Peroneal Tendon Pain: Causes and Prevention

Last updated on March 8th, 2024 at 04:21 pm

If you’re experiencing peroneal tendon pain, you’re not alone. This type of injury is quite common, especially among athletes. In this article, we’ll discuss the causes of peroneal tendon pain and some tips on how to prevent it. We’ll also provide a few treatment options that you can try if the pain persists.

Causes of peroneal tendon pain

Several factors can contribute to peroneal tendon pain. Overuse is the most common cause, particularly among athletes who participate in activities that put a lot of stress on the peroneal tendons (such as running or jumping). Other causes include sudden trauma to the area (like an ankle sprain), degenerative changes (due to ageing), or an underlying medical condition (such as diabetes).

When pain is acute or early on in the pathology it can be termed peroneal tendinitis (has some inflammation). however, when it becomes chronic it is termed peroneal tendinopathy (a degenerative condition). Opinions are divided on this, and each clinician will have something to say.

Tendons are not as vascular (good blood supply) as muscles. They are very strong and their collagen fibres are very rope-like in arrangement. As you can imagine, if they get injured, they can be difficult to heal. For this reason, tendons do not like sudden increases in load.

While for some athletes this can be the case, it’s the people who don’t exercise regularly who are most at risk as they are the ones more likely to increase their workload suddenly from not doing much.

Unnatural foot biomechanics which may alter the mechanics of gait can cause strain on the peroneal tendons. The tendon aid in everting and stabilising the foot. A foot that is supinated and points inward (inverted) places the peroneal tendon under strain and makes it susceptible to injury and peroneal tendon pain. Footwear which is not very supportive is also a contributing factor (Walt and Massey, 2023).

Anatomy of the peroneal tendon

The peroneal tendons are a pair of tendons located on the outside of your ankle. These tendons attach your calf muscles to your foot bones and help you move your foot outward (evert).

The peroneal tendons are surrounded by a connective tissue sheath that helps to protect them from injury. This sheath is called the superior and inferior retinaculum (These can get injured too, and misdiagnosed as peroneal tendinitis or tendinopathy).

There are two peroneal tendons: the peroneus longus and the peroneus brevis. The peroneus longus tendon is the longer of the two and it attaches your calf muscle to your first metatarsal bone (the bone behind your big toe). The peroneus brevis tendon attaches your calf muscle to your fifth metatarsal bone (the bone behind your little toe).

Diagnosing the cause of your peroneal tendon pain

A peroneal tendon injury is diagnosed based on a medical history and physical examination. Your doctor will ask about your symptoms and when they began. They will also ask about your activities, previous injuries, and any underlying medical conditions.

A physical examination will be performed to assess the tenderness, swelling, bruising, muscle strength, and range of motion in your ankle and foot.

They may also ask about the type of footwear that you use and your current weight to see whether they may have had an impact. Your clinician may ask to see you walk to assess any impact of your gait on the problem. This could include observed walking in a corridor or treadmill recorded or unrecorded.

Imaging tests, such as an MRI or ultrasound, may be ordered to confirm the diagnosis or rule out other possible causes of your pain. However, these tests are not always necessary. Your doctor may be able to diagnose a peroneal tendon injury based on your symptoms and physical examination alone.

Are there any other symptoms apart from pain?

There may be other symptoms associated with peroneal tendon pain. These can include:

Swelling and/or bruising around the ankle or foot
Tenderness to touch along the peroneal tendons
Ankle pain when moving the foot outward (everting) or when pressure is applied to the peroneal tendons
Instability or “giving way” of the ankle
Weakness in the muscles that attach to the peroneal tendons (peroneus longus and peroneus brevis)
Limited range of motion in the ankle joint
Visible deformities around the ankle or foot, such as a lump or bump

If you experience any of these symptoms, it is important to see your podiatrist or physiotherapist for a full assessment.

How can peroneal tendon pain be prevented?

There are several things that you can do to help prevent peroneal tendon pain. These include:

Wearing supportive shoes that have good arch support and a cushioned sole
Avoiding sudden increases in activity level or intensity
Warming up before exercise and cooling down afterwards
Stretching the calf muscles regularly
Maintaining a healthy weight
Consume a healthy diet to aid recovery
Get enough rest so that the body can rebuild broken-down tissue
Use proper technique when you when participate in sports or activities

Can orthotics help relieve peroneal tendon pain?

Yes, orthotics can be helpful in the management of peroneal tendon pain. Orthotics are devices that are worn inside the shoes and they help to support the foot. They can be custom-made or bought over-the-counter. An orthotic with a lateral valgus post may help to offload the strain on the tendon and aid in healing.

You won’t necessarily get this over the counter, it may have to be prescribed. Your podiatrist or physiotherapist will be able to advise you on which type of orthotic will be best for you.

What types of exercise can be done at home to aid rehabilitation?

There are a number of exercises that can be done at home to help rehabilitate peroneal tendon pain and give ankle stability, thus reducing the chances of re-injury. These include:

Calf raises: Stand with your feet hip-width apart and raise up onto your toes, then lower back down again. Repeat this 15 times.

Eccentric calf raises: This exercise is the same as a regular calf raise, but when lowering back down, take three seconds or a little longer to lower the heel below the level of the toes. Repeat this 15 times.

Ankle eversion: Sit on the floor with your legs out in front of you. Place a resistance band around your foot and pull the foot outwards away from the body. Repeat this 15 times.

Ankle inversion: Sit on the floor with your legs out in front of you. Place a resistance band around your foot and pull the foot inwards towards the body. Repeat this 15 times.

If you experience any pain when doing these exercises, stop immediately and seek advice from your podiatrist or physiotherapist.

What role does surgery play if any peroneal tendon pain?

Most peroneal tendon problems can be treated without surgery. However, in some cases, surgery may be recommended. Surgery is usually only considered if there is a tear in the tendon that has not healed with conservative treatment or if there is chronic peroneal tendon instability that has not improved with other treatments. Surgery involves preparing the tear or getting rid of dead devitalised tissue.

What risks are associated with peroneal tendon pain?

The main risks associated with peroneal tendon pain are:

Chronic pain
Recurrent peroneal tendon tears
Ankle instability
Arthritis in the ankle joint

These risks can be reduced by seeking treatment early, following your rehabilitation programme and using proper techniques when participating in activities or sports.

What is the prognosis of peroneal tendon pain?

The prognosis of peroneal tendon pain is generally good. Most people make a full recovery with conservative treatment and do not require surgery. However, you have to make sure that you are compliant in following your rehabilitation programme and take care when participating in activities or sports to prevent re-injury.

Which health professional should I see?

The best health professional to see for peroneal tendon pain is a podiatrist, physiotherapist or general practitioner. They will be able to diagnose the problem and provide you with a treatment plan. If surgery is required, they will refer you to an orthopaedic surgeon.

Summary

Peroneal tendon pain is a common injury that can be caused by overuse or acute trauma. It is important to seek treatment early to prevent chronic pain or recurrent injuries. There are a number of exercises that can be done at home to help rehabilitate peroneal tendon pain and give ankle stability, thus reducing the chances of re-injury.

Surgery is usually only considered if there is a tear in the tendon that has not healed with conservative treatment or if there is chronic peroneal tendon instability that has not improved with other treatments.

Final thoughts

Health is a very valuable commodity which should be cherished, If you are suffering and are worried about peroneal tendon pain, please do not suffer in silence, seek help as soon as possible.

Reference

Davda, K., Malhotra, K., O’Donnell, P., Singh, D and Cullen, N. (2017). Peroneal tendon disorders. NIH. 2(6), p.281–292. [Online]. Available at: 10.1302/2058-5241.2.160047 [Accessed 4 January 2024].
Walt, J and Massey, p. (2023). Peroneal Tendon Syndromes. [Online]. NIH. Last Updated: May 23, 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK544354/ [Accessed 4 January 2024].