Lateral Ankle Pain and Peroneal Tendon Tears: Causes, Symptoms, and Treatment Options

Peroneal tendon pain and tears are common yet often overlooked causes of ankle discomfort and instability. These injuries can significantly affect mobility and quality of life, particularly among active individuals and those with certain foot structures. Understanding the causes, symptoms, and treatment options can help you recognize the problem early and choose the best path to recovery.

Ankle anatomy highlighting peroneal tendons

What Are Peroneal Tendons and Why Are They Important?

The peroneal tendons run along the outside of the ankle and foot. They connect the muscles of the lower leg to the bones of the foot and help stabilize the ankle during movement. These tendons play a key role in:

• Preventing the ankle from rolling inward (inversion)

• Supporting the arch of the foot

• Allowing smooth side-to-side foot motion

  
  

Because of their location and function, the peroneal tendons are vulnerable to injury, particularly in individuals with ankle instability, recurrent ankle sprains, or high-arched feet.

Causes of Peroneal Tendon Pain and Tears

Peroneal tendon problems usually develop from a combination of factors rather than a single event. Common causes include:

• Repeated ankle sprains: Each sprain can stretch or weaken the tendons, leading to inflammation or tears over time.

• Ankle instability: When the ankle is unstable, the peroneal tendons work harder to maintain joint stability, increasing the risk of injury.

• High-arched feet (pes cavus): This foot shape places increased tension on the tendons, making them more susceptible to irritation and tears.

• Sudden trauma: A sharp twist or direct blow to the ankle can cause acute tendon tears.

• Overuse: Activities that involve frequent running, jumping, or uneven surfaces can strain the tendons.

• Anatomical variations: Some individuals have a shallow groove behind the fibula, where the tendons pass, which can cause the tendons to slip out of place and become damaged.

  
  

Crushing of the Peroneus brevis by the peroneus longus against the fibula.

Recognizing Symptoms of Peroneal Tendon Injuries

Symptoms can vary depending on the severity of the tendon damage, but often include:

• Pain along the outside of the ankle, especially during or after activity

• Swelling and tenderness near the tendons

• A feeling of instability or weakness in the ankle

• A popping or snapping sensation during injury or movement

• Difficulty walking or bearing weight on the affected foot

• Stiffness or limited range of motion in the ankle

  
  

If symptoms persist for more than a few days or worsen, it is important to seek medical evaluation to prevent further damage.

How Peroneal Tendon Problems Link to Ankle Instability and Repeated Sprains

Ankle instability often results from weakened ligaments after multiple sprains. This instability forces the peroneal tendons to compensate by increasing their effort to stabilize the ankle. Over time, this additional strain can lead to inflammation, tendinopathy, or tears.

Repeated ankle sprains also directly injure the tendons by overstretching or partially tearing them. Without proper healing, the tendons become weaker and more prone to further injury, creating a cycle of pain and instability.

People with high-arched feet experience increased tension on the peroneal tendons because their foot shape reduces shock absorption and alters normal foot mechanics. This tension can cause chronic irritation and increase the risk of tears.

Diagnosing Peroneal Tendon Injuries

A healthcare provider typically begins with a physical examination, assessing for tenderness, swelling, and ankle stability. They may ask about your history of ankle injuries and foot shape.

Imaging tests often help confirm the diagnosis:

• X-rays: Rule out bone fractures or other bone problems. - Search for the presence of an enlarged peroneal tubercle, which could contribute to tendon irritation and tearing.

• Ultrasound: Shows tendon inflammation or tears in real time.

• MRI: Provides detailed images of soft tissues, including the extent of tendon damage.

  
  

Early diagnosis is key to preventing further injury and selecting the appropriate treatment.

Conservative Treatment Options

Many peroneal tendon injuries respond well to non-surgical treatments, particularly when detected early. Conservative options include:

• Rest and activity modification: Avoid activities that cause pain or strain on the ankle.

• Ice therapy: Applying ice reduces swelling and pain.

• Compression and elevation: Helps control inflammation.

• Physical therapy: Focuses on strengthening the peroneal muscles, improving ankle stability, and restoring range of motion.

• Orthotics: Custom shoe inserts can support the arch and reduce tendon strain, especially for high-arched feet.

• Anti-inflammatory medications: Over-the-counter drugs such as ibuprofen can reduce pain and swelling.

• Immobilization: Walking boot or ankle brace immobilization.

  
  

Conservative treatment typically lasts several weeks to several months, depending on the severity of the injury. Regular follow-up facilitates progress monitoring and therapy adjustments.

When Surgery Becomes Necessary

Surgery may be needed if:

• The tendon tear is large or complete

• Conservative treatment fails to relieve symptoms after several months

• There is persistent ankle instability or tendon subluxation (slipping out of place)

• The tendon is severely degenerated or damaged

  
  

Surgical options vary but often involve:

• Repairing or stitching torn tendons

• Removing damaged tendon tissue

• Deepening the groove behind the fibula to prevent tendon slipping

• Stabilizing the ankle ligaments if instability is present

• Removing enlarged or low-hanging muscle bellies, which could increase impingement

• Tendon re-enforcement or transfer

  
  

Recovery from surgery includes immobilization followed by physical therapy. Full healing can take several months, but surgery often restores function and reduces pain effectively.

Preventing Peroneal Tendon Injuries

You can reduce the risk of peroneal tendon problems by:

• Strengthening ankle muscles with targeted exercises

• Wearing supportive footwear, especially if you have high arches

• Using ankle braces during high-risk activities or sports

• Avoiding uneven surfaces or sudden changes in activity intensity

• Treating ankle sprains promptly and fully before returning to activity

  
  

Early attention to ankle pain and instability helps prevent chronic tendon damage.

If you have been experiencing lateral ankle pain, call us at 832-743-0508 to schedule an appointment. Or visit us at www.SelectFAS.com to schedule online.