Peroneal tendonitis is a common ankle injury among endurance runners but doesn’t get the same attention as other better-known running ailments such as Runner’s Knee or Iliotibial Band Syndrome.
Peroneal tendonitis is often categorized by pain or discomfort present along the outside of the ankle, heel, and foot, with an incidence rate estimated at around 0.6%.
Most runners suffering from peroneal tendonitis will usually recover fully, but it will take some time and, in most cases, a reduced volume or short break from running.
It is crucial to follow a structured rehabilitation program to recover effectively and reduce the risk of re-occurrence.
In this article, we will provide up-to-date science regarding how to effectively treat and recover from peroneal tendonitis so that you can get back out on those trails!
In this article, we will discuss the following:
- What Is Peroneal Tendonitis?
- Peroneal Tendon Anatomy
- Peroneal Tendonitis Running Diagnosis
- What Does Peroneal Tendonitis Feel Like?: Symptoms
- Causes Of Peroneal Tendonitis
- Can You Run With Peroneal Tendonitis?
- Peroneal Tendonitis Treatment
Let’s jump into it!
What is peroneal tendonitis?
Simply put, peroneal tendonitis is inflammation in the peroneal tendon.
Tendonitis usually occurs when an excessive build-up of micro tears causes tendon damage and inflammation, leading to pain and difficulty exercising.
Many ask, where is the specific peroneal tendonitis pain location?
The most common areas to feel pain is at the turn around the bony lump on the outside of the ankle (lateral malleolus) and in the peroneus longus tendon, particularly at the point that the tendon curves around the cuboid bone in the foot.
The peroneus longus and brevis muscles contract to point the foot down (plantarflexion) and turn the foot out (eversion.) When standing and running, the peroneus muscles act to stabilize the ankle and arch of the foot.
We’ll take a closer look at the anatomy to give you an idea of what we’re talking about!
Peroneal Tendon Anatomy
There are two peroneal tendons, which attach the peroneus longus and peroneus brevis muscles. They are situated at the lateral side of the lower leg, running side by side down the fibula and behind the lateral malleolus.
Both the peroneus brevis and peroneus longus muscles become tendons near the ankle joint and pass the lateral malleolus.
The peroneus brevis tendon attaches to the outside of the foot at the fifth metatarsal (little toe), hence why this condition is often referred to as 5th metatarsal tendonitis. In comparison, the peroneus longus tendon goes underneath the foot and attaches to the inside of the arch.
What does peroneal tendonitis feel like?: Symptoms
The level and severity of symptoms that you experience will depend on whether your tendonitis is acute or chronic.
Some 5th metatarsal tendonitis symptoms that you can expect are:
- Pain around the bony lump on the outside of the ankle
- Pain that gets worse during activity and usually decreases during rest
- Pain when turning the foot in or out (inversion, eversion)
- Swelling at the ankle
- Warmth around the tendon
- Gradual onset of pain
Peroneal Tendonitis Running diagnosis
You should always consult with a medical professional. It is vital to get an accurate diagnosis to ensure you can treat the injury correctly.
- A physiotherapist will likely discuss your medical history with you. This will look to determine whether there is a clear cause, like overuse.
- A medical professional will perform a series of physical tests by moving the foot and ankle into different positions and applying pressure.
- In rare cases, an X-ray, ultrasound, or MRI scan may be necessary.
Causes of Peroneal Tendonitis
There are a number of possible contributing factors when it comes to peroneal tendonitis.
These are:
#1: Overuse
As with all tendonitis injuries, overuse is the public enemy number one. In fact, overuse accounts for a staggering 80% of running injuries. What is deemed too much is relative to the individual. For some, 5km will be overdoing it; for others, 50km is easily manageable.
If we consistently load the tendon without allowing it to repair, we will accumulate damage and subsequent inflammation.
Take a look back at what you have been up to. Have you recently increased your mileage or intensity? Muscles and bones take time to adapt to new loads placed on them.
Having a structured training plan is a great way to avoid risking an overuse injury.
It’s a simple mistake to make, it is easy to catch a running bug, and for great reason, it’s fun! However, we have to be sure to give our bodies adequate time to adapt.
#2: Poor Foot Biomechanics
Poor foot biomechanics, such as excessive eversion or overpronation, will put the peroneus tendons under undue stress. This leaves them more vulnerable during higher-intensity periods of training.
Additionally, weak muscles surrounding the ankle can jeopardize stability and tracking whilst you are running.
If you think this may be a causal factor that is affecting you, try and book an appointment with a local running gait specialist.
We’ll go over some exercises to help correct poor biomechanics and strengthen the peroneus later!
#3: Direct Trauma
Tendonitis can also be triggered by a direct impact or ankle sprain in which the peroneus tendons have been damaged. The pain is likely to be acute.
If you have recently knocked the ankle or slipped whilst out on a run, then this may be the cause.
You will likely notice swelling or bruising in the area. Take a week or two off initially so you can accurately assess the damage.
Can you run with peroneal tendonitis?
As mentioned earlier, peroneal tendonitis pain can be chronic, meaning that it develops over time, or it can be acute, meaning that it comes on suddenly.
In both of these scenarios, there is room to continue running if you have to. But that doesn’t necessarily mean you should.
Why do we run? The answer will be different for each individual, and each answer is important. A realistic assessment of your ability to run is crucial if you are to avoid aggravating tendonitis.
If running is clearly an aggravating injury, stop.
However, if the pain is very mild and doesn’t get worse after exercise, you may be able to continue running. To stay on the safe side, it would be advised that you reduce your running volume and intensity.
Effective treatment requires active participation in a rehabilitation program, so if you have to hang up your shoes for a couple of weeks, get involved in strengthening!
Peroneal Tendonitis treatment
The best way to heal peroneal tendonitis is to progressively heal and strengthen the tendon through exercise therapy. This is a gradual process; as the tendon gets stronger, you can increase the difficulty of the exercises.
Alongside these specific peroneus exercises, be sure to cross-train. This may be going for a cycle, swimming, or similar activity of your choice. Keeping metabolically fit will put you in good stead for when you eventually get back to running!
Here are 4 exercises to get you back on track!
#1: Standing Calf Stretch
- Find a sturdy wall or structure to use for support. Stand facing the wall with your feet shoulder-width apart.
- Place your hands on the wall at shoulder height and shoulder-width apart, keeping your arms straight.
- Take a step back with one foot, keeping it flat on the ground. Keep your other foot planted with your toes pointing straight ahead.
- Bend your front knee and lean your body forward, keeping your back heel on the ground. You should feel a stretch in your calf muscle.
- Hold the stretch for 20-30 seconds. Repeat on the other side.
You can repeat this stretch 2-3 times on each leg, holding each stretch for 20-30 seconds.
Remember to listen to your body and not overstretch. If you feel any pain or discomfort, ease off the stretch and try again with a smaller step.
#2: Step Up
- Make sure you have a stable platform or step about knee height.
- Stand in front of the platform with your feet hip-width apart.
- Place one foot firmly on the platform, keeping your knee aligned with your toes.
- Push through your heel to lift your body up onto the platform, bringing your other foot up to rest on the step.
- Pause at the top of the movement, making sure your entire foot is on the platform.
- Lower yourself back down to the starting position, leading with the foot that first touched the platform.
- Repeat for the desired amount of time, alternating which foot you step up with each time.
3 sets of 2 minutes intervals
Tips:
- Keep your core engaged and your back straight throughout the exercise.
- Focus on pushing through your heel rather than your toes.
- If you want to increase the difficulty, hold a dumbbell in each hand or add a knee raise at the top of the movement.
#3: Calf Raise
- Stand with your feet hip-width apart and place the balls of your feet on a raised surface like a step or block, with your heels hanging off the edge.
- Keep your knees straight or slightly bent, depending on your comfort level.
- Place your hands on a wall or a stable surface for support.
- Slowly raise your heels by pushing up with the balls of your feet, keeping your core engaged and your back straight.
- Pause for a moment at the top of the movement.
- Slowly lower your heels back down below the step or block.
Repeat for 3 sets of 15 repetitions
Tips:
- Make sure to perform the exercise in a slow and controlled manner, avoiding any bouncing or jerking movements.
- If you want to increase the difficulty, hold a dumbbell in one or both hands or try a single-legged calf raise.
#4: Resisted Ankle Eversion
- Securely attach one end of a resistance band to an anchor, such as a table leg or your opposite leg
- Sit on the floor with your legs extended straight out in front of you.
- Wrap the other end of the resistance band around the outside of the active foot,
- Keep your toes pointing up toward the ceiling, and slowly rotate your ankle outward, away from your other foot.
- Pause for a moment at the end of the movement.
- Slowly return your ankle to the starting position, and repeat the movement for the desired number of reps.
- Switch to the other foot and repeat the exercise.
3 sets of 15-20 repetitions.
Check out this video for a visual guide!
Tips:
- Keep your toes pointing up throughout the exercise.
- Use a light resistance band to start, gradually increasing the resistance as your strength improves.
- Keep your movements slow and controlled, avoiding any sudden jerking motions.
Follow these tips and be well on your way to running again soon!
If you are experiencing ankle pain, have a read of: Why do my ankles hurt when I run?
