Peroneal Tendon Injury/Overuse


  • Peroneal tendons are two major tendons which help to stabilise the rearfoot and prevent lateral (inversion) ankle sprains.
  • Overuse and injury of these tendons causes dysfunction and weakness.
  • People with higher arches are at risk for developing peroneal tendon injuries.
  • Basic types of peroneal tendon injuries are tendonitis (due to repetitive use of tendon), tears (caused by repetitive activity or trauma), and subluxation (one or both tendons have slipped out of their normal position).

Diagnostic tips

  1. Swelling, decreased sensation or burning behind or under the lateral malleolus.
  2. Pain in the outer part of the ankle or just behind the lateral malleolus (more pain when pressure is applied along the tendons and if foot is pulled down and inwards, stretching the peroneal tendons).
  3. Warmth to the touch.
  4. Weakness or instability of the foot and ankle.
  5. Patient walks with a limp.

Tests and Imaging

  1. Clinical examination of the ankle.
  2. X-rays to exclude fracture or other problem.
  3. Ultrasound or MRI to assess tendon damage.

Immediate Treatment

  1. Advise resting from activities.
  2. Immobilize foot and lower leg in a short-leg walking boot for two to four weeks.

Possible Referral

  1. Podiatrist for cam walker, stirrup ankle brace, arch support, or lateral heel wedge to take tension off the sore tendons, followed by stretching, strengthening, ankle coordination exercises.
  2. Foot and ankle surgeon for tendon repair, debridement, or synovectomy in patients with a large peroneal tendon tear or a bony prominence that is serving as a physical irritant to the tendon.