Peroneal tendonitis is often confused with Achilles tendonitis or plantar fasciitis, which can make it difficult to diagnose.
However, once you know that you’re suffering from peroneal tendonitis, it’s important to take the right steps to treat it.
But you may wonder how long it takes to recover from peroneal tendonitis?
In this article, we’ll look at the condition, how you can prevent it, some ways to treat it, and how long you can expect recovery to take.
What Is Peroneal Tendonitis?
Peroneal tendonitis is when one or both of your peroneal tendons become inflamed due to either overuse or an injury.
The two peroneal tendons run along the outside of the ankle, connecting the peroneal muscles—also called fibularis muscles—in the outside of the leg to your foot.
Both tendons sit behind the ankle bone, on top of each other. They then split and attach to different points on the foot.
The peroneus brevis tendon attaches to the bone on the outside of your foot just below your fifth toe.
The peroneus longus runs behind your ankle, underneath your foot, and attaches to the medial cuneiform and first metatarsal.
Both tendons help to move the foot outwards and stabilize the ankle joint.
The peroneus longus tendon also supports and stabilizes the transverse arch in your foot.
It plays a vital role in stabilizing your arch and distributing weight when you balance on one leg or when your foot moves from your heel to toes when you walk or run.
Symptoms of Peroneal Tendonitis
The main symptom of peroneal tendonitis is pain or an achy sensation behind the outer ankle bone.
The tendons will be tender to the touch and it will hurt when you stretch or move your foot outwards.
You may also experience pain on the outside of your foot where the tendon attaches below your fifth metatarsal joint.
The pain of peroneal tendonitis can be severe and can radiate into the arch of your foot. You’ll also notice swelling around the ankle bone and the outer side of your foot
The pain of peroneal tendonitis subsides when you rest your foot and increases as you go about your daily activities.
Causes of Peroneal Tendonitis
In most cases, peroneal tendonitis is caused by overuse but it can also be caused by an injury like a sprained ankle.
There are also a number of factors that can contribute to the development of the condition.
Participating in sports that involve repetitive ankle motion, like the thousands of repeated strides or pedaling of runners and cyclists.
This can cause the overuse of the peroneal muscles or peroneal tendons and the condition develops over time.
You may develop the condition if you’re training with improper form, or have a sudden increase in your training, or if you wear shoes that don’t provide adequate support for your feet.
You may also develop peroneal tendonitis if you have high arches or if you supinate—also known as underpronation.
Both high arches and supination will force your tendons to work harder to stabilize the foot when you walk, run or jump. The increased load on the tendons leads to inflammation in and around the tendons.
Wearing shoes that don’t provide adequate support for the arch of your foot or supination can exacerbate the condition.
Both weak hip muscles and tight calf muscles increase the amount of strain that’s placed on the peroneal muscles.
The peroneal muscles then put excessive pressure on the tendons in the ankle, which causes the tendons to be inflamed.
Spraining your ankle a few times will cause the tendons to overstretch and weaken, which can lead to you developing the condition.
Runners who run on the same side of the street every time or on sloped streets that cause your foot to roll outwards will be at a higher risk of developing peroneal tendonitis.
This increases the load that’s placed on the peroneal muscles and peroneal tendons, causing them to become inflamed.
How Can You Prevent Peroneal Tendonitis?
Fortunately, there are a number of steps that you can take to prevent peroneal tendonitis.
If you experience foot or ankle pain, don’t push through it! Stop the activity that’s causing the pain immediately and pay attention to where you feel the pain.
Make sure that you allow for plenty of rest between exercising or other physical activities. This will give the peroneal tendons time to rest and heal.
Wear shoes that provide adequate support for your foot shape.
If you do supinate or overpronate, you can look at adding an orthotic to your shoes to help reduce lateral movement and help reduce the load on the tendons.
You can also look at wearing a supportive neutral shoe when walking or running. While sandals aren’t always supportive, a sandal for peroneal tendonitis can help.
Warm-up properly before your exercise and make sure that you spend time stretching your calves and peroneal muscles.
Include strength exercises into your workouts which include the hip and outer calf muscles.
Gradually increase the frequency, intensity, and duration of your training. This will allow the tendons time to adapt to the exercise.
Runners should avoid running on sloped or uneven surfaces. You should also avoid making any quick, pivoting movements that could increase your risk of injuring the tendon.
Don’t return to exercise too soon if you’re recovering from an injured ankle, especially if you’ve sprained it numerous times.
Give your ankle the time it needs to heal properly, as this will reduce your risk of developing peroneal tendonitis.
If you have weak ankles or you’ve sprained or injured your ankles multiple times, you may want to support your ankle by using an ankle brace during your activities.
Treatment for Peroneal Tendonitis Includes:
Non-Surgical Treatment and Recovery Time
Try these non-surgical ways to heal from personal tendonitis. For most people, it will be about a month before you can start your regular activities again.
Rest and RICE
The best way to treat peroneal tendonitis is to rest your foot as much as possible.
Elevate your affected foot, as this will help to reduce the swelling. It’s also a good opportunity for you to apply ice along your tendons.
You can apply ice to the tender area 2 to 3 times a day for 20 minutes. To prevent any skin irritation while icing, wrap the ice pack in a cloth and then place it on your ankle.
To allow the tendons to heal properly, you may have to wear a walking boot, ankle brace, or a soft cast to immobilize your foot.
Your doctor may recommend that you use crutches for a few weeks as well. This will take the pressure off of the peroneal tendons so that they can heal properly.
Compression socks can alleviate peroneal tendonitis pain, reduce swelling, and encourage healing, as they stimulate blood flow to the tendons.
To alleviate the pain and reduce inflammation, you can use oral pain medication like Ibuprofen, Motrin, Advil, or Aleve. You can also try a topical analgesic gel like Biofreeze. Self-massage for peroneal tendonitis may also work.
While you’re recovering from peroneal tendonitis, you’ll need to avoid walking, jogging, running, biking, or using the elliptical for exercise.
Once the tendons have healed, you’ll need to introduce exercise and stretching slowly.
If you start exercising with peroneal tendonitis too early, you risk damaging the peroneal tendons further. This could delay your recovery and can increase your risk of having surgery.
Your doctor may recommend that you see a physical therapist who can guide you through some exercises and stretches. These will help you to regain strength and flexibility in your foot and ankle.
By incorporating them into your daily routine, they’ll help you to prevent the peroneal tendonitis from recurring.
It’s important to maintain a healthy weight, as you can increase the amount of pressure that’s placed on your feet by more than 8 pounds for every pound that’s over your ideal body weight.
This will place your hips, knees and ankles under excessive pressure. In some cases, the weight may be more than your ankle can bear and this will place more stress on your joints and soft tissue.
By shedding a few extra pounds or by maintaining a healthy weight, you’ll be reducing your risk of developing conditions like peroneal tendonitis.
You may need to change the type of shoes that you’re wearing and choose shoes that provide adequate support for your feet.
Avoid walking barefoot or wearing flip-flops and flat shoes, as these will aggravate the peroneal tendons, as well place them under excessive strain.
Look at adding orthotics to your shoes that will help limit lateral movement on your heel and reduce the load that’s placed on the tendon.
Have your gait analyzed by your podiatrist, as you may need to start wearing a motion control shoe or a supportive neutral shoe.
If you do switch to either a motion control shoe or a supportive neutral shoe, allow for a break-in period. Your feet are going to be guided into a more neutral alignment, taking the load off of your tendons, and this will require some getting used to.
In some cases, you may need surgery to repair either one or both tendons, especially if your pain hasn’t improved with conservative treatments.
With that being said, conservative treatment could last for a year before surgery would be recommended.
Depending on the severity of the peroneal tendonitis, your doctor may recommend a minimally invasive operation known as a synovectomy.
How Long Does Recovery After Surgery Take?
Recovery from surgery would be between 6 and 12 weeks up to 4 months, depending on the type of surgery you had.
Your affected foot would be immobilized and you won’t be allowed to put any weight on your foot for several weeks.
If you had to return to early activity while the tendon is healing, it would result in a delay of your recovery time.
Your doctor will recommend that you see a physical therapist, as your ankle will feel weak when you stop wearing the boot.
It’s important to do the stretches and exercises, as they’ll help you to rebuild strength and regain your foot’s normal range of motion.
You may have to wear an ankle brace once you stop wearing the soft cast or walking boot—which could be about 8 weeks after surgery—and return slowly to your day-to-day activities.
By following your doctor’s recommendations and physical therapist’s routine, you could be returning to your exercise routines within 6 months.