Peroneal Tendon Injury

Peroneal Tendon Injury Overview

The peroneal tendons are two strong tendons that run along the outer side of the ankle and foot. They play a key role in stabilising the ankle, especially during walking, running, and side-to-side movement. Peroneal tendon injuries are a common cause of pain and instability on the outside of the ankle and are often underdiagnosed.

Injury may involve tendinitis (inflammation), tears (partial or complete), or subluxation/dislocation (when the tendons slip out of their normal position behind the fibula). These injuries can be acute, following trauma such as an ankle sprain, or chronic due to overuse or structural problems in the foot.

Peroneal Tendon Injury Symptoms and Diagnosis

Symptoms typically include:

• Pain and/or swelling on the outer side of the ankle

• A clicking or snapping sensation when moving the ankle

• Ankle weakness or feeling of giving way

• Tenderness behind the fibula (the bone on the outer ankle)

• Pain during or after activity, especially walking on uneven ground or pushing off the foot

In cases of tendon subluxation, patients may feel or hear the tendons popping out of place.

Diagnosis is based on clinical examination and is often confirmed with imaging:

• Ultrasound is useful for dynamic assessment and to detect tendon subluxation or tears

• MRI provides detailed information on tendon inflammation, tears, and associated ankle joint pathology

• X-rays may be used to rule out fractures or assess for associated bone abnormalities

Peroneal Tendon Injury Causes

Peroneal tendon injuries can occur due to:

• Acute ankle sprains, especially with inversion (rolling the ankle inwards)

• Repetitive overuse in running or sports requiring sudden directional change

• High-arched feet (pes cavus), which place extra stress on the tendons

• Congenital or acquired laxity of the retinaculum (the ligament that holds the tendons in place)

• Degenerative changes in the tendons over time

Poor footwear, inadequate rehabilitation of ankle injuries, or anatomical variations can also increase the risk.

Peroneal Tendon Injury Treatment and Prevention

Non-surgical treatment is often effective for mild or moderate injuries:

• Rest, ice, compression and elevation (RICE) in the early phase

• Immobilisation in a walking boot for a period of 2–6 weeks depending on severity

• Anti-inflammatory medication to reduce pain and swelling

• Physiotherapy focusing on ankle strength, proprioception, and tendon stability

• Custom orthotics or bracing to support the foot and reduce tendon strain

In cases of chronic subluxation, a retinaculum strengthening brace or taping may help stabilise the tendons.

If conservative treatment fails or the tendon is torn or unstable, surgery may be considered.

Peroneal Tendon Injury Surgery

Surgical options vary depending on the nature and severity of the injury and may include:

• Tendon debridement and repair for partial tears

• Retinaculum repair or reconstruction to stabilise the tendons

• Tendon grafting or transfer for large or chronic tears

• Groove deepening of the fibula (peroneal groove) to help contain the tendons

• Excision of low-lying muscle belly if causing crowding or irritation

Surgery is typically performed under general anaesthetic, usually as a day case procedure.

Mr Hester will discuss the specific surgical plan with you, tailored to the findings on imaging and intra-operative assessment.

Peroneal Tendon Surgery Recovery

After surgery, you will be placed in a cast or boot and instructed to rest and keep the foot elevated:

• 0–2 weeks: Non-weight-bearing in a bulky dressing or cast

• 2–6 weeks: Light cast or boot continues. Wound reviewed and sutures trimmed or removed at 2 weeks

• 6–12 weeks: Gradual return to weight-bearing in a boot. Physiotherapy begins

• 12+ weeks: Transition into supportive footwear with orthotic or ankle brace as needed

Return to high-impact sports is usually from 3–6 months, depending on tendon healing and rehabilitation progress.