Peroneal tendonitis is a painful condition affecting the two tendons (peroneus longus and peroneus brevis) located on the outside of the ankle and foot. These tendons stabilize the foot and protect against ankle sprains. The condition develops when they become inflamed or suffer degeneration (tendinopathy) due to repetitive stress or overuse. Factors like a sudden increase in activity, improper footwear, or underlying foot mechanics, such as high arches, place excessive strain on the tendons, leading to pain and swelling.
Immediate Steps for Pain Relief
When symptoms first appear, initial self-management focuses on reducing pain and inflammation. The R.I.C.E. protocol (Rest, Ice, Compression, and Elevation) is the standard first response for acute flare-ups. Rest involves relative activity modification, meaning you should temporarily stop or significantly reduce any painful activity. Complete immobilization is often unnecessary.
Applying ice to the outer ankle for 15 to 20 minutes several times a day helps minimize swelling and acute pain in the first 48 to 72 hours. Compression, using an elastic bandage, and elevating the foot above heart level also control swelling around the irritated tendons. Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, can provide short-term relief from pain and inflammation.
Professional Treatment Options
If initial steps do not resolve symptoms within a few weeks, seek professional evaluation from an orthopedist or physical therapist. Diagnosis involves a physical examination and may include imaging studies like ultrasound or MRI to assess the extent of tendon damage. Physical therapy is frequently prescribed as a primary treatment, utilizing various modalities to facilitate healing.
A therapist may use hands-on techniques like manual therapy to mobilize ankle joints and soft tissue, aiming to improve circulation and reduce tendon tension. Other tools include therapeutic ultrasound or dry needling to target muscle tightness and promote healing. Supportive devices are also employed, such as custom or off-the-shelf orthotics, to correct foot alignment and reduce stress on the tendons, especially for individuals with high arches or overpronation.
If conservative measures fail, advanced interventions like injections may be considered. Corticosteroid injections offer short-term pain relief by reducing inflammation, but risk weakening the tendon tissue over time. Platelet-Rich Plasma (PRP) injections are an alternative, using the patient’s own growth factors to stimulate long-term tissue repair. Surgery is reserved as a final option, typically only necessary for chronic cases involving tendon tears or instability that have failed to improve after three to six months of conservative treatment.
Structured Rehabilitation and Strengthening
Long-term healing requires a structured rehabilitation program centered on progressively loading the tendon to restore its strength and resilience. The initial phase of rehabilitation focuses on restoring pain-free range of motion and flexibility. Gentle calf stretches, performed with the knee straight and then bent, help to lengthen the calf muscles and reduce tension on the peroneal tendons.
The program then advances to targeted strengthening, which is foundational for tendon recovery. A crucial element is eccentric strengthening, where the muscle lengthens while contracting, such as slowly lowering the heel during a calf raise. Resistance band exercises are used to specifically strengthen the peroneal muscles, focusing on eversion, the motion of turning the foot outward against resistance.
Finally, the rehabilitation progresses to proprioception and balance training, which is the body’s ability to sense its position in space. Exercises like a single-leg stance, performed first on a stable surface and then on an unstable one like a folded towel or wobble board, retrain the ankle’s stabilizing muscles. This progressive loading and balance work is essential to ensure the tendon can handle the dynamic demands of daily activity and sport without re-injury.
Preventing Future Injuries
Maintaining long-term tendon health involves making sustainable adjustments to activity and footwear once the pain has resolved. Selecting appropriate footwear is a primary consideration, especially for individuals engaging in repetitive or high-impact activities. Shoes should offer adequate arch support and heel stability to maintain proper foot alignment and minimize excessive strain on the outer ankle.
Activity levels must be scaled gradually to prevent a recurrence of the condition. Avoiding sudden spikes in training volume, intensity, or duration allows the tendons sufficient time to adapt to increased load. A general guideline is to increase weekly mileage or intensity by no more than ten percent.
Regular maintenance exercises, including the strengthening and stretching routines learned during rehabilitation, help to ensure muscle balance and tendon resilience. Addressing underlying biomechanical issues, such as flat feet or high arches, is also important. Continued use of supportive orthotics or appropriate footwear helps distribute forces evenly across the foot and ankle to safeguard against future irritation.