MSK Peroneal tendinopathy (lateral ankle pain)

Peroneal tendinopathy should be suspected when a patient presents with chronic lateral ankle pain. Ankle sprains are common and 40% will go on to develop chronic ankle pain including peroneal tendinopathy.

The peroneal muscle group are the primary evertors and plantar flexors of the foot and function as lateral ankle stabilisers. The patient may give a history of ankle inversion injuries or lateral ankle instability. The pain or swelling is commonly posterior to the lateral malleolus and may follow the course of the tendon extending distally into the lateral plantar midfoot, pain is elicited with inversion of the foot.

Patients may correlate pain with rising onto the ball of the foot and onset of pain after periods of rest. Pain is commonly of gradual onset and progressively worsens. Common contributing factors of peroneal tendinopathy include sudden increase in physical activity, unsupportive footwear, history of ankle sprains/trauma, being overweight, and running on uneven surfaces.

Who to refer, who not to refer, how to refer

Who to refer:

Anyone regardless of age with lateral ankle pain if self-management measures have failed.

Who not to refer:

Patients who are undergoing ongoing management for this condition with another service.

How to Refer:

Refer via SCI Gateway or ask patient to complete self-referral form here: podiatry-self-referral.docx (live.com)

Primary care management

General Advice

If pain is caused by traumatic ankle inversion provide information on RICE. If considered appropriate, consider referral for x-ray.
Provide patient leaflet – Rehabilitation for ankle sprains
Activity modification to manage symptoms
Consider pain relief
Footwear advice: Changing Footwear to comfortable running style trainers/ shoe or hiking boots with a slight increase at heel height compared to toes will provide the best support for the peroneals. A wide base of support (wide sole unit) or high-collar boots, can help to avoid further ankle inversion injuries whilst the ankle is less stable than usual.
If no improvement in pain after following advice for 6 weeks, or recurrent ankle sprains occur refer to for advice, or refer to orthotics for insoles or ankle bracing.

Resources and links

National and local websites for further information

For patients:

NHS Borders patient information leaflet: Peroneal Tendinopathy: Patient Information Leaflet: Peroneal Tendinopathy

For Health professionals:

Some damaged to the peroneal muscles can take the form of a traumatic injury, the NHS Inform ankle sprain page provides information on this: Ankle sprain | NHS inform

Local service details

Podiatryadmin@borders.scot.nhs.uk

Last reviewed: 29/05/2024

Next review date: 29/05/2026

Author(s): Laura Bolan.

Author email(s): laura.bolan3@nhs.scot.