Peroneal tendonitis is a more widely used term for what we should really be referring to as peroneal tendinopathy (here’s why). For the sake of this article, I’ll be referring to peroneal tendonitis, as it’s the more widely used term in the running community!
Peroneal tendonitis is an injury to the peroneal tendons of the outer lower leg, where a structural change to the tendon tissue is caused by increased loading of the tendon, and overuse of the peroneal muscles. Prolonged overloading of the tendon can cause painful irritation and thickening of the tendon tissue, and if left untreated, eventually dysrepair and breakdown.
Although swelling of the local area to the peroneal tendons may be present, this ankle tendon injury is not thought to be inflammatory in nature.
WHAT CAUSES PERONEAL TENDONITIS?
There are various different potential causes of peroneal tendonitis.
These risk factors for peroneal tendonitis include:
- Training errors (e.g. sudden increases in running distance, frequency or intensity)
- Poor footwear selection and/or running in worn-out running shoes
- Muscle imbalances around the foot, ankle and higher up the kinetic chain
- Poor foot and ankle biomechanics, or running technique
- Biomechanical compensations and weakness remaining from a previous injury, such as an ankle sprain
WHAT DOES PERONEAL TENDONITIS FEEL LIKE?
Symptoms of peroneal tendinopathy often include a progressively increasing pain on the outer aspect of the ankle, pain upon ankle inversion (turning-in) and eversion (turning-out) movements, and feelings of instability at the ankle joint upon weight-bearing.
CAN YOU RUN WITH PERONEAL TENDONITIS?
I don’t recommend running with peroneal tendonitis. You will recover from this injury more quickly with rest from running and rehabilitation exercises. If you must continue running, be sure to reduce your overall training load and stop running if your pain suddenly starts getting more severe.
While continuing to run with peroneal tendonitis is usually painful, it is also quite possible. If your tendon pain follows a predictably reactive pattern of becoming more painful after a run then settling quickly in the next 36 hours, it should be ok to run on… if you can handle the discomfort.
However, if your tendon is getting progressively more painful run after run and takes longer to calm down after each run, you need to stop to let it rest and seek further treatment. This pattern of progressive worsening may signal the start of degenerative changes occurring in the tendon, and the tissue entering a state of dysrepair.
Regardless, in both cases, your best bet is to find a running specialist physio to assess your ankle and devise a personal treatment plan for you to follow.
Dr. Christopher Segler shares some practical advice for running with peroneal tendonitis in this video, and gives his unique perspective on the question of whether you can continue to run with peroneal tendonitis:
PERONEAL TENDONITIS EXERCISES
There are of course exercises you can use to benefit your recovery from peroneal tendinopathy, both in progressively loading your tendons during the rehabilitation process, and working on the health of surrounding tissues.
These peroneal tendonitis rehab exercises include:
- Foam rolling techniques for the peroneal muscles of the lower leg
- Resistance band ankle strengthening exercises
- Weight-bearing ankle strengthening exercises
- The single-leg balance exercises from Stage 1 of our Free 30 Day Challenge
Best of luck with your recovery from this ankle injury. Whether you choose to try and run with peroneal tendonitis or opt to rest and give your ankle time to recover, be sure to listen to your body.
If in doubt, ask your physio!