 280–288.

Heckman, D. S. Surgical treatment of peroneal tendon disease. The Journal of Bone and Joint Surgery (American) 2008, 90 (2), 404.

Alvarez, R.; Marini, A.; Schmitt, C.; Saltzman, C. L., Stage I and II posterior tibial tendon dysfunction treated by a structured nonsurgical treatment protocol: An orthotic and exercise program. Foot & Ankle International 2006, 27(1), 2-8.

Verhagen, E., The effect of a proprioceptive balance board exercise program in preventing ankle sprains: A prospective controlled study. American Journal of Sports Medicine 2004, 32(6), 1385-1393.

Selmani, E.; Lange, V.; Gjika, E., Current Concepts Review: Peronealsehnenerkrankungen. Foot & Ankle International 2006, 27(3), 221-228.

Kilkelly, F.X.; McHale, K.A., Acute rupture of the peroneus longus tendon in a runner: A case report and review of the literature. Foot & Ankle International 1994, 15(10), 567-569.

Silbernagel, KG; Thomee, R.; Eriksson, B.I.; Karlsson, J., Continued exercise using a pain monitoring model during rehabilitation in patients with Achilles tendinitis: A randomized controlled trial. The American Journal of Sports Medicine 2007, 35(6), 897-906.

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7 answers

  1. My eyes couldn't believe when I saw this article, you describe point by point everything I needed to know about this injury and a way to fix it that makes perfect sense.
    After almost 2 years of useless visits to doctors and physiotherapists, this is a ray of light and hope. I started the exercises yesterday and they feel so good it really makes sense. Thanks very much.


  2. There is another cause of peroneal tendinitis. While it seems fairly rare, it's something I'm looking into right now. Some people have an extra navicular (an extra bone in the foot). Usually this "extra bone" is on the inside of the foot, but in my case it's on the outside of the fifth metatarsal. It's been there my whole life, but it hasn't started causing problems with my peroneal tendon until recently.

    The treatments you documented are pretty much the same as what my doctor prescribed, with a supplement. Since I actually have a fairly low arch, she recommended wearing a foot/ankle brace that helps rotate the foot outward. That takes some pressure off the tendon.


    1. I think I have the exact problem you are having. An extra bone in the upper part of my foot and quite an arch. My pain started three months ago with first a painful calf strain, then an Achilles tendon tear and now peroneal tendonitis pain on the inside and outside of my ankle. Went to a sports doctor who didn't help. who should i see Can you recommend a special bandage or brace to help?


  3. Is anyone related to this injury? Post a comment and we'll do our best to help.


    1. I was diagnosed with Plantar Fasciitis and Peroneal Tendonitis! I've had orthotics (casts) done, injections, MRI!! My podiatrist wants to build up my arch or do more arch injections every time I go in!! my arches, heels and the outside of my foot on the 5th metatarsal and the pain runs up my calf, hurts every time I walk whether I stand or move! I tried taping my ankle with no relief! I wear Brooks with my orthotics, I'm having a hard time getting through my 12 hour shift at work, the pain is unbearable!!


  4. I'm working through the topic right now. I used a trigger point foam roller on the IT band and lower calf along with a Rogue Supernova Ball for isolated treatment just above and behind the ankle. I've been there for a week and I'm noticing significant progress. This treatment approach also worked when I had severe knee pain that was due to an IT band that was too tight. I find that most tendon problems can be treated with mobility exercises on a roller, kind of like a ball, and the pain is coming from an area without pain, so you have to look for it.


  5. I think I have a peroneus injury on BOTH feet at the same time??? Is it even possible?

    Last Saturday I did a run that was longer than usual. I usually do 7-12K, and this time I did 16K. (Not bright...I know). Felt good day and night. The next day I was at the market in the morning and suddenly it felt like knives were stabbing into the sides of my feet with every step. I hobbled home and have been using ice and ibuprofen ever since. As of today (Wednesday) I'm feeling a little better, but still not great. It hurts a lot more when I wear shoes. It hurts less if I tiptoe and avoid letting my heel touch the ground.

    I see other posts on this but haven't seen a case where both feet were affected. I've spoken to friends who train pretty hard and they've never heard of this happening in either foot. Could it be coming from my shoes as it is in both feet?

    If anyone has any insight into these I would really appreciate it. I'm really disappointed because I felt great after the run and was looking forward to longer runs and now it feels like I haven't run for quite a while.




1. Does peroneal tendonitis go away?
(Beyond the Scalpel with Dr. Paull)
2. Peroneal Tendonitis (Side of Foot Pain), Causes & Self-Treatment.
(Bob & Brad)
3. Peroneal Tendinopathy or Tendonitis - Causes & Treatment
(Sports Injury Physio)
4. How you can remove the pain of Peroneal Tendonitis
(Jon W Sports Injury)
5. Acute Peroneal Tendinitis Evaluation with @OrthoEvalPal
(Ortho Eval Pal with Paul Marquis PT)
6. Research-Backed Treatments for Peroneal Tendonitis (Pain on the Outside of Your Foot When Running)


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