Peroneal tendonitis is one of the sneakiest running related injuries out there. Every runner knows somebody who’s had it (maybe that somebody is you), but it’s not one of the famous show dogs like runner’s knee or Achilles tendonitis. That being said, Peroneal tendon pain nags runners like us all over the world. Today we’re going to explain the causes then show you the three best exercises for Peroneal Tendonitis in runners.
(image adapted from foothealthfacts.org)
What causes peroneal tendonitis?
The peroneal muscles and tendons position the foot during the running stride and work with the larger muscles of the lower leg to power the runner forward. Interestingly enough, very little research has been done on peroneal tendon pain (here’s one study), so most of our recommendations today are extrapolations from what the scientific community learned about other forms of tendonitis / tendinopathy in the last 10 years. Whether you feel the soreness on the outside of your ankle or further down along the outside of your foot, the cause of peroneal tendonitis is probably simple. You likely ran a bit more than the tendon was ready for. That could mean more mileage, more speed, too little time between hard workouts. It could mean not enough sleep or too little food / nutrients. It could also just be a freak thing. When you run a lot, 
happens!
BUT DO NOT FEAR, like most running injuries, you can probably treat peroneal tendonitis at home with a few simple exercises.
Just so you know, if you google Peroneal Tendonitis, you’ll find a bunch of outdated recommendations to ice and stretch (Runner’s World medical content is often about 20 years out of date FYI).
- Research on icing is limited and mostly in rats, but the evidence suggests it may actually slow healing down slightly (study)
- Stretching doesn’t really do anything to tendons (review) so at this time there isn’t any good reason to tell an athlete with tendonitis to stretch.
So, if icing doesn’t work and stretching does nothing, what’s left? You guessed it! Strengthening!!
The best way to get rid of peroneal tendonitis is to encourage the tendon to heal itself through exercise therapy and increase the amount of load the tendon and your legs can tolerate overall.
What’s happening inside the tendon?
When you put a bit too much load through a tendon, it freaks. The normally neat and orderly strands of collagen become disorganized and the whole thing thickens up. Basically, the body does this to quickly reinforce everything to avoid a serious problem like a tear. The way to get it back on track is to introduce the correct amount of load. This tells the body that things are OK and basically guide it back to a pattern of laying down new strands of orderly, healthy collagen.
Before we start, we want to be super clear. If you’re experiencing pain along a bone such as one of the bones of your forefoot, it’s ALWAYS a good move to rule out a bone stress injury. If it hurts to hop on one foot or it hurts to press down on the bone, we suggest you see a doctor to be safe. They can do an X-ray and rule out a more serious issue extremely quickly.
The best exercises for peroneal tendonitis
Heavy loading is usually the right way to retrain a frustrated tendon while prioritizing athlete satisfaction (review). The first exercise we’re about to show you loads the peroneal tendons and associated muscles directly, so it is the most important. To our knowledge, no study has been done comparing different forms of exercise therapy for peroneal tendonitis in runners, but when they do that study, it is highly likely this will be one of the first exercises they test.
Perform these exercises 3 times per week. The load should be heavy enough that it is challenging to complete 10 reps. 3 sets of 10 reps of each exercise is a good place to start
Exercise 1: Ankle Eversions with Resistance band
This exercise loads the peroneal tendon most effectively. Be sure to move using the muscles of the ankle, not by just rotating your knee. You should feel it on the outside of your lower leg and will likely feel load through the peroneal tendons.
Exercise 2: Ankle Inversions with Resistance Bands
This exercise strengthens the muscles on the other side of the leg. Since both sets of these small muscles work together, strength in both is critical.
Exercise 3: Weighted calf raises
Expanding the strength of your lower leg is the best way to prevent problems like Peroneal Tendonitis from showing up in the future. This is the best exercise to expand the strength of your lower leg. Simple, but extremely effective.
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