Peroneal Tendon Injuries: Causes, Symptoms, and Treatment

The peroneal tendons run along the outside of the ankle and play an important role in stabilizing the foot, supporting the arch, and preventing the ankle from rolling outward. When these tendons become irritated, torn, or unstable, patients often experience pain and difficulty with everyday activities. Understanding the warning signs and treatment options can help prevent long-term problems.

What Are the Peroneal Tendons?

There are two peroneal tendons:

Peroneus longus

Peroneus brevis

These tendons help control foot movement and contribute to balance during walking, running, and jumping. Because they sit close to the ankle, they are vulnerable to injury during twisting motions or repetitive stress.

Common Causes of Injury

Peroneal tendon injuries occur for several reasons, including:

Overuse: Repetitive ankle motion or increased training intensity can lead to inflammation.

Ankle sprains: Rolling the ankle outward can stretch or tear the tendons.

High-arched feet: This foot shape places more stress on the peroneal tendons.

Sudden trauma: Falls, missteps, or hard landings during sports.

Poor footwear: Shoes without proper support increase strain on the tendons.

Athletes in sports that involve cutting, pivoting, and uneven surfaces are at higher risk.

Types of Peroneal Tendon Injuries

Several conditions can affect these tendons:

Tendinitis: Inflammation of the tendon from irritation or overuse.

Tendinosis: Degeneration of tendon tissue over time.

Tears: Partial or complete tears that cause pain and instability.

Subluxation: When the tendons slip out of place behind the ankle bone due to damaged supporting ligaments.

Identifying the exact type of injury helps guide treatment.

Symptoms to Watch For

Patients may experience:

Pain or tenderness along the outside of the ankle

Swelling or warmth in the area

Instability or a feeling the ankle may “give out”

Pain during activity, especially running or cutting motions

A snapping sensation behind the ankle (in cases of subluxation)

Symptoms often worsen with continued activity.

Diagnosis

Diagnosis typically includes:

A physical examination to evaluate tenderness, swelling, and stability

X-rays to rule out fractures or bone abnormalities

MRI or ultrasound to assess the tendon tissue and detect tears

Early evaluation helps prevent chronic injury.

Treatment Options

Treatment depends on severity:

Nonsurgical Care

Most mild to moderate injuries respond well to:

Rest and activity modification

Ice and anti-inflammatory medications

Immobilization with a boot or brace

Physical therapy to strengthen surrounding muscles

Supportive footwear or custom orthotics

Surgical Treatment

Surgery may be considered if:

The tendon is torn

Symptoms persist despite conservative care

There is tendon subluxation

Degeneration prevents proper healing

Surgical procedures may repair or reconstruct damaged tissue and stabilize nearby structures.

Recovery and Rehabilitation

Rehabilitation plays a major role in successful recovery. Patients can expect:

A period of immobilization

Gradual reintroduction of movement

Strengthening and balance exercises

Return-to-sport progression when appropriate

Full recovery time varies but can range from several months depending on injury severity and treatment approach.

When to See a Specialist

Seek orthopedic evaluation if you experience:

Persistent ankle pain on the outside of the foot

Recurrent ankle sprains

Swelling or instability that interferes with daily activity

A snapping sensation behind the ankle

Prompt care helps prevent long-term weakness, instability, and arthritis.

The Bottom Line

Peroneal tendon injuries are common but often overlooked. With early diagnosis and tailored treatment, whether conservative care or surgical repair, most patients can return to comfortable movement and avoid chronic ankle problems. If you’re experiencing ongoing pain or instability on the outside of the ankle, consulting an orthopedic specialist is an important first step toward relief.