Peroneal Tendonitis Physical Therapy – Everything You Need To Know

Peroneal tendonitis is an inflammation of the peroneal tendons and surrounding tissues which is characterized by the pain on the outside of the ankle and/or along the course of the peroneal tendons. It is an acute injury which is caused by the overuse.

However, every tendon is under a constant repetitive stress. Over time, that stress causes structural changes in the tendon, also known as degeneration. Tendinosis, a medical term used for this condition, is characterized by the pain in the same area as tendonitis. The difference is that this pain can also be present when you’re not active.


Both tendonitis and tendinosis are actually parts of the same condition. This is why peroneal tendinopathy is a better term for it.

Peroneal tendinopathy is a condition which has similar symptoms as other, more often ankle injuries. This is why it is often misdiagnosed and not treated properly. Without proper treatment, peroneal tendonitis can escalate into a more serious tendinosis, which sometimes requires surgical treatment.

As with any other sports injury, initial treatment consists of rest, ice, compression and elevation, along with anti-inflammatory medications. The point is to reduce stress, inflammation and give time for the tendon to heal properly. However, these treatments are ineffective in the long term.

This is why you should start physical therapy as soon as the pain is gone. With physical therapy you’re going to prevent further injuries and slow down the progression of this chronic condition.

In order to understand the physical therapy in peroneal tendinopathy, you should get to know the function of peroneal tendons and the causes of peroneal tendinopathy.

What are the peroneal tendons and what are their functions?

The first step in understanding the importance of physical therapy is to know the anatomy and function of the peroneal muscles and tendons.

There are two peroneal tendons that emerge from two peroneal muscles – peroneus longus and peroneus brevis. They run parallel to each other down the back of the fibula (outer bone of the lower leg) and behind the lateral malleolus (the bony lump on the outside of the ankle).

One peroneal tendon attaches to the outer part of the midfoot, at the base of the fifth metatarsal bone (little toe), while the other continues underneath the foot and attaches to the inside of the arch.

These muscles and tendons are responsible for:

  • Eversion – outward roll of the foot
    • When peroneal muscles contract, the peroneal tendons stretch and rolls the ankle outwards 
  • Plantar flexion – pointing the foot downward
  • Lateral stabilization and balance – they stabilize the foot and ankle, especially during weight-bearing activities such as walking, running etc.

What are the causes for peroneal tendinopathy?

Peroneal tendinopathy is primarily an overuse injury, caused by the repetitive stress on the tendon. Overload, a sudden increase in physical activity without the proper adaptation can also cause the injury. In general, any physical activity that involves repetitive ankle motion can cause peroneal tendonitis. That it why it is often seen in sports like running, football, basketball etc.

There are many factors that elevate the risk of developing peroneal tendonitis:

  • High arched, supinated feet

Peroneal muscles and tendons work harder to reduce the supination by pronating the foot, causing more stress on the peroneal tendons

  • Ankle sprains

Peroneal tendon injury can be caused at the time of injury or due to an unstable ankle after injury.

  • Tight calf muscles

Tight calf muscles cause a more rapid transfer of stress onto your midfoot during running and therefore increase stress on the peroneal tendons too.

What is peroneal tendonitis physical therapy and what are the benefits?

Peroneal tendonitis physical therapy consists of various stretching, strengthening and balance exercises. For the best results, it is recommended to combine all three types of exercises. However, the combination of these exercises should depend on the current state of your medical conditions. Some of them can be done even while you’re in recovery, while other require for your injury to settle.

Stretching and strengthening exercises are good for both muscles and tendons. By stretching the tight muscles, you will reduce the stress on the tendons. On the other hand, stretching the tendons will improve the healing process of the tendon and its strength.

Balance exercises are used for improving your proprioception. Proprioception is the sense of knowing where your body parts are in space. Poor proprioception means poor balance and instability. Peroneal tendon injuries can decrease your proprioception and subsequently your balance. However, these exercises will re-educate your body to quickly react to the wobbly movements and regain your balance and stability.

Some of the best exercises for peroneal tendinopathy

When it comes to stretching exercises, it is best to focus on calf muscles, because tight calf muscles are the often cause of peroneal tendinopathy. Stretching the muscles of the foot and calf will decrease your pain and improve healing.

  • Towel stretch
    • Sit on the ground with straight feet in front of you. 
    • Wrap a towel around your toes. 
    • Pull back gently until you feel a stretch at the bottom of the foot and the back of the lower leg. 
    • Do this for 30 seconds 
    • Repeat 3 times.
  • Standing calf stretch
    • Stand facing a wall with your hands on the wall at the eye level.
    • Keep your injured leg back with your heel on the floor.
    • Keep the other leg forward with the knee bent.
    • Slowly lean into the wall until you feel a stretch in the back of your calf. 
    • Hold the stretch for 15 to 30 seconds. 
    • Return to the starting position.
    • Repeat 3 times.
  • Standing soleus stretch
    • Stand facing a wall with your hands on the wall at chest height
    • Keep your injured leg back with your heel on the floor
    • Keep the other leg forward with the knee bent
    • Bend your back knee slightly and gently lean into the wall until you feel a stretch in the lower calf of your injured leg.
    • Hold the stretch for 15 to 30 seconds.
    • Return to the starting position.
    • Repeat 3 times.

Because peroneus muscles and tendons are crucial for eversion of the foot, strengthening exercises should be focused on eversion of the foot against resistance.

  • Foot eversion and inversion
    • Sit on a chair with your injured leg crossed over your other knee. 
    • Hold the bottom of the foot with your hand. 
    • Slowly tilt the sole of your foot toward the floor. 
    • Hold this position for 5 to 10 seconds. 
    • Pull your foot toward you. 
    • Repeat 10 times.

The important thing with balance exercises is that they should be done in a structured, progressive way. You should start with basic single-leg balance exercise, then progress to adding more complex motions. More complex motions are reaching forward, to the right, and to the left with your upper body. You can also use wobble balance board or a foam balance mat if you have.

  • Single-leg balance exercise
    • Try to balance on your injured leg for 30 seconds

First with your eyes open

Then with your eyes closed.

    • Stand up and then rock back on your heels so that your toes are off the ground for about five seconds. 
    • Repeat 10 times and then do two more sets of 10.


It is important to start your treatment for peroneal tendinopathy as soon as possible. Inflamed and degenerated peroneal tendon that is not treated properly can begin to tear, causing a more serious condition. With an early diagnosis, physical therapy can successfully treat peroneal tendinopathy. That is why as soon as you don’t have the pain, you should start with exercises.

However, there are couple of things you should know before you start with your exercises.

First, find the appropriate shoes. Fitting and supportive shoes will give your foot and ankle a proper support. This is really important, especially if you have the abnormal foot structure like high-arched foot.

If you’re not sure what type of shoes you should buy, I made a list of best shoes for peroneal tendonitis in my opinion.

Sometimes it is necessary to get foot orthotic especially when performing more intensive activities, such as walking or running on uneven surfaces. However, you should avoid any activities on uneven surfaces, especially after the injury.

Start each exercise slowly. Don’t do exercises that cause pain. If you’re not sure what exercises you should do or if your injury is healed properly, go to a doctor. They will give you the right treatment and physical therapy for your condition.

I hope that with this text I’ve thought you the basics of peroneal tendonitis physical therapy, so the next time you feel the symptoms on the outside of the ankle and foot you will know what to do.


Click Here to Leave a Comment Below 1 comments
Tyson Alison - March 22, 2018

Thank you so much for the great article, it was fluent and to the point. Cheers.


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