Peroneal Tendinopathy

First Metatarsophalangeal Joint

What is Peroneal Tendinopathy?

Peroneal tendinopathy, also known as peroneal tendonitis, is an overuse injury that affects the peroneal tendons, which are the two tendons that run along the outer side of the ankle that help control the movement of the foot, specifically eversion (turning the foot outwards). The tendons originate in the outer shin and run behind the bony prominence on the outside of the ankle, attaching in the outer side of the foot.

Risk for MTPJ

Who is at risk of peroneal tendinopathy?

Peroneal tendinopathy is most common in athletes who participate in activities that involve repetitive movements of the ankle, such as running, jumping, or playing sports that require cutting and pivoting. It is also more common in people who have flat feet and in individuals who are overweight or obese.

What are the main symptoms of peroneal tendinopathy?


The main symptoms of peroneal tendinopathy are pain, swelling, and tenderness on the outer side of the ankle and foot. The pain is often worse with weight-bearing activity such as walking or running and improves with rest. Other symptoms may include:

Ball of the Foot

Difficulty walking or running on uneven surfaces

Foot Joint

Difficulty walking up or down stairs

Foot Swelling

A feeling of instability in the ankle

Peroneal Tendinopathy Diagnosis

How is peroneal tendinopathy diagnosed?

A doctor can diagnose peroneal tendinopathy by taking a medical history, performing a physical examination, and ordering imaging tests. The physical examination will focus on assessing pain, tenderness, and swelling around the outer side of the ankle. The doctor will also look for pain on resisted testing, asking the patient to push their foot outwards against resistance. Imaging tests that may be ordered include:

  • Ultrasound:

    Ultrasound can be used to demonstrate a thickened and disorganised appearance of the peroneal tendons, as well as assessing for fluid in the tendon sheath.
  • X-ray:

    X-ray can rule out other conditions that could be causing the pain, such as a fracture or bone spur.
  • MRI:

    MRI can provide the most detailed images of the soft tissues around the ankle joint, including any areas of inflammation or damage in and around the peroneal tendons.

How is Peroneal tendinopathy treated?


Treatment for peroneal tendinopathy typically involves conservative measures, such as:

Rest Foot
  • Rest:

    Avoiding activities that aggravate the symptoms.
  • Ice:

    Applying ice packs to the affected area for 10-15 minutes at a time, several times a day.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs):

    Taking over-the-counter NSAIDs, such as ibuprofen or naproxen, to reduce pain and inflammation.
  • Stretching and strengthening exercises:

    Once the pain has subsided, stretching and strengthening exercises can help to improve flexibility and strength in the muscles around the ankle.
  • Podiatry:

    A formal podiatric assessment will involve assessing the patient statically, when lying or standing and dynamically, when walking. The podiatrist may consider orthotics (heel inserts) to take the stress off the damaged or overloaded peroneal tendons.
  • Corticosteroid injections:

    Injecting corticosteroids into the peroneal tendon sheath can help to reduce inflammation and pain.
Icing on Foot

At The Joint Injection Clinic, these injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you in a lying position.  The outer aspect of the ankle is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  Local anaesthetic is injected from the skin to the tendon sheath under ultrasound guidance.  After giving the local anaesthetic a few minutes to take effect, the tendon sheath injection is performed with a small dose of steroid and local anaesthetic.

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area

Surgery: Surgery is typically only considered for severe cases of peroneal tendinopathy that do not respond to other treatments. Surgery involves removing the damaged tissue and repairing the tendon.