Peroneal Tendinosis

Pain in the Back of Ankle

What could be my problem?

The peroneal tendons run on the outside of the ankle just behind the bone called the fibula. Tendons connect muscle to bone and allow them to extend their force across the joints that separate bones. Ligaments, on the other hand, connect bone to bone. Tendinitis implies there is inflammation in the tendon. Tendinosis means there is enlargement and thickening with swelling of the tendon. It is usually an overuse injury.

What causes Peroneal Tendinosis?

  • Improper training or rapid increases in training
  • Improper footwear
  • Hind foot varus posture (heel slightly turned inward)

When to see a foot and ankle specialist about Peroneal Tendinosis:

  • If you have pain around the back of the ankle tenderness with walking

If I have Peroneal Tendinosis, what are my treatment options?


  • Rest
  • Walking boot
  • Ankle brace
  • Custom orthotics
  • Proper footwear
  • Physical Therapy
  • Platelet-rich Plasma (PRP) therapy


If conservative treatment fails after four to six weeks, surgery may be recommended by your foot and ankle specialist.

  • An incision is made along the outside of the ankle, along with the peroneal tendons. Tendons are inspected for any tears. If less than 50% of the tendon had tears running through it, the tendon tissue usually can be sewn back together with sutures.
  • If greater than 50% of the tendon is torn or frayed then a tenodisis is performed. The damaged portion of the tendon is cut away and the remaining portion is sutured to the other peroneal tendon next to it.
  • In some cases when the tendon is dislocated the tissue that typically holds your peroneal tendons in the tunnel behind your fibula is loose.  Suturing this tissue back to itself tightens the tendon tunnel.  This helps prevent future tendon dislocations