Peroneal Tendon Injury and Running

Run on a ladder image by Aliaksandr Zabudzko from

Running injuries are an inherent part of the sport. According to van Mechelen in "Running Injuries: A Review of the Epidemiological Literature," 37 to 56 percent of all runners experience an annual injury. Injuries to the peroneal tendons are common running injuries that cause lateral, or outer, ankle pain and instability. By understanding the anatomy and function of the peroneal tendons as well as the nature of injuries to those tendons, runners will have the tools to recover and return to their sport.

Anatomy and Function

In "Peroneal Tendinopathy," Health Library states that the peroneus longus and peroneus brevis are two long, thin muscles that compose the lateral portion of the lower leg. These two muscles travel down the lateral leg and behind the malleolus, the bony protuberance of the lateral ankle, and insert into two different foot bones as tendons. The peroneals function as foot and ankle stabilizers, according to in "Peroneal Tendon Injury," controlling the medial-to-lateral, or side-to-side, movement of the ankle while standing, walking and running.

Peroneal Tendon Injuries and Their Causes

In "Peroneal Tendon Dislocation," the "Wheeles' Textbook of Orthopaedics" indicates that peroneal tendon injuries in runners are divided into two categories. Acute injuries are caused by a single, forceful event in which the ankle becomes inverted, or rolled to the outside, under a heavy load. This, for example, can happen when a runner lands on an uneven surface and the ankle rolls hard to the outside. Peroneal tendon subluxations, or dislocations, and tears are the typical results from these acute events.

The second type of peroneal tendon injury is that of the chronic kind, says Health Library, when the foot is repetitively, but not severely, inverted under light loads. A runner might develop a peroneal tendon injury over time if, due to some biomechanical deviation, his foot inverts just a bit upon every stance phase of running. Peroneal tendinitis, or an inflammation of the peroneal tendons, is often the result of this repetitive stress.


Runners who have dislocated or torn tendons or have developed tendinitis in the peroneal tendons report a variety of lateral ankle symptoms. Some runners complain of ankle pain, swelling, redness and tenderness around the back of the malleolus. Others report a snapping noise and sensation in the lateral ankle. Still others identify a feeling of instability, as if they are unable to control the way the foot hits or the way they push the foot off the ground during the stance phase of running.

Initial Injury Treatment

Health care professionals who have diagnosed a peroneal tendon injury use an array of treatments to help runners get back into their running shoes. To treat this injury in its acute phase, doctors and physical therapists may prescribe rest from running, icing and the immobilization of the peroneals via an air cast, brace or tape. Depending on the injury type, some health care professionals may also prescribe a non-steroidal anti-inflammatory medication. Through this initial injury treatment phase, says, health care professionals seek to decrease pain, swelling and improper movement of the peroneal tendons.

Return to Running

Once a peroneal injury is on the recovery road, health care professionals restore normal peroneus longus and peroneus brevis muscle/tendon movement and strength through massage, stretches and strengthening exercises, states "Wheeles' Textbook of Orthopaedics." At this time, health care professionals are likely to provide runners with a modified running schedule that provides for a methodical return to a normal training regimen.