Your outer foot or ankle is sore and stiff when you get out of bed. After a few minutes of walking it loosens up and feels better. Then later in the day, the ache and stiffness return. You can’t think of an injury that started it. It just began and won’t go away.
This pattern is common with peroneal tendinopathy, an irritation of the tendons that run along the outside of your ankle and foot.
Pain on the inside of your ankle or arch instead? Read about tibialis posterior tendinopathy.
What Causes Peroneal Tendinopathy?
Understanding the cause is the key to getting better.
Peroneal tendinopathy is usually a repetitive strain injury, meaning stress that builds up slowly over time rather than from one event. It often starts with small mechanical problems in the foot and ankle, such as:
- A stiff ankle or tight calf
- Stiff or restricted joints in the foot
- Muscle weakness
At first you don’t notice these problems because your body compensates. But the compensation changes how your foot and ankle move and shifts extra stress onto the peroneal muscles. These muscles run down the outside of your lower leg and attach to the outer edge of your foot. Over time, that stress can build into pain and tendon damage.
Our Approach: It’s Two Problems, Not One
It’s important to realize that peroneal tendinopathy isn’t one problem. It’s two.
Problem #1: The injured tendon. The tendon itself needs to heal and be rehabilitated. Our treatment combines:
- Shockwave therapy, which helps stimulate tissue healing. Research shows it can be an effective treatment for tendon problems.
- Progressive loading exercises, which are the foundation of tendon rehab. The exercises have to be challenging enough to trigger healing but not so hard that they flare the tendon up. That balance is why a customized program works better than generic exercises from YouTube or TikTok.
Problem #2: What caused it in the first place. This is the part that’s often missed, and it’s just as important. Most people, and many treatment plans, focus only on the pain. But if the stiff joints, tight muscles, and weakness that overloaded the tendon are never addressed, the tendon keeps getting stressed. That’s why these conditions can be so stubborn and keep coming back, even after a period of rest or treatment.
To find the cause, we perform a thorough exam to identify the specific muscle and joint restrictions and weaknesses behind your problem, then make correcting them a major part of your treatment plan. This includes:
- Active Release Technique (ART): a hands-on soft tissue method that releases tight, restricted muscles in the calf and foot that are hard to reach on your own
- Joint manipulation: to restore normal movement to stiff joints in the foot, when appropriate
- Home stretches and exercises
Treating both problems is what gives you the best chance of not just feeling better, but staying better.
What to Expect
Your first visit. We take a full history and perform a detailed exam. This confirms your diagnosis and uncovers what is driving the problem in your case. Only then do we build your treatment plan.
Timeline. This is not a quick fix. Tendons take time to heal. We can help them heal faster and better, but most plans run about 6-8 weeks, though this varies from person to person.
Visits. Treatments like ART and shockwave can’t be done at home, so we see you in the office, usually twice a week at first, then less often as you progress.
Home exercises. Your rehab program is prescribed in our office but done at home, typically about 30 minutes a day. Please consider this commitment before booking, since the exercises are a big part of why treatment works.
When Should You Get It Checked?
It’s worth having your foot assessed if:
- The pain has lasted more than a couple of weeks
- It improves with rest but keeps coming back
- It’s starting to affect walking, exercise, or work
- Your ankle feels unstable or like it’s giving way
Tendon problems are generally easier to treat when they’re caught early, before months of compensation have built up.
Seek urgent medical care instead if you felt a sudden pop or snap, can’t put weight on your foot, or have significant swelling, bruising, numbness, or redness and warmth with a fever.
See How We Treat It
Here’s a short video on how we assess and treat foot pain in our office.
Ready to Get Started?
If outer foot pain has been hanging around, we can help you find the cause and build a plan to fix it. Book your appointment here or call us at (905) 685-7227.