Peroneal Tendon Disorders


Tendons are structures that attach muscle to bone and help us move our skeleton. These structures have relatively low or poor circulation compared to other tissues in our body such as muscle and bone.

The peroneal tendons (peroneus longus and peroneus brevis) are located on the back and outside of the ankle and help stabilize the ankle while on uneven ground. Their normal function is to move the ankle down and out.

These tendons are the most commonly injured tendons in the typical ankle sprain because of a rapid contraction that occurs when the body is trying to protect itself from injury. That rapid contraction may cause tendinitis, tendon tears or partial or complete dislocation of the tendons from behind the ankle bone.


Patients usually describe a previous ankle sprain or twisting injury but sometimes the cause is simply progressive and worsening pain behind the ankle. They usually describe clicking, popping, and feelings of instability and pain on the side of the ankle. It is common to see swelling and tenderness over the tendons. Occasionally there is the appearance of a small mass or bump that may represent a tear.

Inversion sprain to the ankle


Many times there is a clear diagnosis of peroneal pain. Usually patients have pain along the tendons and weakness to resistance testing. However, the exact pathology sometimes will require x-rays, MRI or a CT scan.


If you experience symptoms with a peroneal tendon disorder, initial treatment is usually directed at decreasing swelling and inflammation.  Usually a short period of immobilization or rest will calm down the tendons and then a progression to normal function will involve improving flexibility, range of motion and strengthening.  Some of the various treatment options include:

  • Activity modifications. Cut down on activities that bring you pain and avoid prolonged walking and standing to give your arches a rest.
  • Weight loss. If you are overweight, try to lose weight. Putting too much weight on your arches may aggravate your symptoms.
  • Orthotic devices. A custom orthotic can be fitted for your shoes to give more support to the arches and properly balance your feet.
  • Immobilization.In some cases, it may be necessary to use a brace, a boot, a walking cast or to completely avoid weight-bearing.
  • Medications.Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation.
  • Physical therapy. Ultrasound therapy or other physical therapy modalities may be used to provide temporary relief.
  • Surgery.In some patients, pain may not adequately be relieved by the above treatments and surgery may be considered.

Surgery for Peroneal Tendon Disorders

In more severe cases, surgery may be required to adequately treat peroneal tendon disorders. Surgery often involves repairing the damaged tendon and the overlying fascia to stabilize the tendon in its tunnel.  Occasionally, peroneal tendon tears are beyond repair and require more advanced surgical procedures like tendon transfers or reconstruction or deepening the tendon groove. Dr. DeMill will discuss the surgical procedure best suited for your case based on the type and severity of your injury as well as your activity level.

After surgery, rehabilitation is extremely important. Completing your rehabilitation program is crucial to a successful outcome. Be sure to continue to see Dr. DeMill during this period to ensure that your ankle heals properly and function is restored.


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