Massage therapy · Kitchener–WaterlooPeroneal Tendinopathy

Peroneal tendinopathy is a problem with the peroneal tendons. These tendons run down the outside of the lower leg and pass behind the bony bump on the outside of the ankle. Together they help to stabilise the ankle and foot, especially on uneven ground (Kent Community Health NHS Foundation Trust, 2024; NHS Borders, n.d.). The tendons may develop small tears or become irritated and painful. Pain usually comes on with activity, such as walking, running and jumping, and eases with rest (NHS Borders, n.d.). Tendinopathy tends to be a longer-lasting condition, but it is treatable.

Tendinopathy literally means tendon pathology, or a problem with the tendon. In most cases it is an overuse injury (NHS Borders, n.d.).

Peroneal Tendinopathy Occurs From

• An ankle sprain or sudden twisting of the foot or ankle. The peroneal tendons are commonly injured during ankle sprains (Kent Community Health NHS Foundation Trust, 2024).
• Having high-arched feet, which are linked to peroneal tendon problems (Davda et al., 2017).
• Repeated overuse, for example in sports, long-distance running or manual work, or walking or running on uneven ground, especially in worn shoes (Davda et al., 2017; Kent Community Health NHS Foundation Trust, 2024).
• Sudden increases in activity, not allowing enough recovery time, and weakness or tightness in the leg muscles (NHS Borders, n.d.).
• Ankle instability, meaning weak or "giving way" ankles (Davda et al., 2017).

Peroneal Tendinopathy Anatomy

Three bones make up the ankle joint: the shin bone (tibia), the smaller bone of the lower leg (fibula), and the talus, a small bone that sits between the heel bone and the tibia and fibula. There are three peroneal muscles: peroneus longus, peroneus brevis and peroneus tertius. Only the tendons of peroneus longus and peroneus brevis run down the outside of the leg and wrap behind the bony bump on the outside of the ankle. Peroneus tertius lies at the front of the lower leg and ankle (Davda et al., 2017).

How to Treat Peroneal Tendinopathy

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• Make sure any ankle sprains are fully healed before you rush back into any activity where you use the foot and ankle continually.
• Build strength and stay agile. A regular strength training programme for the ankles and feet is important.
• Take the time to warm up before you start exercising. If your calves are tight, ask me about calf stretches (Kent Community Health NHS Foundation Trust, 2024).
• When taking part in activities and exercise, try to avoid situations where you are at risk of injuring the ankle.
• If you have a history of ankle instability (weak or "giving way" ankles), you are more at risk of developing this condition (Davda et al., 2017). Working on your balance will help. I can give you advice and exercises.

Peroneal tendon pain usually comes from asking the tendons on the outside of your ankle to handle more than they're ready for, often after an ankle sprain or with ankles that give way. My aim is to settle the tendons down, then build their strength gradually, along with the balance and ankle control that protect them.

I start by assessing how your foot and ankle move, testing the strength of the muscles that turn your foot outward, checking your balance and the shape of your arch, and asking about your activities, footwear and any past sprains.

When It's Sore

• Cutting back the activities that flare it, rather than stopping everything
• Hands-on work for the calf and the muscles down the outside of the shin, keeping pressure off the sore tendon itself
• Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
• Taping to support the ankle in the short term, and I'll show you how to tape it yourself

As It Settles

1. Davda, K., Malhotra, K., O'Donnell, P. et al. (2017) 'Peroneal tendon disorders', EFORT Open Reviews, 2(6), pp. 281–292. doi: 10.1302/2058-5241.2.160047
2. Kent Community Health NHS Foundation Trust (2024) Peroneal tendinopathy. Available at: https://www.kentcht.nhs.uk/leaflet/peroneal-tendinopathy/ (Accessed: 7 October 2026).
3. NHS Borders (n.d.) Information about peroneal tendinopathy. Available at: https://www.nhsborders.scot.nhs.uk/media/907583/NHS-Borders-Peroneal-tendinopathy.pdf (Accessed: 7 October 2026).