Peroneal tendonitis is a common cause of pain around the back and outside of the foot due to injury or damage to the tendons.

The peroneal tendons are strong, cord-like structures that link the peroneal muscles of the calf to the bones of the foot. Tendonitis occurs when microtears cause tendon damage and inflammation, leading to pain and difficulty walking.

According to American Family Physician, when tendonitis occurs, people often experience pain and swelling around the back and outside of the foot. Other symptoms include popping and the feeling of ankle instability.

The pain is usually worse with activity, comes on slowly, and gets progressively worse over time. The most common cause of peroneal tendonitis is overuse. This injury is common in runners and other athletes whose sports require repetitive motion of the ankle or foot.

Treatment includes the RICE principle (rest, ice, compression, elevation) as well as anti-inflammatory medications such as ibuprofen (Advil, Motrin, and others), massage, physical therapy, and stretches and strengthening exercises for the foot and calf.

Controlled stretching is known to increase collagen synthesis and improve muscle fiber organization. Better organization may result in stronger muscles and tendons after recovery.

During the recovery phase of a tendon injury, your physical therapist may prescribe a home exercise program that includes stretching and strengthening exercises. The goal of stretching is to prevent problems due to adhesions, shortening, or improper healing in the tendon.

Check with your therapist to see if these stretches can help to decrease symptoms and maintain flexibility in the ankle and calf following peroneal tendonitis.

Stretching the muscles of the foot and calf may help decrease your pain and improve healing of a peroneal tendon injury. This stretch can be performed by sitting on the ground with your feet straight out in front of you:

  1. Wrap a towel around your toes and gently pull back until you feel a stretch at the bottom of the foot and back of the lower leg.
  2. Hold this stretch for 30 seconds and repeat three times.

A standing calf stretch allows for more tension on the ankle and calf than while stretching in a sitting position:

  1. Stand to face a wall, one foot extended out in front of you, toes pointing up.
  2. Slowly lean forward until you feel a stretch in the back of your lower leg.
  3. Hold for 30 seconds and repeat three times.

The soleus muscle is a deep calf muscle that is often tight in endurance athletes. You can stretch this muscle by doing the following stretch:

  1. Stand a few feet away from a wall and face the wall.
  2. Your injured leg should be back with your heel on the floor. Bring your other leg forward, toward the wall.
  3. Turn your injured foot slightly inward toward the other.
  4. Keep your other leg forward and slightly bend that knee and lean into the wall until you feel a stretch on your affected leg.
  5. Hold for 30 seconds and repeat three times.

Maintaining flexibility of the ankle is important during recovery. Since the peroneal tendon helps assist in turning the foot outward (eversion), this motion can often be difficult and painful. Don’t do any movement that causes pain. Check with your physical therapist for alternatives if needed.

  1. Sit on a chair with the affected leg crossed over your other knee.
  2. Holding the bottom of the foot with your hand, slowly tilt the sole of your foot toward the floor.
  3. Hold this position for 5 to 10 seconds and then pull your foot toward you, tilting it to the ceiling. Repeat 10 times.

Peroneal tendonitis can be prevented by wearing proper footwear, avoiding training on a sloped or uneven surface (for example, beach running), and refraining from quick pivoting movements.

Most importantly, it can be avoided by not overtraining. It can also be prevented by not returning to exercise too soon after an ankle sprain or injury.

Always consult your doctor before starting a new exercise program. Your healthcare provider will be able to determine an appropriate plan of care for your condition.

If these exercises cause your pain to get worse or you experience swelling, warmth, or redness, stop immediately.

If pain doesn’t improve with rest, always seek medical care, as this could be more serious and, in some cases, require surgery.

Peroneal tendonitis is a common injury in runners and endurance athletes. With proper rest and conservative management, it often heals without surgery. Stretching may help increase flexibility and maintain range of motion in the foot and ankle.