About peroneal tendinopathy
The two peroneal tendons run behind the outer ankle bone and along the outside of the foot. They turn the foot outward and help keep the ankle stable on uneven ground. When they are overworked, especially after a sprain or with repeated side-to-side movement, they can become painful and swollen.
Peroneal tendinopathy is common in runners, court and field athletes, and people with high arches or ankles that roll easily. Sometimes the tendons develop small splits, or they slip out of their groove behind the ankle bone.
Treatment focuses on restoring strength and control around the ankle so the tendons are not overloaded, while keeping you as active as possible.
Common symptoms
- Pain behind or below the outer ankle bone
- Swelling along the outside of the ankle
- Pain that worsens with walking on uneven ground or turning
- A feeling of the ankle being weak or unstable
- Snapping or popping behind the outer ankle bone in some cases
Common causes and risk factors
- Previous ankle sprains and ongoing ankle instability
- Repetitive cutting, pivoting, or running on uneven or banked surfaces
- High arches or a heel that tips inward
- A sudden increase in training
How we diagnose it
Dr. Gruner examines the ankle and uses diagnostic ultrasound at the exam table to watch the peroneal tendons at rest and as you move your foot. Dynamic ultrasound can show thickening, small split tears, fluid in the tendon sheath, and tendons slipping out of place, which are hard to see on a still image. MRI is added if a larger tear is suspected.
How Propel treats peroneal tendinopathy
We begin with progressive strengthening of the peroneal and calf muscles, balance training, and a gradual return to sport. Bracing or taping may help during the early phase, and we adjust training and footwear to reduce load on the tendons.
For pain that lingers, Dr. Gruner can place PRP under ultrasound to support healing of the tendon and small partial tears, and tendon scraping to free the tendons from irritated surrounding tissue and small nerves. A large tear or tendons that repeatedly dislocate may need a surgical opinion, and we help coordinate that referral.
What to expect at your visit
- 1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
- 2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
- 3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
- 4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.
Questions about peroneal tendinopathy
- Can a sprained ankle lead to peroneal tendon problems?
- Yes. The peroneal tendons work hard to protect the ankle after a sprain, and they can become overloaded or injured along with the ligaments. Outer ankle pain that lingers after a sprain is worth checking with ultrasound.
- What is a peroneal tendon split tear?
- A split tear is a lengthwise tear in one of the peroneal tendons, often the shorter of the two. Small splits can often be managed with rehab and ultrasound-guided treatment, while larger ones may need surgical repair.
- Will balance exercises help peroneal tendinopathy?
- Balance and strength training are central to treatment. They help the ankle react better to uneven ground and reduce the strain on the peroneal tendons.