Peroneal Tendon Injuries

The feet form the foundation that supports the entire body weight, and any injury to the feet can cause pain and discomfort. One such injury is a peroneal tendon injury. The peroneal tendons are two bands of tissues that connect the muscles to the bones, running side by side behind the outer ankle bone. They stabilize the ankles and protect them from sprains. In this article, we’ll discuss the causes, symptoms, diagnosis, and treatment of peroneal tendon injuries.

Causes and Symptoms of Peroneal Tendon Injuries

Peroneal tendon injuries may occur acutely (suddenly) or chronically (developing over time). They are common among individuals who participate in sports activities, which involve repetitive ankle motion. People with higher arches are also at risk of developing peroneal tendon injuries. There are three basic types of peroneal tendon injuries: tendonitis, tears, and subluxation.

Tendonitis is an inflammation of one or both peroneal tendons caused by repetitive use, overuse or trauma. Symptoms of tendonitis include pain, swelling, and warmth to the touch. Acute tears, caused by repetitive activity or trauma, have similar symptoms, but they can also cause weakness or instability of the foot and ankle. With time, the tears may alter the shape of the foot, making the arch higher. Degenerative tears or tendonosis result from overuse over long periods. In this case, the tendon becomes thin and eventually frays like overstretched taffy. People with higher arches also experience degenerative tears. The symptom of degenerative tears may include sporadic pain on the outside of the ankle, weakness or instability in the ankle, and an increase in the height of the arch.

Subluxation occurs when one or both peroneal tendons slip out of their normal position. In some cases, subluxation results from a condition where the person is born with a variation in the bone or muscle shape. In other cases, subluxation happens after trauma, such as an ankle sprain. Chronic tendon subluxation can occur when the tissues that stabilize the tendons (retinaculum) are damaged or injured. The symptoms of subluxation include a snapping feeling of the tendon around the ankle bone, sporadic pain behind the outside ankle bone, and ankle instability or weakness. Early treatment of subluxation is critical since a tendon that continues to sublux or move out of position is more likely to tear or rupture. Therefore, if you feel the characteristic snap, please see a foot and ankle surgeon such as Dr Gilbert Huang DPM immediately.


Peroneal tendon injuries can sometimes be misdiagnosed, and without proper treatment, they may worsen. Therefore, we recommend prompt evaluation by a foot and ankle surgeon. To diagnose a peroneal tendon injury, the surgeon will examine the foot for pain, instability, swelling, warmth, and weakness on the outer side of the ankle. Also, x-ray or advanced imaging studies, if needed, help evaluate the injury. The foot and ankle surgeon will also look out for any ankle sprain and any other related injuries that sometimes accompany peroneal tendon injury. Proper diagnosis is essential since prolonged discomfort after a simple sprain may signify other issues.

Non-Surgical Treatment

The course of treatment for peroneal tendon injury depends on the type of injury. Immobilization using a cast or splint may be used to keep the foot and ankle from moving and allow the injury to heal. Medications such as oral or injected anti-inflammatory drugs may help relieve pain and inflammation. Physical therapy, including ice, heat or ultrasound therapy, may reduce swelling and pain, and exercises can be added to strengthen the muscles, regain range of motion and improve balance. Bracing may also be an option when a patient is not a candidate for surgery.

When Is Surgery Needed?

In some cases, peroneal tendon injury may require surgery to repair the tendon or tendons and, perhaps, the supporting structures of the foot. The foot and ankle surgeon will determine the most appropriate procedure for the patient’s condition and lifestyle. After surgery, physical therapy is an important part of rehabilitation.


Peroneal tendon injuries can be painful and cause prolonged discomfort. Nonetheless, prompt evaluation by a foot and ankle surgeon and proper diagnosis is critical as it is essential to determine the kind of treatment required for the injury. Dr Gilbert Huang DPM is a foot and ankle surgeon that is well equipped with the skills and experience to diagnose and treat peroneal tendon injuries. Treatment may include non-surgical or surgical methods, depending on the type of injury. With proper diagnosis and treatment, patients can regain painless mobility in their feet and ankles.