If you’ve been recovering from Achilles tendonitis but it’s not improving, you may actually be suffering from peroneal tendonitis instead.
It’s very similar, but the pain is located in a slightly different place and radiates a bit differently as well. Try these stretches and exercises for peroneal tendonitis to see if it eases the pain and loosens up the tight tendon.
Achilles tendonitis and peroneal tendonitis are often confused with one another. Here’s how to know if your foot and ankle pain is peroneal tendonitis instead of Achilles tendonitis.
What Is Peroneal Tendonitis?
Peroneal tendonitis occurs when one or both of the peroneal tendons become inflamed. This causes pain around the outside ankle bone and side of your foot.
The two peroneal tendons—peroneus longus and peroneus brevis—are strong bands of tissue that run side by side behind the outer ankle, connecting the muscles in your lower leg to the bones in your foot.
The peroneus brevis tendon attaches on the outside of the foot just beneath your fifth toe. The other tendon—peroneus longus—runs underneath your foot, attaching near the inside of the arch of your foot.
These two tendons stabilize the ankle, help to move the foot inward and outwards, and protect the foot from injuries like sprains.
Causes of Peroneal Tendonitis
Peroneal tendonitis is most often caused by overuse, but there are several factors that contribute to the condition.
Inflammation of the peroneal tendons can develop over time, especially if you take part in sports that involve repetitive ankle motion, like running or cycling. But you can also develop the condition suddenly if you have an acute ankle injury like a sprain.
If you’ve had one too many ankle sprains, this can weaken the tendons, which can make you more prone to the condition.
A sudden increase in training, improper training, or wearing shoes that are either poorly fitting or don’t provide adequate support for your feet, can lead to peroneal tendonitis.
You may be more prone to developing the condition if you have high arches and if you supinate—also known as underpronation—as your weight is shifted to the outer edges of your feet. This places the tendons under excessive stress, leading to inflammation and pain.
Wearing the wrong shoes when you supinate can also exacerbate the condition.
Runners who run on sloped streets can develop peroneal tendonitis due to the increased friction between the tendon and the bone as your foot rolls outwards.
Tight calf muscles can increase the tension that’s placed on the tendons, leading to inflammation which causes them to rub over the bone.
Symptoms of Peroneal Tendonitis
The main symptom is a sharp pain or an achy sensation around the outer ankle bone and the outer edge of your affected foot. You may even experience pain just below your fifth metatarsal joint, where one of the tendons attaches.
If the tendon that runs underneath your foot and supports the arch is inflamed, then you may notice pain just in front of your heel, underneath your foot. The inflammation of this tendon can aggravate your plantar fascia, causing it to become tight and irritated.
If you go about your daily activities or exercise, the pain will increase and you may feel it on the outside of your lower leg where the tendon attaches to the peroneal muscles. You may even experience a burning or tingling sensation on the outside of your lower leg.
It will hurt when you turn your foot inwards and outwards. Fortunately, there won’t be any pain when you touch the tendons or while standing. The pain will also subside when you rest your foot.
You may notice swelling around your outer ankle bone and on top of your foot on the outer edge. The affected area will be warm to the touch.
Your ankle may feel weak or unstable when you’re walking and the affected area is warm to the touch.
How Can You Prevent Peroneal Tendonitis?
There are several things you can do to prevent peroneal tendonitis from developing.
First, make sure that you’re wearing shoes that support the arch of your foot. They should also have cushioning to help with shock absorption. If your shoes don’t have enough support you can also use insoles for peroneal tendonitis. If you wear open toed shoes, make sure they can support your feet – we recommend these peroneal tendonitis sandals.
Make sure that you warm up properly before your exercise and that you spend time stretching your calves and peroneal muscles.
You’ll also have to include stretching and strengthening exercises into your workout routine.
Gradually increase your training load and intensity, as this will allow the tendons time to adapt to the exercise.
If you do run, avoid running on sloped or uneven surfaces and avoid making any quick, pivoting movements.
Don’t return to exercise too soon if you’ve injured your ankle and allow for rest time between each workout.
If you’ve sprained or injured your ankles multiple times, then you may want to look into using ankle braces to help support your ankle.
How Long Does Recovery Take?
Peroneal tendonitis generally takes between 6 to 8 weeks to heal. But if you return to physical activity too early while the tendon is healing, then it could take several weeks to a few months to heal.
Depending on the severity of tendonitis, you may have to keep your weight off of the affected foot, allowing the peroneal tendon time to recover.
How to Treat Peroneal Tendonitis
The first step to treating peroneal tendonitis is to stabilize the ankle and avoid weight-bearing activities.
You’ll have to cut back on your physical activities that could aggravate the tendons, as well as avoid walking on the foot until the inflammation and pain subsides.
Depending on the severity of the peroneal tendonitis you may have to wear a walking boot, splint, or ankle brace. This will decrease the movement of the ankle. You’ll be taking the tension off the tendons and this will allow them to heal faster.
Rest your foot as much as possible, making sure that you keep your foot elevated, preferably above the level of your heart.
You can also apply an ice pack to the affected area for 20 minutes every 2 to 3 hours. This will help reduce the swelling and alleviate the pain.
You can also apply a compression bandage to the foot and ankle to help reduce the swelling.
Your doctor may recommend physical therapy so that you can regain strength and flexibility in your foot and ankle.
Your therapist may apply kinesiology tape to provide additional support and stability to your foot and ankle, while alleviating some of the discomfort from the tendonitis.
The physical therapist will also guide you and give you stretches and exercises to do that can prevent tendonitis from recurring.
To help alleviate pain, reduce swelling, and promote recovery, you can take anti-inflammatory medication, like ibuprofen, Advil, naproxen, and Aleve.
You may have to make some lifestyle adjustments, like wearing a brace for certain activities, especially if they involve repetitive ankle motion.
For additional support and to help decrease the tension on the peroneal tendons, use orthotics.
Exercises to Help You With Peroneal Tendonitis
Once the pain and swelling have subsided, you can incorporate stretches and exercises to help improve your range of motion and increase strength and flexibility.
1. Towel Stretch
This exercise helps to stretch the muscles of the calf and foot, which can reduce the tension that’s placed on the peroneal tendons.
Start by sitting on the floor with your legs stretched out in front of you.
Then wrap a towel around your toes, pulling the towel back towards you until you feel the stretch in the bottom of your foot and lower leg.
Hold the stretch for 30 seconds and repeat the exercise 3 times.
2. Standing Soleus Stretch
This stretch will help release tension in the often very tight soleus muscle on the side and lower part of the calf.
Stand a few feet away from a wall while you’re facing the wall.
Then take a step forward and bring your uninjured leg forward towards the wall, while keeping the leg that’s affected by the tendonitis back with your heels flat on the floor.
Turn your injured foot so that it points slightly inward towards your other foot.
Keeping your weight evenly distributed on both feet with your heels on the ground, slowly bend your knees and lean into the wall.
You should feel a stretch in the back leg, just above the heel.
Hold the stretch for 30 seconds and repeat three times.
3. Standing Calf Stretch
This stretch will target the entire calf muscle and help to release any stiffness and tension.
Start by placing your palms on the wall making sure that you’re standing at an arm’s length away from the wall.
Your hands should be shoulder-width apart.
Then extend your injured leg behind you and keep your heel on the ground. Keep the uninjured leg closer to the wall, bending slightly at the knee.
Gently push your hips towards the wall as you lean in, until you feel the stretch in the calf of your extended leg.
Hold this stretch for 30 seconds, then change sides. Repeat this stretch 3 times on each leg.
If you want a deeper stretch, just move your foot further back on the leg that you’re extending behind you.
4. Eversion and Inversion
This exercise will help you to maintain flexibility in the ankle. You should only do this exercise if the pain and swelling have subsided.
If you’re unsure, then check with your physical therapist before doing it, as they can advise if you need to look at an alternative.
Start by sitting on a chair and taking the injured leg and crossing it over your other knee.
Then hold the bottom of your foot with your hand and slowly tilt the sole of your foot towards the floor. Hold this position for 5 to 10 seconds.
Now tilt your foot towards the ceiling and hold that position for 5 to 10 seconds.
Repeat this movement 10 times.
5. Heel Raises
Stand behind a countertop, table, or chair and hold onto it so that you can maintain your balance when you first start this exercise.
Start the movement with both feet flat on the floor and then gently rise up onto your toes. Hold this position for 5 to 10 seconds before gently lowering yourself down.
Repeat this movement 15 times for 3 sets with 30 to 60 seconds of rest between each set.
6. Plantar Fascia Stretch
For this stretch, you’re going to need either a small to medium-sized foam roller or a tennis ball.
Start this exercise by sitting in the chair and placing the foam roller or tennis ball under the ball of your foot.
Gently apply comfortable pressure to the foam roller or tennis ball with your foot and then roll your foot back and forth for 1 minute.
Then take your leg and cross it over the other leg. Hold your big toe in your hand and then pull it towards your shin.
You should feel a stretch underneath your foot between your heel and the ball of your foot. Hold this stretch for 30 to 45 seconds.
Then switch your legs and repeat this movement on your other foot.
You should only do this exercise 2 to 3 times on each foot.
7. Ankle Flexion
For this exercise, you’re going to need a resistance band. It’s advisable that you start on the lightest resistance band and increase the tension as needed.
Start by sitting upright on the floor and place the resistance band around the ball of the foot of the injured leg. Then extend the leg out in front of you.
Point the toes on the extended leg away from the body, then slowly flex the ankle by pulling the toes toward the shin.
Repeat the movement up to 10 times on each foot.
Tips for Stretching the Peroneal Tendons
Stretching your foot and calf muscles may help decrease your pain and improve healing of a peroneal tendon injury.
You should always start your stretching program slowly and gently, and avoid doing any movements that aggravate your ankle or make it feel unstable.
Stay consistent with your stretching program and try to increase the duration that you hold the stretches for.
Make sure that you warm up properly before you start with any form of exercise. If you feel pain in the outside of the foot or outside of the ankle, stop immediately.