Ankle
Peroneal Tendon Pathology
About Your Condition
The peroneal tendons run behind the outer ankle bone and down the outer side of the foot, responsible for turning the foot outward and providing stability to the outer ankle. Peroneal tendon tears and subluxation are commonly associated with lateral ankle sprains or chronic ankle instability. Problems fall into two main categories: peroneal tendon tears — longitudinal splits or tears within the substance of the tendon, most commonly affecting peroneus brevis, causing persistent outer ankle pain, swelling, and weakness — and peroneal tendon subluxation, where the tendons slip out of their groove behind the fibula, often snapping in and out, causing a snapping sensation at the outer ankle.
An MRI scan is typically used to confirm the diagnosis, assess the extent of any tendon tears, and plan treatment. Foot shape is also an important consideration — a cavus (high-arched) foot increases load through the outer border of the foot and places excessive stress on the peroneal tendons. If a cavus foot is contributing, non-operative management alone is unlikely to resolve symptoms, as the underlying mechanical cause remains uncorrected.
Non-Operative Management
Many patients respond to non-operative measures, particularly in the earlier stages.
Bracing and Footwear
- An ankle brace or lace-up support reduces mechanical stress on the peroneal tendons during activity.
- In acute presentations, a period in a walking boot may be recommended to rest the tendons.
- Stable, supportive footwear with a firm heel counter reduces outer ankle loading.
Physiotherapy
- Progressive peroneal strengthening and proprioception training is the mainstay of rehabilitation, aiming for around 5–10 minutes, 2–3 times a day — resisted eversion, single-leg balance work, and calf and peroneal stretching.
- Progress gradually, guided by symptoms — some mild discomfort during exercise is expected, but pain persisting for more than a day afterward suggests the load should be reduced.
- In mild or acute cases of subluxation, immobilisation can allow the retinaculum to heal, but established, recurrent subluxation generally does not resolve without surgical correction.
When to Consider Surgery
Surgery is considered when symptoms significantly limit your daily activities despite an adequate trial of non-operative treatment, or when the pattern of pathology — particularly ongoing subluxation or an uncorrected cavus foot — is unlikely to resolve conservatively.
The operation offered addresses peroneal tendon repair and subluxation correction as needed, with correction of any underlying cavus foot deformity where this is a contributing factor.