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Peroneal tendinopathy

Peroneal tendinopathy is pain along the outside of the ankle from the peroneal tendons, usually after overuse or an ankle sprain. The first steps are easing the load, keeping gently active and building up gradually. A podiatrist or physiotherapist can guide exercises if it isn't settling.

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPodLast reviewed 27 October 2026 6 min read

Jump to a section
  1. 1. What is peroneal tendinopathy, and how common is it?
  2. 2. What causes it, and who gets it?
  3. 3. What does it feel like, and how is it diagnosed?
  4. 4. What helps first?
  5. 5. What helps if that isn't enough?
  6. 6. How long does it take to get better, and how can I stop it coming back?
  7. 7. When to see a podiatrist

At a glance

  • It's pain on the outside of the ankle, from the peroneal tendons, that tends to build with activity and ease with rest.
  • It's usually an overuse problem, often after a sudden change in activity or an ankle sprain.
  • Easing the load comes first: cut back on what hurts most, keep gently moving, and build up gradually.
  • A sprain that won't settle is worth having rechecked by a podiatrist or your GP, because peroneal problems are often mistaken for sprains.
  • Improvement can be slow, so give each step time.

What is peroneal tendinopathy, and how common is it?

Peroneal tendinopathy (also called peroneal tendonitis or fibularis tendinopathy) is pain and reduced strength in the peroneal tendons. These are two strong tendons that run down the outside of your ankle. They help steady your ankle and foot, especially on uneven ground or when you stand on one leg.

You'll usually feel it on the outer foot or just behind the outer ankle bone, and it often follows a change in activity levels. Peroneal tendon problems are now seen as a significant cause of outer-ankle symptoms in active people, and after ankle sprains.

What causes it, and who gets it?

It's thought to be mainly an overuse problem. A tendon can become sore when daily activity goes beyond what it can cope with: a sudden increase, such as taking up running, or a drop in activity after illness or a long rest. The tendons can also be hurt in an ankle sprain, and walking or running on uneven ground in worn shoes can bring it on.

Other things are linked with it: a high-arched or flat foot shape, being overweight and unsupportive footwear, long-term steroid tablets, a family of antibiotics called fluoroquinolones, and smoking. Diabetes and high cholesterol are linked with tendon problems and poorer healing in general. These are links, not proven causes. If a medicine applies to you, mention it to your doctor, and don't stop any medicine without talking to your prescriber.

What does it feel like, and how is it diagnosed?

You'll typically notice pain, sometimes with swelling, on the outside of the ankle (above, behind or below the outer ankle bone) or along the outer edge of your foot. It tends to come on gradually, get worse with walking, running and jumping, and ease with rest. Pain after rest or first thing in the morning is common. The ankle often looks normal.

A podiatrist or doctor will ask about your activity and any past sprains, and examine the ankle. They may check for weakness when you push outward with your foot, compared with the other side. Whether a scan is worthwhile is their call.

Peroneal problems are often missed or mistaken for ankle sprains at first. See a podiatrist or your GP if outer-ankle pain lingers after a sprain.

What helps first?

Non-surgical care is the first step, and the treatment of choice for most sudden-onset cases. How much each part helps isn't clear yet, so a podiatrist or physiotherapist can shape a plan for you.

  • Ease the load. Cut back on what hurts most. Avoid high-impact activity such as running, which puts a lot of load through the tendon, and keep to walking, swimming or cycling. Don't stop moving altogether: long periods of inactivity can irritate the tendon and weaken muscles.
  • Settle it early on. Rest, ice, compression and elevation can help at the start.
  • Add exercises. Once putting weight through the foot is painless, gentle movement and then tendon-strengthening exercises come next. Long spells in a boot or cast are generally best avoided.

If you haven't improved after 6–8 weeks of this, see your GP about a physiotherapy referral.

What helps if that isn't enough?

Ask a podiatrist, physiotherapist or GP to reassess rather than trying options on your own. Irritation of the tendon's covering (tenosynovitis) typically responds to non-surgical care, with surgery kept for cases that don't respond.

Leaving it can allow persistent outer-ankle pain and ongoing difficulty with daily activities. Steroid injections are a question to talk through first: there's no agreement on their use, because of a risk the tendon could tear. Platelet-rich plasma injections don't have enough support behind them.

How long does it take to get better, and how can I stop it coming back?

No reliable timeline has been found. If you're improving, even slowly, carry on with self-care for up to 3 months.

Poor diet, high cholesterol and diabetes are linked with poorer healing, so it helps to manage them with your GP. If you're carrying extra weight, the added load can make symptoms worse, and losing some weight is advised.

It isn't clear yet what stops it coming back. Sensible steps are building up new activity gradually, replacing worn shoes, and returning to running and jumping slowly.

When to see a podiatrist

See your GP or a podiatrist the same day if:

  • you felt a pop, or the tendon seems to have slipped out of place;
  • you can't put weight on your foot after an injury;
  • you have sudden swelling and redness around the tendon, which can mean a tear;
  • your ankle is hot, swollen and tender;
  • you have significant swelling, a colour or temperature change in your foot or ankle (or extending up your leg), or signs of infection such as a high temperature, unusual night sweats or feeling unwell;
  • you have diabetes and a wound, sore, blister or colour change on your foot.

For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic.

See your GP soon if you notice a lump in your foot or ankle, or have unexplained weight loss.

See a podiatrist or your GP if your pain hasn't started to improve after 12 weeks, or your ankle is giving way more.

Common questions

Can I keep running with peroneal tendon pain?

It's usually best to swap running and jumping for lower-impact activity such as walking, swimming or cycling while the tendon settles, because running puts a lot of load through it. Return to running gradually, and stop if the pain builds. A podiatrist or physiotherapist can help you plan how to get back to it.

Is peroneal tendinopathy the same as a sprained ankle?

No, but the two are linked. A sprain is an injury to the ligaments of the ankle, while peroneal tendinopathy is pain in the tendons on the outside of the ankle. The tendons can be hurt in a sprain, and tendon problems are often mistaken for sprains, so see a podiatrist or your GP if outer-ankle pain lingers.

Do I need an ultrasound or MRI?

Not always. A podiatrist or doctor can usually start with your story and an examination of your ankle. A scan may be suggested if you aren't improving or a tear is suspected. They can tell you whether one is worthwhile in your situation.

Can supportive shoes or insoles help?

Supportive shoes in good condition are a sensible step, especially if you walk or run on uneven ground, because worn shoes can bring the problem on. It isn't clear yet whether insoles help peroneal tendon pain. A podiatrist can check your footwear and foot shape and talk through what suits you.

Further reading

Want to know more? Peroneal tendinopathy on Clindice

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod

Podiatrist

Reviewed 27 October 2026. Next review by 27 October 2027.

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Sources

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  3. 3.Peroneal TendinopathyNHS
  4. 4.The ESSKA-AFAS international consensus statement on peroneal tendon pathologiesvan Dijk PA, Miller D, Calder J et al. · Knee Surgery, Sports Traumatology, Arthroscopy · 2018
  5. 5.Peroneal TendinopathyNHS Lanarkshire · 2021
  6. 6.Peroneal Tendon PainNHS
  7. 7.MSK Peroneal tendinopathy (lateral ankle pain)NHS
  8. 8.Peroneal tendon disordersDavda K, Malhotra K, O'Donnell P et al. · EFORT Open Reviews · 2017
  9. 9.Information about Peroneal TendinopathyNHS
  10. 10.Operative treatment for peroneal tendon disordersHeckman DS, Reddy S, Pedowitz D et al. · The Journal of Bone and Joint Surgery · 2008
  11. 11.Outer ankle pain (Peroneal Tendinopathy)NHS

This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.

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