‘Outside Ankle Pain when Walking – Peroneal tendon Injury’

Pain behind the outside ankle bone when walking or running can indicate an injury to the peroneal tendons of the ankle. The Peroneal tendons (Peroneus Longus & Peroneus brevis tendons) which are situated on the outside aspect of the lower leg and run behind the outer ankle bone (lateral malleolus bone) attaching underneath the foot to the undersurface of the 5th and 1st metatarsal bones. They help support the position of the foot when walking and turn the foot out to the side (eversion). Peroneal tendon problems occur due to persistent overuse when training or from a simple ankle sprain causing the tendons to become irritated and inflammed or even partially torn within the lateral retinaculum sheath.

The lateral retinaculum is a fibrous sheath that is situated behind the outside ankle bone covering the peroneal tendons in the groove behind the ankle bone. Its role is to house the peroneal tendons and prevent them slipping over the outside ankle bone. Additionally a person can subluxate or dislocate their peroneal tendon over the outside ankle bone when the lateral retinaculum strap is torn during an ankle sprain trauma.

Causes of Peroneal Tendon Injury

  • Training on uneven surfaces such as poor road terrain

  • Poor shoewear

  • Sudden increases in training frequency and distance

  • High foot arches or hindfoot varus (slight turning inwards of heel bone) forcing the peroneal tendons to work harder.

  • Ankle sprain which cause a forceful stretch on the peroneal tears and in some causes cause a vertical tear in the tendon.

Signs & Symptoms

  • Tenderness & swelling along the Peroneal tendons on the outside ankle

  • Weak ankle and sporadic pain when walking & running

  • Stretching the foot inwards aggravates the pain.

Treatment & Management

The majority of peroneal tendonopathy injuries do not require surgery and will heel with rest. The use of aids such as a CAM walker or ankle brace can be prescribed by an Orthopaedic Consultant. The use of Orthotics to correct the abnormal heel varus angle, more suitable footwear and training programme are all important changes that should be implemented. In addition, Physical therapy that focuses on strengthening the tendons is required. If there is a subluxation or vertical tear in the tendon, then surgery will be required with a post surgical rehabilitation timeframe of 3 months.

Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles.

Contact Number: 0504 26672

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Physiotherapy & Injury Rehabilitation Clinic in Tipperary

0504 26672


The Surgery, Fianna Road, Thurles


Riverside Medical Centre, 7 Upper

Irishtown, Clonmel

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