Outer Ankle Tendon Pain (Peroneal Tendinopathy): Symptoms, Causes & PT Treatment
Updated October 20261 minute read
Peroneal tendinopathy is irritation of the tendons that run behind and below the bony bump on the outside of your ankle. It causes pain along the outer ankle, often after an ankle sprain or a spike in activity. It's not serious and responds well to progressive strengthening and load management. A sudden snapping sensation or a feeling of the tendon "flicking" over the bone deserves a closer look.
What is peroneal tendinopathy?
The peroneal tendons stabilize the outer ankle and help turn the foot outward. Overload irritates them, especially after sprains that strain the same area.
Symptoms
Common features are pain and tenderness along the outer ankle (behind/below the bony bump), worse with activity, walking on uneven ground, or turning the foot. Some people notice swelling along the tendon.
What causes it / risk factors
A prior ankle sprain, a sudden increase in activity, running on uneven surfaces, and ankle instability contribute.
How it's diagnosed
Diagnosis is clinical from the location and aggravating activities, sometimes supported by imaging in unclear cases.
Physical therapy treatment
What a PT does. Your therapist offloads the tendons, restores ankle strength and balance, and addresses any underlying instability. Exercises & progression (overview). Progressive peroneal and ankle strengthening, balance work, and graded return to activity. Recovery timeline. Many cases improve over several weeks to a few months.
Treatment options compared
PT and load management are first-line. Bracing may help instability-related cases; surgery is uncommon.
Red flags
Seek care for a snapping/dislocating sensation of the tendon, inability to bear weight, or a hot feverish joint.
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Frequently asked questions
The peroneal tendons run through the area injured in a sprain and can stay irritated.
Sources (5)
- Roster B, et al. Peroneal Tendon Disorders. Clin Sports Med. 2015. — PubMed
- van Dijk PAD, et al. Chronic Disorders of the Peroneal Tendons: Current Concepts Review of the Literature. J Am Acad Orthop Surg. 2019. — PubMed
- Vuurberg G, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018. — BJSM
- Doherty C, et al. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med. 2017. — BJSM
- MedlinePlus. Ankle injuries and disorders. — MedlinePlus
This article is for education only and isn't medical advice. Always talk to a licensed clinician about your specific situation.