What is Peroneal Tendinopathy?

This refers to pain to the outside of your ankle or foot which eases with rest and worsens with activity such as walking or running. The peroneal muscles start in the outside of the leg, travel behind the ankle bone and into the foot. They help provide stability to the ankle when walking and help stop your ankle rolling.

What are the causes?

An over-use injury, or repetitive stress upon the tendons.

  • Older in age
  • Overweight
  • Systemic conditions diabetes, rheumatoid arthritis
  • Tight leg muscles
  • Training errors
  • Previous foot and ankle injury
  • Smoking

What are the symptoms?

  • Pain and/or swelling around the outside of the ankle
  • Pain on the outside border or instep of the foot
  • Poor balance
  • Gradual increase in symptoms with walking/activity
  • Struggle with uneven surfaces


Managing weight is important therefore a balanced healthy diet is encouraged. This will aid your recovery and long-term health.

See our “Healthy Living” section for more information on local healthy weight services

Activity Modification

Some resting of the foot might provide relief in the early stages, especially if it is inflamed in the area. This will allow the foot to settle to then start your mobility and strengthening exercises. If you are doing activity/exercise, make adjustments to reduce high-impact activity. Although staying active is still encouraged for your health, walking distance might need to be adjusted. If you notice that certain tasks are aggravating your pain, you may need to reduce the amount, intensity or cease all together whilst your foot recovers.

Pain Relief

An ice pack can help but be careful not to put ice or heat packs directly on the skin – wrap them with a tea towel cover. Elevate the foot if there is pain and swelling, and a compression bandage may also provide some relief.

Medication such as ibuprofen might interfere with the body’s ability to repair the tendon so paracetamol is preferred.





Generally, avoiding footwear that aggravates your symptoms is advised. However,  we need to be careful about this as sometimes the shoes might not be the aggravator it might simply be the task you’re doing. We advise wearing a practical, cushioned, stable shoe with a 8-10mm heel support, (such as running trainers or walking shoes) avoid flat and unsupportive options.  Walking boots can provide further ankle stability in some cases which can help ease symptoms on longer walks.

The Correct Shoes for Insoles – YouTube

Foot Insole / Orthotic

Foot orthotics can provide arch support which can reduce the stress upon the soft tissues and help your return to normal function. They will work best in more practical footwear, and it helps to remove the insole liner if they are full length. In flat painful feet foot orthosis tend to have a stiffer support to provide greater stability for the foot

Ankle Brace

An ankle foot orthosis is used to support the ankle by an external structure to provide stability for the ankle. These might be used in cases whereby surgery is not suitable. However, they can be bulky around the ankle and sometimes they can rub, causing discomfort.

Here is an example of an ankle brace:

Aircast AirLift PTTD Ankle Brace – ShoeInsoles.co.uk


The aim of exercises are to improve the ankle mobility and to strengthen the personal muscles to improve stability and support.

Phase 1: Ankle Mobility

If you prefer to stretch your calf muscles whilst seated you can use a towel or a belt to stretch your calf muscle.

  1. Sit down with one leg outstretched and the other bent.
  2. Place a strap around the ball of your outstretched foot and hold the ends of the strap in your hands.
  3. Pull up against the strap until you feel a stretch at the back of your leg.
  4. Maintain the position and hold for 15 seconds.
  5. Do for 2mins x3 Daily

Phase 1: Seated Heel Raise

  1. Sit with your knee bent at 90 degrees, feet flat to the floor
  2. Slowly raise both heels off the ground to full height (control rising)
  3. Hold for 3 seconds then slowly lower to the ground.
  4. 15 repetitions x 3 Daily

Phase 1: Isometric Foot Eversion

  1. Sit on a chair with the outside of your foot placed against a wall with an object (for example a football / rolled towel / cushion)
  2. Push the outside of your foot against the object towards the wall without moving the foot.
  3. The aim is to contract the muscle to help aid its recovery, hold for 5 seconds each time.
  4. Do this for 2mins 3 times a day.

Phase 2: Calf Stretch Standing 

  1. Facing the wall, put both hands on the wall at shoulder height
  2. Place one foot in front of the other- feet facing forwards
  3. The front foot should be about 30cm from the wall
  4. Bend the front knee towards the wall until the calf in the back of the leg feels tight.
  5. Hold for 10 seconds
  6. Repetitions x15 x3 Daily

Phase 2: Elastic Band Resisted Eversion

  1. Sit in a chair with an elastic tied around your foot and against a stable object you can place the other foot on it as the anchor.
  2. Keep your knee still and your heel in contact with the floor while you move the sole of your foot towards the outside.
  3. Return in control and repeat.


Surgery is only considered when all other treatments have not worked. Not everybody will be a suitable candidate for surgical intervention so this can be discussed with a health professional.

There are risks to foot and ankle surgery (can these expand out when clicked on)

Off-work: There will be a requirement to elevate your foot and rest non weight bearing then semi weight bearing.

Infection: The act of surgery is invasive which is also a risk to infection. In some cases, this can delay healing and will require antibiotic treatment.

Delayed Healing: If the blood supply is not so good or you have poor health this might affect healing time. Smoking has been shown to affect healing to bones and soft tissues. Non-union of bone fixations will require further surgical input.

Blood Clots: A small risk of developing a blood clot after foot surgery. Following the pre and post operative advice will help reduce this risk.

Scarring: Any type of surgery will leave a scar. Occasionally this can cause pain and irritation. If this happens, please discuss this with your consultant.

Metalwork: Occasionally screws or plates can cause pain after surgery. If this is the case, please discuss your concern with your consultant as it may be possible to remove the metalwork once the tissues have healed.

Swelling and Stiffness: The foot can swell as a response to surgery and as part of the healing process. It can take up to six months for swelling to completely settle in some cases. Although in some cases post-surgery there may be increased stiffness in the foot.

Numbness: Can exist in the surgical site if there has been disruption to a nerve.

Chronic Regional Pain Syndrome: Surgery can sometimes result in a swollen, painful and highly sensitive foot. This can be challenging to manage and often patients will be referred to the pain clinic for support.

If you are struggling to manage your foot condition?

Contact your general practice if you need further help and guidance, a referral to local musculoskeletal services is required in some instances, and they can advise on appropriate treatment or pathways suitable to you.

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