Pain along the outside of your ankle can make walking, running, standing, and participating in sports uncomfortable. One possible cause is peroneal tendinopathy, a condition affecting the tendons that run along the outer side of your ankle and foot.
These tendons help stabilise your ankle, support foot movement, and maintain balance when walking on uneven surfaces. Repetitive activities, sudden increases in exercise, or previous ankle injuries can contribute to tendon irritation and pain.
Some people experience discomfort only during physical activity, while others notice swelling, tenderness, or weakness around the outside of the ankle.
In this guide, we explore seven helpful tips for managing peroneal tendinopathy, understanding the recovery process, and how physiotherapy may support ankle rehabilitation.
What Is Peroneal Tendinopathy?
Peroneal tendinopathy is a condition involving irritation or changes within one or both peroneal tendons.
There are two main peroneal tendons:
Peroneus longus: Runs behind the outer ankle bone and underneath the foot, helping with foot stability and movement.
Peroneus brevis: Runs behind the outer ankle bone and attaches to the outside of the foot, helping move the foot outward.
Together, these tendons help stabilise the ankle and control foot movement during activities such as walking, running, and balancing.
Peroneal tendon problems may develop due to repeated loading, sudden increases in physical activity, or an ankle injury.
Common contributing factors include:
Previous ankle sprains.
Repeated running or jumping activities.
Walking or exercising on uneven surfaces.
Sudden increases in training intensity.
Inadequate recovery between workouts.
Unsupportive footwear.
Certain foot shapes or movement patterns.
Peroneal tendinopathy is different from an ordinary ankle sprain, although both conditions can occur together.
Common Symptoms of Peroneal Tendinopathy
Symptoms may develop gradually or appear following an ankle injury.
Common signs include:
Outer ankle pain: Discomfort behind or below the outer ankle bone.
Swelling: Puffiness or swelling along the affected tendon.
Tenderness: Pain when pressing around the outside of the ankle.
Activity-related discomfort: Pain that increases during walking, running, or exercise.
Ankle weakness: Difficulty controlling the foot during certain movements.
Balance difficulties: Reduced confidence when standing on one leg or walking on uneven ground.
Pain during foot movement: Discomfort when turning the foot outward or inward.
Symptoms may improve with rest but return when the tendon is loaded again.
Persistent pain, snapping sensations, or a feeling that the ankle is giving way should be assessed because these symptoms may indicate a more significant tendon problem.
7 Helpful Tips for Managing Peroneal Tendinopathy
The following strategies may help manage symptoms and support tendon recovery. The right approach depends on the severity of the condition and your individual assessment.
1. Reduce Activities That Aggravate Ankle Pain
Repeatedly loading an irritated tendon without allowing adequate recovery may increase discomfort.
If running, jumping, or prolonged walking makes your ankle hurt, consider temporarily reducing the intensity or duration of these activities.
You may find it helpful to:
Reduce running distance when symptoms increase.
Avoid repeated jumping during painful periods.
Limit activities on uneven surfaces.
Take breaks during prolonged walking.
Avoid pushing through worsening ankle pain.
You do not necessarily need to stop all physical activity. Lower-impact activities, such as swimming or comfortable cycling, may be suitable alternatives if they do not aggravate your symptoms.
The aim is to manage tendon loading rather than completely avoid movement.
2. Choose Supportive Footwear
Footwear can influence how pressure is distributed through your feet and ankles.
Shoes that provide insufficient support may increase discomfort during walking or exercise, particularly when the ankle is already irritated.
Consider choosing footwear that offers:
A comfortable and secure fit.
Adequate cushioning.
Suitable support around the heel.
A stable sole for everyday walking.
Enough space for your toes.
Avoid footwear that consistently increases your ankle discomfort, including worn-out shoes or very unsupportive sandals.
If you have persistent symptoms, a podiatrist or qualified healthcare professional can help assess whether particular footwear or orthotic support may be appropriate.
3. Manage Pain and Swelling
If your ankle becomes painful or swollen after activity, temporarily reducing the load may help settle symptoms.
You can consider:
Resting from activities that aggravate the tendon.
Elevating your foot when comfortable.
Applying a wrapped cold pack for short periods.
Using comfortable footwear while walking.
Avoiding unnecessary pressure around the affected area.
If using a cold pack, wrap it in a towel and apply it for up to 20 minutes. Never place ice directly against your skin.
Compression or an ankle support may be suitable for some people, but it should not be too tight or cause additional discomfort.
If swelling is significant, symptoms develop suddenly, or you have difficulty bearing weight, seek medical assessment.
4. Maintain Comfortable Ankle Movement
Avoiding all ankle movement for long periods may contribute to stiffness and reduced function.
When comfortable, gentle movement can help maintain mobility while you recover.
Depending on your symptoms, you may try:
Gentle ankle circles.
Comfortable ankle movements up and down.
Controlled foot movements within a pain-free range.
Short walks on level surfaces if tolerated.
Regular changes in position during prolonged sitting.
Avoid forcing movements that produce sharp pain or increase swelling.
If movement is significantly restricted, a healthcare professional can assess whether additional treatment or temporary support is necessary.
5. Gradually Rebuild Ankle and Foot Strength
Strengthening exercises are an important part of many tendon rehabilitation programmes.
The peroneal muscles help control foot movement and support ankle stability. Gradually rebuilding their strength may improve your ability to manage everyday and sporting activities.
Depending on your assessment, exercises may include:
Gentle resisted ankle eversion.
Controlled calf raises.
Foot and ankle strengthening exercises.
Balance exercises.
Single-leg stability training.
Start with exercises appropriate to your current strength and symptoms.
Avoid suddenly increasing resistance, repetitions, or training duration. If an exercise causes significant pain or symptoms remain worse afterwards, reduce the load and seek professional guidance.
6. Consider Individualised Physiotherapy
Physiotherapy may help manage peroneal tendinopathy by addressing pain, strength limitations, movement difficulties, and activity-related problems.
An assessment may examine:
Ankle and foot movement.
Peroneal muscle strength.
Tenderness around the affected tendons.
Walking and balance.
Footwear and activity habits.
Previous ankle injuries.
Based on the findings, your physiotherapist may recommend:
Progressive ankle strengthening.
Appropriate mobility exercises.
Balance and stability training.
Advice on modifying physical activities.
Guidance on gradually increasing walking or running.
A structured return-to-sport programme.
For example, someone who experiences outer ankle pain while running may benefit from temporarily reducing running volume and gradually rebuilding ankle strength and exercise tolerance.
Physiotherapy cannot guarantee that every tendon injury will resolve without additional treatment. Significant tendon tears or persistent symptoms may require further medical assessment.
At PAX Physiotherapy in Modbury North, you can enquire about available physiotherapy and exercise rehabilitation services to discuss whether an assessment may be suitable for your ankle-related concerns.
7. Return to Exercise Gradually
Returning to intense exercise too quickly may overload the recovering tendon.
Before increasing your activity, consider whether you can:
Walk comfortably on level ground.
Move your ankle without significant discomfort.
Perform appropriate strengthening exercises.
Maintain balance during suitable activities.
Complete everyday activities without worsening symptoms.
When returning to running or sport, begin with manageable activity levels and increase them gradually.
Pay attention to how your ankle responds during exercise and over the following day. If pain or swelling increases significantly, reduce the training load and consider reassessment.
A gradual return-to-activity plan can help you rebuild confidence and physical capacity.
How Is Peroneal Tendinopathy Diagnosed?
A healthcare professional will usually begin by discussing your symptoms, medical history, previous ankle injuries, and daily activities.
A physical examination may include:
Checking ankle and foot movement.
Assessing tenderness along the peroneal tendons.
Testing foot strength.
Examining balance and walking.
Assessing movements that reproduce your symptoms.
In many cases, the diagnosis can be made through clinical assessment.
However, imaging may be recommended when the diagnosis is uncertain or a tendon tear or another injury is suspected.
Possible investigations include:
Ultrasound: Can help examine the tendon structure and identify certain tendon abnormalities.
MRI: May provide more detailed information about tendon damage and surrounding structures.
X-ray: May be recommended to investigate possible bone injuries or other structural problems.
Not everyone requires imaging. The appropriate investigation depends on the symptoms and examination findings.
How Can Physiotherapy Help With Peroneal Tendinopathy?
Physiotherapy may support recovery by helping improve ankle movement, muscle strength, balance, and tolerance for everyday activities.
The rehabilitation programme is generally adjusted according to the condition’s severity and your progress.
Pain and Activity Management
The initial focus may include:
Identifying activities that aggravate symptoms.
Adjusting walking and exercise levels.
Maintaining comfortable ankle movement.
Providing advice on suitable activity modifications.
Strength and Stability Rehabilitation
As symptoms allow, rehabilitation may gradually introduce:
Peroneal muscle strengthening.
Calf strengthening.
Foot and ankle control exercises.
Balance training.
Functional movement exercises.
Return to Everyday Activities and Sports
The later stages may focus on improving your ability to walk longer distances, exercise, and participate in sports.
Your physiotherapist can help monitor your progress and adjust exercise intensity when necessary.
The goal is to improve ankle function and help you return to your preferred activities safely.
Can Peroneal Tendinopathy Heal Without Surgery?
Many people with peroneal tendinopathy initially receive non-surgical treatment.
Depending on the condition, this may include:
Modifying activities that aggravate symptoms.
Wearing comfortable, supportive footwear.
Following an appropriate strengthening programme.
Using temporary ankle support when recommended.
Receiving physiotherapy.
Allowing adequate recovery between demanding activities.
If symptoms remain significant despite appropriate conservative management, further investigation may be needed.
Surgery may be considered in selected cases involving substantial tendon damage, persistent symptoms, or other structural problems.
A specialist can explain the available treatment options based on the examination and imaging findings.
How Long Does Peroneal Tendinopathy Take to Improve?
Recovery time varies depending on the severity of tendon involvement, how long symptoms have been present, and how the tendon responds to rehabilitation.
Some people notice improvement within several weeks, while others may require several months.
Factors that may influence recovery include:
The extent of tendon irritation or damage.
Previous ankle injuries.
Daily walking and standing requirements.
Exercise intensity.
Footwear and activity habits.
Consistency with an appropriate rehabilitation programme.
It is important to remember that pain improvement does not always mean the tendon has regained its previous strength and capacity.
Gradually rebuilding strength and activity tolerance is an important part of recovery.
If symptoms continue, worsen, or repeatedly return, seek further assessment.
Frequently Asked Questions About Peroneal Tendinopathy
1. What does peroneal tendinopathy feel like?
It commonly causes pain or tenderness along the outside of the ankle, particularly behind or below the outer ankle bone. Some people also experience swelling, weakness, or discomfort during walking and exercise.
2. Can walking make peroneal tendinopathy worse?
Prolonged walking may aggravate symptoms, especially when the tendon is already irritated. Adjust your walking distance according to your comfort and gradually increase activity as your symptoms improve.
3. Is peroneal tendinopathy the same as an ankle sprain?
No. An ankle sprain involves injury to one or more ligaments, while peroneal tendinopathy affects the tendons along the outside of the ankle. Both conditions can sometimes occur following the same ankle injury.
4. Can physiotherapy help with peroneal tendinopathy?
Yes. Physiotherapy may help improve ankle strength, movement, balance, and activity tolerance through an individualised rehabilitation programme.
5. Should I exercise with peroneal tendinopathy?
Suitable exercise may help maintain movement and gradually rebuild tendon capacity. However, activities that significantly increase pain or swelling should be modified. A healthcare professional can guide you on appropriate exercises.
6. Does peroneal tendinopathy require surgery?
Most people initially receive non-surgical management. Surgery may be considered when there is significant tendon damage or symptoms do not improve with appropriate conservative treatment.
7. When should I see a doctor for outer ankle pain?
Seek medical advice if ankle pain persists, swelling develops, or walking becomes difficult. Seek prompt assessment if you experience sudden severe pain, a snapping sensation, significant swelling, or an inability to bear weight.
Get Support for Outer Ankle Pain at PAX Physiotherapy
Outer ankle pain can affect your walking, exercise routine, sports participation, and everyday activities. Understanding the possible cause of your discomfort is an important step towards choosing suitable treatment.
If you are experiencing persistent ankle pain, swelling, or difficulty with movement, consider seeking professional assessment to identify the cause and discuss appropriate rehabilitation options.
PAX Physiotherapy in Modbury North offers physiotherapy and exercise rehabilitation services for suitable musculoskeletal conditions. Contact the clinic to discuss available services and appointment options.
PAX Physiotherapy
Address: Unit 2, 438 Montague Road, Modbury North SA 5092
Phone: 08 8333 8333
Mobile: 0499 999 636
Email: admin@paxphysiotherapy.com.au
Medical Disclaimer
This article provides general educational information and is not a substitute for professional medical advice, diagnosis, or treatment. Outer ankle pain can have several causes, including tendon injuries, ligament injuries, and fractures. Consult a qualified healthcare professional for an assessment, particularly if you experience severe pain, significant swelling, a snapping sensation, or difficulty bearing weight.
