Peroneal Tendinopathy and Running

By: Rebecca Schumer, MedStar Health Physical Therapy

Runners are commonly aware of tendon issues in the Achilles (back of the heel) and patella (front of the knee), but what happens when you have pain somewhere along the outer part of your lower leg and often continuing down around the outside of your ankle and onto the base of your little toe where the bone is a little more prominent? That could potentially be indicative of peroneal tendonitis or tendinopathy. “Itis” implies it’s an acute issue within the last couple of weeks, whereas when it begins to linger on longer, it becomes a “tendinopathy” issue which we treat very differently in physical therapy. It’s important to seek attention sooner than later when you start to feel these pains or discomforts, so that we can address it more quickly and hopefully prevent them from turning into a chronic issue leading to more time off your feet.

The peroneal tendons, sometimes called the fibularis tendons, are made up of two tendons, a longus and a brevis. The peroneal tendons are responsible for actively bringing your foot & ankle outward, but also work together with the tendons on the inside of the foot & ankle to provide stability to your foot & ankle when walking and running. As stated above, these tendons can get irritated with walking or running creating an inflammatory process, but it’s also possible to tear these tendons and for them to sometimes come out of the groove they are housed in. More commonly with we will see the tendon irritation issues with running and walking.

Here are some tips or things to be aware of to reduce the likelihood of injuring your peroneal tendons:

1. Wear proper shoes, see someone at Charm City Run to get fitted properly
2. Improve mobility or your ankle, best to see a Physical Therapist for this to discern why it’s tight
3. Ensure your calves aren’t too tight, try foam rolling your calves AND the outside of your lower leg
4. Work on strengthening your ankle, try balancing on one foot keeping your foot flat against the floor, not allowing it to roll inwards or outwards, try some heel raises coming up on your toes, or using a resistance band to push inward and outward with your ankle and toes
5. See a Physical Therapist for a running gait analysis to identify any other risk factors that may be contributing to your discomfort or pain

In summary, the peroneal tendons are important tendons that help provide stability to your foot & ankle when walking and running. If you start to feel pain on the outside of your lower leg, chances are it’s the beginning of a tendon irritation injury and best to try the above tips or seek out a professional opinion on the next best steps to help you get better more quickly.