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Peroneal Tendinopathy

Presenting as pain around the outer ankle, outer edge of the foot or across the bottom of the foot. It often occurs in people with higher arched feet, after ankle sprains or in people doing lots of uphill walking.

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A graphic rendering of the foot showing the attachment of peroneus brevis into the base of the fifth metatarsal.

About Peroneal Tendinopathy

There are two main peroneal tendons: peroneus longus and peroneus brevis. 

Peroneus longus runs along the outer edge of the foot then runs across the bottom of the foot and attaches to the inside edge of the foot at the base of the first metatarsal. 

Peroneus brevis runs along the outer edge of the foot and attaches to base of the fifth metatarsal. 

Types of Peroneal Tendinopathy

Peroneal tendon problems should be diagnosed specifically, and may affect either:

  • Peroneus Longus, or

  • Peroneus Brevis

and may also affect the:

  • mid-portion of the tendon

  • insertion of the tendon to the bone

It is also not uncommon for patients to have a partial tear along some of the length of the tendon. 

This does not often affect the treatment plan though.

A graphic rendering of a foot and ankle which highlights the Achilles but also demonstrates the pathways of peroneus brevis and peroneus longus.
A graphic rendering of the lower legs and feet skeletal bones as well as the plantaris tendon.

What else could it be?

The peroneal tendons, due to their position anatomically, can be difficult to misdiagnose. There are a few conditions that may also occur:

  • Plantar fasciitis

  • Achilles tendinitis

  • Iselin's disease

    • apophysitis of the 5th metatarsal

  • Cuboid syndrome​

  • Stress fracture

  • Sinus tarsi syndrome

  • Sural nerve entrapment

How are Peroneal tendon problems diagnosed?

Clinical examination and a thorough history is often adequate, however, in some instances it can be useful to use imaging to

  • Confirm the diagnosis

  • Identify how severe the problem is

  • Rule out other problems.

Imaging that can be used for Achilles issues is:

  • Ultrasound scans

  • MRI Scans

A podiatrist performing an ultrasound scan.
A person standing up on their tip toes which is an exercise that gets used for foot pain.

How is Peroneal Tendinopathy treated?

The core of treatment for all tendinopathies is 'loading', so doing exercises. However, the types of exercises and positions used will vary according to the type of tendinitis. 

Other treatments for Achilles Tendinopathy include:

  • Rest (rare!)

  • Anti-inflammatories (rare!)

  • Shockwave therapy

  • High-volume image guided injections

  • Orthotics

  • Heel raises

  • Gait retraining

  • Soft-tissue mobilisation

How long does it take to cure Peroneal Tendinopathy?

The duration will vary based on:

  • Severity of the problem

  • Duration of the problem

  • How well patients stick to their treatment plan.

In my experience, patients with a very recent onset of pain can be back to functioning relatively normally within 2-3 weeks. 

If symptoms have been ongoing for more than a month, then it can be more persistent, but very manageable nonetheless.

No two people can be treated the same way when it comes to any medical issues, and the goal of how we treat patients is always to get you back to what you want to be doing. 

Lady running with her dog
Ready to say goodbye to your pain?

At Keep On Your Feet, we openly acknowledge that we cannot guarantee a cure for things: but we will work as hard as we can with you to help you reach your goals. 

If your symptoms fit the above, you will need to book a 'Foot Pain' consultation. This will be £95 and lasts approximately 60 minutes usually. If you need insoles, we'll give you some basic ones to try out (or some fancier ones and reduce their price!). 

This is a picture of Jeremy Ousey, director and podiatrist of Keep On Your Feet.

About the Author

Jeremy Ousey is the owner at Swansea's podiatry clinic: Keep On Your Feet. All the information found on this page was written by him (there's no AI or Chat-GPT here!), and has been carefully chosen to provide you with the information that you need to know about the condition. Jeremy has a Bachelor of Science in Podiatry, with honours, a Post-Graduate Certificate in Podiatric Sports Medicine, a Post-Graduate Diploma in Medical Ultrasound, and two Master's of Science degrees in the Theory of Podiatric Surgery, and Sports & Exercise Medicine. If you would like to know more about Jeremy, please click here.

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