Peroneal tendonitis can be painful just to walk on, never mind running on! Ankle pain can be enough to sideline you for a few weeks, but there are always those runners who want to push through the pain, especially if there’s a big race coming up.
But can you go running with peroneal tendonitis, or is it not worth the risk? Here’s our advice based on science and personal experience!
What Are the Peroneal Tendons?
Your peroneal tendons are two strong tendons that run alongside each other on the outside of your leg. They continue behind the ankle bone, where they split up and attach to different points on your foot.
The peroneus brevis tendon connects to the short muscle—known as fibularis brevis
— on the lower outside part of leg and runs behind the ankle bone, where it connects to your foot just below your fifth toe.
The peroneus longus tendon connects to the peroneus longus muscle—also known as fibularis longus—which is just below your knee on the outside of your leg. It then runs behind the ankle, goes underneath your foot, and attaches to the medial cuneiform—middle foot—and first metatarsal.
What Do the Peroneal Tendons Do?
The peroneal tendons are vital throughout your gait cycle, as they stabilize your foot and ankle. The peroneus longus tendon supports the transverse arch in your foot, which is responsible for about forty percent of “foot stiffness”.
Your transverse arch provides both flexibility and stiffness to act as a lever and spring when walking and running. The tendon and the transverse arch help you maintain your balance by stabilizing the muscles in your foot, especially when standing on one foot.
Both the fibular muscles—peroneal muscles—and peroneal tendons assist with extending your foot downward and away from the body—plantar flexion—while tilting the sole of your foot away from the midline of your body—eversion.
This provides dynamic lateral ankle stability, which keeps your foot in a neutral position when walking and running. These tendons also try to prevent inversion sprains—when the ankle turns inward—should you suddenly twist your ankle.
How Does Peroneal Tendonitis Develop in Runners?
While peroneal tendonitis isn’t the most common tendon injury to affect runners, there’s always a potential risk of developing it.
Factors that can increase your risk of peroneal tendonitis include:
- Overuse injury from repetitive overloading or stretching of the peroneal tendons
- Changing up your running routine with sudden increases in frequency, distance, or intensity
- Poor foot and ankle biomechanics
- Weak foot and ankle muscles
- Tight calves
- Muscular compensation higher up the kinetic chain
- Lack of glute, hip, and core strength
- Having high arches, your tendons will be forced to work harder
- Running on very uneven terrain, like trails
- Runners who supinate, as their weight is placed on the outer edges of their feet
- Wearing the wrong shoes, worn-out shoes, or running in new shoes
- Running on the same side of the road or track on every run
- Previous ankle injuries, like sprained ankles
Trail runners are more likely to develop peroneal tendonitis. This is due to the tendons having to work harder and longer to maintain your balance and stability on uneven surfaces.
Symptoms of Peroneal Tendonitis
Peroneal tendonitis can cause inflammation in one or both tendons simultaneously. The most common symptoms include:
- A sharp or aching pain at the back of the ankle, along the length of the tendons, or on the outside of your foot
- Swelling on the outside and back of the ankle
- Redness or warmth around your tendon
- Pain that gets worse with physical activity
- A burning or tingling sensation on the outside of your lower leg during activity
- Noticeable pain when turning your foot inwards or outwards
- The pain subsides when you rest your foot
If the peroneus longus tendon is inflamed, then you may experience additional symptoms. You may notice that the arch of your foot is inflamed and that it’s accompanied by pain just in front of your heel.
The inflamed tendon can aggravate your plantar fascia, which causes it to become irritated and tight. This can often then be mistaken for plantar fasciitis, so make sure to keep an eye on the symptoms.
If left untreated, peroneal tendonitis will get worse, and it can lead to a partial or complete tear of the tendon. In some, the weakened tendons can lead to a partial dislocation—subluxation—of the tendons.
Can You Go Running With Peroneal Tendonitis?
The short answer is, no, you shouldn’t run with peroneal tendonitis!
Pain is your body’s way of saying it’s not happy about something, especially if the niggle or pain is still there 2 to 3 days later. But with peroneal tendonitis, it’s best to stop running and allow the tendons to recover for a few days.
If you try to run with peroneal tendonitis, you’ll find every step painful, or at the very least, you’ll experience discomfort. Running places enormous stress on the peroneal tendons, as a great deal of force is transferred through the tendons.
This leads to them becoming overloaded and inflamed, which aggravates the condition. If you continue to run, you’ll find that the pain worsens and that the tendons take longer to calm down between runs.
Eventually, the continuous excessive loading of the tendons will lead to tendon dysrepair, as the structure of the soft tissue changes. Aside from structural changes, if left untreated, you could develop the following:
- A complete rupture
- Chronic tendonitis
- Tendonosis
These complications often require longer recovery, which can take up to a year. So it’s best to take care of the tendons when you first notice the symptoms to avoid potential setbacks.
How Long Does Peroneal Tendonitis Take to Heal?
The recovery or healing time will vary depending on the severity of the peroneal tendonitis. If the condition is mild, it can take about two to four weeks to heal with conservative treatment.
It can take anything from 8 weeks to 1 year for severe to chronic tendonitis to fully recover. Bear in mind that this will also depend on your treatment method and your response to treatment.
Doctors often prescribe physiotherapy, a walking boot or moon boot, and cortisone injections as a last resort. Surgery may be required if one or both tendons have ruptured, which will take longer to heal.
When Can You Return to Running?
Before you lace up your shoes to go for a run, you want to make sure that it’s safe for you to return to running.
Make sure there’s no swelling around the back or side of your ankle. You should be able to move your foot up, down, and from side to side without any pain. There should be no stiffness and limited range of motion, and your ankle shouldn’t feel unstable.
Then try the following activities, and if you can do them pain-free, you’ll be ready to start running again:
- Walk or cycle briskly for 30 minutes
- Walk/jog intervals without pain or limping
- You’re able to jump and hop on the injured foot
- You can do 20 to 30 single calf raises
Home Treatment for Peroneal Tendonitis
The steps you take to treat your peroneal tendonitis can make a big difference to your recovery.
Seeing a physiotherapist is an excellent way to gain back your mobility and range of motion, but we highly recommend implementing the following home treatment steps to aid in your recovery.
Rest
The best thing you can do for your tendons is to allow them to rest. Avoid any activities that aggravate the tendons or increase your pain. Make sure to elevate your foot above your heart and try not to walk on it for the first 48 hours.
ICE
Grab an ice pack, wrap it in a towel, and place it on the affected ankle for 10 to 20 minutes at various times throughout the day. Make sure to prop your leg up so it’s above your heart, as this will help quickly reduce swelling and decrease pain.
Compression
The tendons in your feet are generally slower to heal as they don’t have blood supply. By wearing compression socks, you’ll increase the blood flow to the tendons. Not only does this help speed up the healing process, but it prevents blood and fluid from pooling in the legs.
This can help reduce the swelling and alleviate pain while the nutrient- and oxygen-rich blood helps the tendons to repair.
Contrast Baths
It’s important to note that you should only start with contrast baths 48 hours after an injury.
Fill a bucket with cold water—as cold as you can tolerate—and fill a second bucket with lukewarm water. Place your affected foot into the cold water for about 1 minute, and then place it straight into the lukewarm water for 30 seconds.
Continue to go back and forth with this process for 5 minutes, but make sure to end off with cold water. This will help decrease pain and swelling and improve your mobility by reducing muscle spasms and joint stiffness.
Use a Brace
You can wear an ankle brace to stabilize and support your ankle as you do your day-to-day activities. It will help protect the ankle from reinjury, reduce the development of scar tissue, and decrease pain.
It can also be worn as a preventative measure when crossing, training, and running if you’re prone to ankle injuries or have weak ankles.
Taping
Taping is an effective option for peroneal tendonitis as it helps offload the stress that’s placed on the tendons. It can also be applied directly to the injury, encouraging lymphatic flow, increasing blood flow, and offering stability.
The tape will help improve proprioception while supporting the ankle joint. It can also prevent you from reinjuring yourself as you complete daily activities without aggravating the tendons.
Stretch Gently
While some specific movements and activities can aggravate the tendons, others can help with the healing process. The movement from gentle stretch exercises can help reduce the pain, increase circulation, reduce stiffness, and improve your range of motion.
You can try adding the following stretches and exercises into your daily routine as your tendons heal:
- Towel stretch
- Calf stretches
- Resisted ankle eversion
- Heel raises
- Ankle flexion
Massage the Peroneal Tendons
Massaging the tendons offers several benefits, like reducing stiffness, decreasing pain and swelling, and improving your range of motion. Research has shown that a massage is effective at reducing swelling and promoting healing.
You could try one of the following massage techniques:
- Trigger Point therapy
- Sports massage
- Myofascial release
- Deep tissue massage
- Deep transverse friction massage
- Plantar foot massage
It’s important to note that you shouldn’t attempt to massage yourself or book a massage within 48 hours after the onset of tendonitis. You’ll achieve the best results when you combine massage therapy with the rest of the conservative treatments above.
Physical Therapy
Physical therapy will provide a comprehensive rehabilitation program that will help strengthen the tendons and surrounding muscles. This will help improve your range of motion to regain normal ankle mobility and prevent the condition from recurring.
Medication
You can use OTC non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain. These drugs will help reduce inflammation and alleviate pain, allowing you to continue with your daily routines.
However, be cautious not to overuse the medication, as it can be tempting to overexert yourself while feeling better.
Exercises You Can Do With Peroneal Tendonitis
Fortunately, there’s no need to stop exercising entirely while you allow your tendons to heal. The trick is to avoid activities or exercises that place stress on the tendons, and the best way to do this is by cross-training.
You can stay fit by doing the following low-impact exercises:
- Swimming, water aerobics, and aqua jogging are low-impact and help you maintain cardiovascular fitness
- Cycling on a stationary bike or getting outdoors can be a good option for building endurance and strength in the legs. As long as the set-up of your bike is right for you, then it won’t put stress on the peroneal tendons
- The elliptical machine is a great option that can help you maintain cardiovascular fitness
Go for short walks
Pay attention to how your body feels before, during, and after your workout. This will let you adjust the workouts without pushing yourself too hard during your recovery.
