Peroneal Tendonitis

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Peroneal tendonitis is an overuse injury that results in inflammation of the peroneal tendons that run along the outside of the ankle. This injury is actually just one of  five different types of foot & ankle tendonitis.  The inflammation of the peroneal tendons then causes pain and swelling of the ankle itself. Symptoms of peroneal tendonitis include aching, pain or swelling around the outer ankle.  In some cases the pain is particularly severe when the patient gets out of bed in the morning. Treatment of peroneal tendonitis normally includes rest for the ankle (including possible use of a walking boot or ankle brace). Other more invasive treatments (such as cortisone injections) may be needed if conservative treatments are unsuccessful.

What Causes Peroneal Tendonitis?

Peroneal tendonitis is an injury that happens mainly to individuals who play a sport that requires repetitive ankle movements.

There are also risk factors that can increase the likelihood of this type of tendonitis. These include:

  • A sudden increase in activity level or training intensity;
  • Wearing footwear that does not provide sufficient foot support.

Peroneal tendonitis is also more likely  to affect individuals with high foot arches or whose lower limb muscles and joints are not well co-ordinated.

In some cases,  this type of tendonitis can be the result of a sprained ankle.


There are actually two types of peroneal tendonitis. It can be either an acute or chronic condition. However, with both types, the patient may experience the following symptoms:

  • Pain on the outer ankle surface (opposite the big toe side) where the peroneal tendons are located. This pain may be more severe during periods of athletic activity or when twisting the foot;
  • Swelling of the outer ankle and a “warm” feeling in the same area.

In severe cases, the patient may also experience difficulty placing weight on the ankle. He or she may feel that it is “giving way”.


As with most overuse injuries, rest is an integral part of the treatment of peroneal tendonitis. The patient needs to keep his or her weight off the ankle as much as possible for a while and allow the peroneal tendons to heal. By sitting or lying down as much as possible, the peroneal tendons will have a chance to recover naturally. A walking boot or ankle brace  will provide additional support to the ankle and increase the rate of progress towards recovery.

In addition, a patient with peroneal tendonitis should pursue the following treatment approaches:

  • Use of ice on the ankle to reduce pain and swelling;
  • Taking NSAID medications like aspirin for additional relief of pain and inflammation;
  • Physical therapy exercises that will strengthen the ankle and reduce the risk of recurrence of peroneal tendonitis. They will also help the ankle to recover its full range of motion more quickly.

Should these conservative treatment approaches fail to treat the peroneal tendonitis, doctors may consider cortisone injections or tendon release to correct the condition.

Cortisone injections contain powerful anti inflammatory agents but may cause tendon rupture, so they should be approached with caution.

Tendon release is a surgical procedure that may be tried if there is excess tissue around the peroneal tendon that may be causing irritation.  A tendon release procedure aims to remove this excess tissue. The aim is to allow the tendon to move more freely without frictional contact with adjacent bones.

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