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Peroneal Tendon Injury

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The peroneal tendons run along the outer side of the ankle and play a key role in stabilising the ankle during walking, running, and side-to-side movement. Peroneal tendon injuries are a common — and often underdiagnosed — cause of outer ankle pain and instability.

Types of Injury

• Tendinitis: Inflammation of the tendon from overuse
• Partial or complete tears: Often following ankle sprains or chronic overuse
• Subluxation or dislocation: The tendons slip out of their groove behind the fibula

Symptoms

• Pain and/or swelling on the outer side of the ankle
• A clicking or snapping sensation when moving the ankle
• Ankle weakness or giving way
• Tenderness behind the fibula
• In subluxation: a feeling of the tendon popping out of place

Diagnosis

Clinical examination confirmed with ultrasound (especially useful for dynamic assessment and detecting subluxation) or MRI for detailed assessment of tears and joint pathology.

Causes

• Acute ankle sprains — especially inversion injuries
• Repetitive overuse in running or sports requiring directional change
• High-arched feet (pes cavus) placing extra stress on the tendons
• Laxity of the retinaculum (ligament holding tendons in place)
• Degenerative changes over time

Non-Surgical Treatment

• Rest, ice, compression, and elevation (RICE) in acute phase
• Immobilisation in a walking boot for 2–6 weeks
• Anti-inflammatory medication
• Physiotherapy for ankle strength, proprioception, and tendon stability
• Custom orthotics or bracing

Surgery

If conservative treatment fails or the tendon is torn or unstable, surgical options 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
• Peroneal groove deepening to better contain the tendons

Recovery

Timeframe	What to Expect
0–2 weeks	Non-weight-bearing. Bulky dressing or cast.
2–6 weeks	Boot continues. Wound review at 2 weeks.
6–12 weeks	Gradual weight-bearing in boot. Physiotherapy begins.
3–6 months	Return to high-impact sport, depending on healing.