If you have a nagging pain on the outer side of your ankle that is not settling like a fresh sprain should, it may not be a sprain at all. Pain along the outer ankle that flares with running or activity can be coming from the peroneal tendons, especially if you have a history of rolling that ankle.
Peroneal tendinopathy is common in runners and in people who have sprained the ankle before, and the two often go together. Here is what it is, why it happens, what tends to help, and when it is worth seeing a podiatrist.
In this article
What is peroneal tendinopathy?
Peroneal tendinopathy is a painful, load-related condition of the peroneal tendons, which run down the outer, or lateral, side of your ankle and behind the bony bump on the outside of the ankle. These tendons help stabilise the ankle and control side-to-side movement of the foot.
When the tendons are loaded more than they can handle, they can become irritated and sensitive. It is a load and capacity issue rather than a sign of serious damage, which is why it usually responds well to the right kind of loading over time. Because the tendons sit on the outside of the ankle, the pain is felt on that lateral side rather than deep in the joint, and it often builds the more you are on your feet.
What does outer ankle pain from the peroneal tendons feel like?
The typical picture is pain along the outer side of the ankle, often behind or below the bony bump on the outside. People commonly notice:
- Pain on the outer ankle that builds with running or time on the feet
- Tenderness along the tendons behind the outer ankle bone
- Aching or stiffness that eases with rest and flares when load picks up again
- A sense that the ankle feels less stable or gives way on uneven ground
Unlike a fresh sprain, which usually follows a specific twist and settles over a few weeks, tendinopathy pain tends to be more grumbling and load-related.
Why is it linked to ankle sprains?
The peroneal tendons and ankle stability are closely connected. Peroneal tendinopathy is common in people with a history of ankle sprains or ankle instability, and the two often feed into each other. Irritated or weak peroneal tendons reduce lateral ankle stability, and an unstable ankle places more demand on those tendons.
The sprain link
Peroneal tendinopathy is common in runners and in people with a history of ankle sprains or ankle instability. Irritated or weak peroneal tendons reduce lateral ankle stability, so the two often go together.
The reassuring part
With graded loading, strengthening, footwear support and sensible training changes, tendinopathies generally recover well.
This is why addressing the tendon and the ankle stability together often matters more than treating either on its own.
Does footwear and training load matter?
Yes. Because this is a load-related condition, how much you do and what you do it in both matter. A sudden jump in running distance, hills, speed work or time on uneven ground can overload the tendons. Supportive, well-fitting footwear helps share the load and support the outer ankle, and is a practical lever you can act on.
Sensible training changes, such as easing back the aggravating load for a while and building it up gradually, give the tendons a chance to settle and adapt.
What helps peroneal tendinopathy?
Most tendinopathies respond well to a graded, active approach. A typical plan includes:
- Graded loading and strengthening for the peroneal tendons and ankle
- Balance and stability work to support the outer ankle
- Footwear support suited to your foot and activity
- Sensible training changes to manage load while symptoms settle
A visit for podiatry in Upper Mount Gravatt can help work out what is loading the tendons, assess your ankle stability and footwear, and build a graded plan matched to your foot and your goals.
When should you see a podiatrist?
Consider a foot assessment if
You have persistent pain on the outer side of the ankle that is not settling, pain that flares with running or activity, a history of ankle sprains or a feeling that the ankle is unstable. A podiatrist can confirm what is going on, check your ankle stability and footwear, and give you a clear, graded plan. The earlier a grumbling tendon is looked at, the easier it usually is to guide your loading and keep you moving.
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Helping You Perform at Your Best
At ACE Sports Medicine in Upper Mount Gravatt, our podiatrists provide personalised care for outer ankle pain and peroneal tendinopathy for people across Brisbane's southside. Your first appointment includes a foot assessment, a look at your ankle stability and footwear, and a graded plan matched to your goals.