Key Points about Peroneal Tendon Injury

  • Peroneal tendon injuries are common in athletes, including runners, who participate in sports that require repetitive ankle motion.
  • Peroneal tendon injuries can be acute, meaning the injury occurred suddenly, or chronic, meaning that damage occurred over time.
  • Symptoms of peroneal tendon injuries can include pain and swelling, weakness in the foot or ankle, warmth to the touch, and a popping sound at the time of injury.
  • Many patients do not need surgical treatment for peroneal tendon injuries. Many can find relief of symptoms with rest, immobilization with a bandage or brace, exercise and/or stretching, and other self-care measures.


Peroneal tendon injuries affect the tough bands of tissue in the foot that connect muscles to bones. People have two peroneal tendons in each foot, running parallel to each other behind the outer ankle bone. One peroneal tendon attaches to the exterior side of the midfoot by the smallest toe, while the other runs beneath the foot and attaches close to the inside of the foot’s arch.

The peroneal tendons act as a stabilizing force while bearing weight in the foot and ankle, protecting them from sprains and other injuries.

Common causes of peroneal tendon injuries include:

  • Wearing unsupportive footwear
  • Overuse from running or exercises that involve repeated ankle movement
  • Trauma to the tendon, such as rolling the ankle
  • Having high arches in the feet
  • Tight calves

Most people with peroneal tendon injuries who receive appropriate treatment will begin to see improvement in two to four weeks. For more severe cases, treatment may include surgery.

Peroneal tendon injury causes

Many peroneal tendon injuries are caused by overuse and repetitive ankle motion during athletic or work-related activities.

Other causes include:

  • High foot arches
  • Sudden trauma
  • Inappropriately fitting footwear
  • Poor form while training
  • Increase in activities such as jumping, running or walking
  • Tight calves

Peroneal tendon injury symptoms

Symptoms of peroneal tendon injuries can develop suddenly or over a period of time.

Signs or symptoms include:

  • Pain in the lower leg and/or ankle
  • Swelling
  • Weakness or instability
  • Warmth in the affected area
  • A popping noise when the injury occurs

Peroneal tendon injury complications

If left untreated, complications of peroneal tendon injuries can develop.

Possible complications include:

  • Worsened pain
  • Increased instability of foot and ankle
  • Tendon rupture
  • Subluxation, or movement of tendons from their normal position

Peroneal tendon injury risk factors

There are a few factors that can increase your chances of developing peroneal tendon injury, including:

  • People who participate in sports or work-related activities, especially running long distances, are at greater risk for peroneal tendon injury.
  • High arches. People with high foot arches are at greater risk for peroneal tendon injuries.
  • Tight calves. People who have tight calves are more likely to sustain peroneal tendon injuries.

Peroneal tendon injury prevention

Some peroneal tendon injuries cannot be prevented. For example, peroneal tendon injuries that occur as a result of trauma or high foot arches may not be prevented. In other cases, you can take action to prevent peroneal tendon injuries by taking a few precautions. Some lifestyle modifications you can make to avoid peroneal tendon injuries include:

  • Stretch and warm-up the calf and peroneal muscles before exercise or prolonged periods of movement
  • Wear the recommended and appropriate footwear for each activity, including shoes and braces
  • When starting a new exercise routine, increase the intensity gradually
  • Choose safe, levels surfaces for running or exercise

Peroneal tendon injury diagnosis

Your doctor can diagnose peroneal tendon injuries. During a clinic visit, your doctor will perform a physical exam and take a full medical history. In some cases, your doctor will order imaging tests such as:

  • X-ray
  • MRI
  • Ultrasound

These tests may be able to determine what is causing your pain.

Peroneal tendon injury treatment

Peroneal tendon injuries can generally be treated with nonsurgical treatments. Many people experience symptom relief within two to four weeks, with rest and medication.

If your pain is affecting your ability to perform your daily activities, your doctor may recommend a nonsurgical treatment such as:

  • Staying off the affected foot and pausing strenuous exercise is imperative during rehabilitation.
  • Heat and ice. Alternating ice and heat can help relieve pain and make movement easier.
  • A cast or splint to immobilize the foot and ankle
  • Physical therapy. Physical therapy is key, first to reduce pain and swelling and then to increase strength and improve range of motion
  • Keep your ankle and foot elevated with a pillow when you’re sitting or lying.
  • OTC medications. Over-the-counter pain relievers such as ibuprofen or naproxen can relieve pain caused by peroneal tendon injuries
  • Injected pain relievers. Your doctor may inject an anti-inflammatory medication such as cortisone into the affected area.

In some cases, peroneal tendon injuries require surgical treatment. The goal of surgery is to repair the injured tendons. Rehabilitation after surgery often includes physical therapy.

When to Seek Care

If your pain lasts more than a week, is severe, or is progressively worsening, call your doctor to schedule an appointment.

Go to the emergency room if you hear snapping or popping because they can indicate rupture or subluxation.

Next Steps

Your doctor will develop a treatment plan customized to your case. Carefully follow your doctor’s treatment instructions.

If your pain intensifies, call your doctor right away to discuss the next steps. You may need a more advanced treatment option if a first-line conservative treatment is not effective.

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