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Peroneus Tendinitis, What Is It And How Do We Treat It?


Peroneal Tendinosis Explained

The peroneal tendons are located running outside the ankle just behind the fibula bone. Muscle and bone are connected by tendons. This enables them to put force across joints that separate the bones. A ligament, however, connects bone to bone. When a person develops Tendinitis that means there is inflammation in their tendon. When you hear the term ‘Tendinosis’, that means there’s a thickening and enlargement along with swelling in tendon.


Several things can cause a person to develop peroneal Tendinosis such as –

Poor Shoewear.

Improper Training.

Increasing Training Too Quickly.

Having a Hindfoot Varus Posture.

What Happens if Not Treated

If this condition is not addressed the tendon can be torn. They can also be weakened, which leads to ankle sprains. If a person needs to have surgery for Tendonitis, they could suffer an infection.

Nerve damage is another concern. There is a nerve running alongside the foot called the ‘sural’ nerve. It provides sensation for the foot. If this nerve is stretched or cut, nerve damage can occur. Any form of instability may cause sprains which can also damage cartilage inside the ankle.



The diagnosis depends largely on what the patient says about their history. From what they say about their activities it can be determined whether or not the problem is overuse, too fast of an increase in activity, or some other form of training error. If any of these things have happened the patient will experience pain on the outside and in back of the ankle.

If the trouble is the fibula there will be pain directly over the bone that is easily palpitated. Peroneal pain happens a little further behind. Patients might experience weakness trying to bring their ankle to the outside. Physiotherapy is able to troubleshoot these things and more. They also check for varus posturing of the heel (the heel is turning inward). That can be a predisposition to the patient’s problem.

Ultrasound is very good at helping doctors to assess problems with tendons. Other methods can be used like radiology and x-rays. MRIs can show a tear as well.


It may take a pretty long while but patients can usually recover fully. It takes patience to allow tendons to heal properly before becoming active again. If surgery was needed, then the recovery time can take even longer (you may be told not to put any weight on your ankle for as long as 6 weeks).

Recovery outcomes are generally good but time is important and patience is required. Anytime there is a tear, it’s followed by a chronic thickening of your tendon, and that generally ends in an outcome that is not as good.

In physiotherapy Cambridge, when this condition reaches the ‘acute’ stage, most of the ankle injuries are treated by using RICE (rest, ice, compression, & elevation). There may still be a brief period where no weight can be put on it. They may also prescribe NSAIDs (Non-steroidal anti-inflammatory drugs) for pain and inflammation. After the pain and swelling have subsided then they can perform a more extensive examination.

Once the patient reaches the point of no significant instability and the symptoms are minimized, then rehabilitation can begin. This will include a program of flexibility, ankle strengthening, and proprioception regimen.

Physiotherapy has to evaluate the core biomechanics. Patients who suffer peroneal injuries may tend to limp or give favor to one side, which can lead to dysfunctions around the lumbosacropelvic area. This can inhibit shift functional leg lengths, muscle firing, and cause additional problems in other places as well (knee and lower back). A comprehensive physiotherapy rehab program has to evaluate core stability as well as including core exercises into the rehab regimen.

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