Peroneal Tendinopathy and Tendonitis

Peroneal tendonitis refers to painful inflammation of the peroneal tendons located on the outer side of the foot, a little behind the ankle bump.

There are two peroneal muscles on the outer side of the lower leg. One long one, called the peroneal longus runs from the knee to the ankle, and one short one, called the peroneal brevis muscle runs from below the knee to the ankle. Both these muscles when they approach the ankle, convert into tendons, which are thick bands of fibers that connect muscle to bone. Both these tendons run side-by-side and curve behind the outer bump of the ankle, then run below the foot where they insert into the bones of the foot.

Diagram of the calf, showing the peroneus longus and peroneus brevis

As the muscle contracts, these tendons pull the lower surfaces of these bones, pulling/bending the foot downward (plantarflexion) and outward (eversion).

Eversion, outward rolling of the foot, can increase the risk of tendonitis

Causes of peroneal tendonitis:

Peroneal tendonitis relates to inflammation of one or both of these tendons. Inflammation is a defensive response of the body to any traumatic or harmful change.

The Peroneal tendons can be traumatised by;

Acute injuries such as an ankle sprain or chronic repetitive stress, as occurs in sports involving repeated ankle movement such as tennis, basketball, skiing or hiking. These sports involve side-to-side play, jumping, running/climbing on uneven surfaces, all of which put an extra load on the peroneal tendons.

Factors that increase the risk of tendonitis include:

- High foot arches
- Weak, brittle tendons (as occurs in the elderly due to age-related changes)
- Over pronation
- Excessive eversion (outward rolling) of the foot (as occurs in running on sloping surfaces)
- Tight calf muscles


- pain on the outside of ankle behind the bony prominence and at the location of the fifth metatarsal
- pain aggravates on activity and also on moving the foot downward or outward
- pain relieved with rest
- swelling and warmth in the affected area
- tendons are tender to the touch, pain can be elicited by pressing on the tendons
- calf muscles may be stiff

In older individuals, repeated stress may lead to a slow degenerative tearing of the tendons called tendonosis. The tendon wears out and becomes loose, leading to recurrent pain and instability of the ankle joint.


Diagnosis is mainly based on the basis of the physical symptoms. The doctor examines and moves the foot in different ways to check for the cause of the pain. An MRI shows swelling or tearing of tendons. X-rays are helpful to rule out any fractures in the area.

Tendons have a limited blood supply; blood is essential, not only for nutrition, but also to provide defence against infections and heal any damage caused by trauma. As tendons have a poor blood supply, their injuries take a long time to heal.


Relieving pain and swelling by:

- Avoiding stressful activities and giving the sore tendon complete rest
- Applying ice and compression
- Using anti-inflammatory drugs
- In case of persistent symptoms, steroids may be injected. However, with steroids, there is the risk of tendon rupture; therefore, physicians usually avoid using steroids.

Supporting the painful tendon by:

- Avoiding walking barefoot or in flat footwear such as slippers, loafers, etc,
- Using orthotic devices such as:

1. A heel lift; lifting the heel, decreases the stretch and thus the load on the peroneal tendons

2. A lateral heel wedge to support and lift the outer part of the heel

3. A lateral sole wedge on the inside or outside of the shoe, which decreases the outward rolling (eversion) of the foot and thus relieves the stress imposed on the peroneal tendons

In severe cases, a walking cast (fitted with a heel) may be applied for 2-4 weeks to immobilize the tendon. Surgery may be required to repair a torn tendon.

Once the symptoms ease, physiotherapy and stretching exercises help to strengthen and stabilize the ankle joint.

Orthotics that will help to treat Peroneal Tendinopathy and Tendonitis by stabilizing the foot can be found below.

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1. Measure your existing shoe insole:

 1. Measure from your heel to ball of foot:


2. Then compare your measurements from above to match the product size charts below:
(you can trim to fit the insoles by approximately 1cm)

Docpods Regular Size Guide - for Slimline, 3 Quarter, Sports

Size  cm cm cm
Small  4-7  4-8  3-6.5  4-7.5  35-40 16  16.3  25.8
Medium  7-9   8-10  6-9  7-10  39-43  17.4 17.2  27.4
Large   9-13  10-14  8-12  9-13  42-47 19.3   18.2 29.4

Docpods Ultra Size Guide - for Ultra Soft

EURO  34  35.5-37.5  38-40  40.5-42  42.5-44  44.5-46.5
UK  2.5  3-4.5  5-6.5  7-8  8.5-9.5  10-12
US MENS  4-5  5.5-6  6.5-7.5  8-9  9.5-10.5  11-13.5
US WOMENS  3.5-5  5.5-7  7.5-9  9.5-10.5  11-12  13-14
LENGTH (cm) 23.2cm 24.9cm 26.2cm 28.8cm 30cm  31.2cm

Docpods Kids Size Guide - for Docpods Kids Fit only

XXS 12-1  19.5cm 13cm 
XS 2-3 22.4cm  15.3cm 

Docpods Foot Pillow - Trim to Fit

  S L
US MENS  4.5 - 9  9 - 13
US WOMENS  6 - 10  10 - 14
LENGTH (cm) 26.5cm 29.2cm