Peroneal Tendinopathy: Treatment, Symptoms and Causes Sydney

Peroneal tendinopathy is a condition involving pain, swelling and stiffness in the tendons that run along the outer side of the ankle and lower leg. These tendons play an important role in stabilising the ankle and foot, particularly during walking, running and movements on uneven surfaces.

Pain is often most noticeable first thing in the morning. It may ease as you move around during the day, although the severity can vary. Symptoms can also feel worse after periods of rest and may settle once the body warms up and becomes more mobile.

Peroneal Tendinopathy: Treatment, Symptoms and Causes Sydney

Peroneal tendinopathy is a condition involving pain, swelling and stiffness in the tendons that run along the outer side of the ankle and lower leg. These tendons play an important role in stabilising the ankle and foot, particularly during walking, running and movements on uneven surfaces.

Pain is often most noticeable first thing in the morning. It may ease as you move around during the day, although the severity can vary. Symptoms can also feel worse after periods of rest and may settle once the body warms up and becomes more mobile.

Symptoms

Symptoms of peroneal tendinopathy can vary between individuals but commonly include:

Pain and/or swelling along the outer side of the ankle (above, behind, or below the outer ankle bone)
Discomfort along the outside of the leg or foot
A feeling of instability when walking, especially on uneven ground
Reduced balance when standing on one leg, with the affected side feeling weaker
Morning pain or discomfort during the first few steps after getting out of bed

Causes

The peroneal tendons include three muscles: peroneus brevis, peroneus longus and peroneus tertius. The peroneus brevis and longus are most commonly involved in tendinopathy. These tendons run behind the bony bump on the outside of the ankle before attaching into the foot.

Peroneal tendinopathy is most commonly related to overuse and reduced muscle capacity. Repeated stress can lead to varying amounts of change within the tendon structure.

Other contributing factors may include:

Overuse or repetitive stress on the tendon.
Sudden increases in activity or training intensity.
Reduce strength in the lower limb.
Tight calf muscles or improper footwear.
Age-related tendon change

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Diagnosis

A diagnosis of peroneal tendinopathy is based on a thorough clinical assessment.

This may include:

Palpation (gently pressing) along the painful area
Assessing ankle and foot joint range of motion
Observing your walking or running pattern

At Sports Podiatry Manly, we utilise a pressure plate treadmill system (Zebris) to analyse how pressure moves through your feet during movement.

In more severe cases, ultrasound or MRI imaging may be recommended. However, imaging is not always necessary.

Treatment

Management of peroneal tendinopathy focuses on reducing pain while maintaining appropriate activity levels. Rather than complete rest, treatment involves careful load management to avoid further irritation while allowing the tendon to recover.

Additional treatment options may include:

Dry needling
Shockwave therapy
Footwear advice
Soft tissue therapy
Orthotics
Foot mobilisation
Taping

With consistent management, symptoms often improve over several weeks, though full recovery may take several months depending on the individual case.

At Sports Podiatry Manly, our podiatrists provide thorough assessment and personalised treatment plans tailored to your individual needs. If you are in Sydney and experiencing ongoing ankle pain or stiffness, booking an assessment may help determine the most appropriate management for you.