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Pain In The Ankle – Peroneal Tendinopathies

What is a peroneal tendinopathy?

A Peroneal tendinopathy is a condition which occurs in response to a fast increase in ankle load or due to overuse. The peroneal tendons attempt to adapt to an increase in training load but are unable to and as a result the tendons around the outside of the ankle can become thick and painful. Peroneal tendinopathies can be caused by a range of activities including ice skating, horse riding and most commonly through running. This condition can be a tricky diagnosis with a recent study finding that only 60% of the 40 peroneal tendon injuries reviewed were accurately diagnosed on the first clinical presentation.1

Where are your peroneal’s? 

The peroneal muscles lie along the lateral aspect of the lower leg and consist of the peroneal longus and peroneal brevis muscles. These muscles travel down the lateral aspect of the fibula to form tendons which run underneath the outside of the ankle into the foot. The peroneal longus tendon travels to attach to the base of the first metatarsal (big toe) and the fibularis brevis tendon attaches at the base of the fifth metatarsal (little toe). Both of these muscles act together to evert (turn the foot outwards) and plantarflex the foot. Your peroneal longus also plays a role in flexing the big toe and supporting the inner arch of your foot.

What are the symptoms?

The symptoms of a peroneal tendinopathy are very similar to that of other lateral ankle injuries, including ankle sprains and ankle fractures. A physiotherapist will be able to help assess your ankle to give you an accurate diagnosis, however there are a number of symptoms that you can watch out for:

  • Pain on the outside of the ankle with loaded weight bearing activities such as walking, running or going up onto the toes.
  • Pain in the lateral ankle when walking on uneven surfaces.
  • Pain and stiffness on the outside of the ankle first thing in the morning.
  • An increase in lateral ankle pain following a period of rest or exercise.
  • Occasionally mild swelling and warmth around the lateral ankle.

How can I avoid developing a peroneal tendinopathy?

The most common way of developing a peroneal tendinopathy is by increasing your training load too quickly. This does not allow your body to adapt to the new demands of your training schedule. Ensuring that you only increase your training at a slow pace can be a great way of avoiding the development of this injury. Other ways to help prevent the development of a peroneal tendinopathy include:

  • Wearing supportive footwear for physical activity.
  • Avoiding uneven surfaces when getting back into training or physical activity.
  • Ensuring a thorough warm up prior to exercise -including calf stretching.

How is a peroneal tendinopathy treated? 

The good news is that conservative treatment is front line management for this condition. Management can involve a range of techniques including strapping, mobilisations, muscle release of your peroneals and calf muscles along with managing activity and sports. The most important part of your recovery is a comprehensive progressive loaded exercise program which will be guided by your Physiotherapist. These conditions can be tricky to treat so it is best to be seen by a physiotherapist as soon as you start to develop symptoms.

If you have a pain in the ankle that won’t go away, book in for a comprehensive Physiotherapy assessment at one of our four Sydney CBD locations.




  1. Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg2003;42:250-258


Emillie Kinkella

Emillie joined the Bend + Mend team after a move east to Sydney from Bunbury, Western Australia. Emillie graduated from Curtin University with a Bachelor of Science (Physiotherapy) in 2017 and since graduation has had experience in both the public and private settings working in musculoskeletal physiotherapy. She has undergone post graduate training in dry needling, tendinopathy management, lower back pain disorders and Clinical Pilates. Emillie grew up in a soccer orientated family and enjoys treating soccer related injuries sustained both on and off the field, along with lower back pain disorders and tendinopathies. Outside of work Emillie enjoys cooking up a storm and exploring the sights of beautiful Sydney.

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