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How to Deal with Peroneal Tendonitis when Running

by Jaydee Vykoukal, PT, DPT September 28, 2021 0 Comments

ankle brace shoes

Running is a great way to stay active and healthy. However, when managing peroneal tendonitis, running can cause pain and frustration to your feet and lower leg. While inflammation of the peroneal tendons is less common than other running injuries, it should be taken seriously to ensure a healthy recovery. Keep reading to learn ways to relieve peroneal tendonitis while running. 

11 Prevention Tips for Your Peroneal Tendon

Now that you understand what might be causing foot and ankle pain, it’s important to take steps to prevent injury or further aggravation.

1. Increase Your Running Volume Gradually

Overuse is a common cause for peroneal tendon pain. A general great rule of thumb to increase running volume while training is to increase no more than 10% of your mileage or intensity per week. This gives your body time to adapt and build endurance sustainably. The exact percentage for each runner, particularly for distance runners,  will vary but it’s a great place to start. 

Learn the causes of peroneal tendonitis

2. Experiment with Different Types of Running

There are two primary forms for running: barefoot running or traditional heel strike running. Barefoot running involves striking the ground with your mid-foot instead of the heel. When done correctly, it reduces impact in your lower leg and spine and optimizes muscle coordination. The caveat is that without proper muscle strength and conditioning, this can lead to strain of the intrinsic foot and ankle muscles and requires a slow gradual start.

3. Improve Your Running Form

Follow these general guidelines:

  • The upper body Should be aligned with the head over the shoulders (not forward), chin tilted down so that your line of vision is parallel with the floor, shoulders pulled back and the upper back only slightly curved (a flat back is not ideal- but we don’t want hunched either).
  • The low back should be neutral, meaning a slight extension curve and the abdominals tight to keep back and pelvis from overextending.
  • The bony protrusions on the front of your pelvis should create a line with your back dimples that is parallel to the floor.
  • There shouldn't be any side leaning, only twisting of the upper trunk with each transitional stride forward while running.
  • Thighs should remain parallel to each other without the knees touching and the kneecaps pointing straight forward.
  • The glutes should produce a strong force with each stride forward to help with propulsion.
  • Watch out for excessive flexion of the hips, poor hip extension range of motion, and the knees being rotated inward or touching.
  • Ankles should remain relatively neutral.
  • Land midfoot as your arch collapses slightly.
  • Majority of your weight should be shifted toward your big toe.
  • Use power and momentum from your calf muscles, hamstrings, and glutes to stride forward without excessive knee or hip flexion.
  • Watch out for common problems like excessive collapsing of the arches or over-pronation of the ankle.

4. Note Your Strides and Cadence

Generally, lower cadences and strides are easier to manage for reduced impact and proper coordination. Although with increased endurance and strength, you may find a cadence somewhere around 175 steps per minute to be ideal. Tune into what cadence, stride length, and stride width helps you feel most powerful with the least amount of strain.

Learn more ways to treat Peroneal Tendon Pain

5. See a Physical Therapist

Without an understanding of human anatomy and biomechanics, it can get overwhelming to assess your own running form. Try some of these basics and if you’re not seeing the results consider physical therapy. A podiatrist or physical therapist can help you determine your exact weak points to address for running form and coach you properly correcting them.

6. Choose Quality Footwear

High-quality footwear can help manage issues with foot or ankle instability. They can also provide support and reduce impact on arches and the metatarsal area. You can buy shoes with built-in heel and arch support specific for your foot alignment and needs. Often, when you go to a store that specializes in running shoes you can get advice on the best shoes for your feet.

7. Consider Orthotics

If you just need a little more support in your current shoes, you might consider custom or prefabricated orthotics. Just as with shoes, there are many different styles of orthotics to meet your running needs, with prefabricated versions being significantly cheaper than custom options. Generally, look for an option that provides your heel pronation support and feels good on your arch.

An ankle brace is another good way to support your leg during rehab. See the best here.

8. Proper Footwear

Change your running shoes regularly. If there are signs of wear or you’ve run more than 500 miles in your shoes, then it’s probably time for a new pair.

9. Lose Weight

The impact that our lower body endures with high-level activities like running can be hard on the body with muscle weaknesses, imbalances or poor form present. Losing weight is a great strategy for reducing strain in all of your joints, stress fractures, or injuries and improving your overall hea

10. Proper Warm Up

Muscle stiffness can lead to poor running form and limited tissue extensibility; putting the ankle tendons at risk of injury. Take the time to stretch and warm up prior to running to boost circulation and prime your body for running.

Try these foot and ankle injuries with these warm up stretches

11. Cool Down/Recovery

Proper cool down is just as important as your warm up. Take time to stretch after you run and try massaging your legs, calves, outside of the ankles and feet to break down any built up lactic may

Massage Techniques for Peroneal Tendonitis

Common Questions About Peroneal Tendonitis

How Does Running Cause Peroneal Tendonitis?

The peroneal muscles are responsible for ankle eversion and are essential for stability of the outside of the foot and ankle stability with weight-bearing activity. Peroneal tendonitis in runners is most often caused by a sudden increase in running speed or distance. Other higher impact activities like jumping can also have similar effects. Additionally, injuries like an ankle sprain can also cause direct or aggravating imbalances in the foot and ankle bone that affect your ability to run.

Learn the causes and symptoms of Peroneal Tendonitis

Can I Run With Peroneal Tendonitis?

This depends on your symptoms. Try these modifications to help minimize pain.

  • Shorter distance
  • Slower pace
  • Proper footwear
  • Treat mild symptoms immediately

If symptoms persist or worsen with modification, you should stop running and seek help from a physical therapist to recover properly.

How Do I Find the Right Balance with Running and Rest?

It’s all about tuning into your body to find the right balance. If you try to do too much too soon, it can lead to longer recovery times. Yet, too much rest can quickly lead to loss of hard-earned endurance and strength. Try incorporating stretches and other exercises that are safe and beneficial to the peroneal tendon to help build strength and resilience.

Peroneal Tendon Stretches

Ankle Strengthening Exercises

If you’re feeling unsure of where to start, talk to your doctor or physical therapist for personalized recommendations that will maximize your return to running.

Can I Heal Peroneal Tendonitis Fast?

While you can find quick and short term relief from painful symptoms with simple home treatment like ice, medications, and gentle exercise, you’ll need to address any underlying issues that have caused your peroneal tendonitis for sustainable long term relief.

How to Treat Peroneal Tendon Pain

What Happens if I Ignore Symptoms?

If the original causes are not formally addressed, you will be left in a cycle of frustrating pain and injury that you can’t seem to get rid of. A formal assessment of your lower body function and coordination with running can help determine the best options for a long term recovery

Learn more ab out the causes of peroneal tendonitis

Safely Returning to Pavement

When returning to running, following these tips and paying attention to your symptoms is crucial. As you heal, you can sustainably increase your running mileage and intensity. With proper care and time you will be on track to reach your ultimate running goals.

If you experience an exacerbation of symptoms with running that affects your quality of life or just can’t seem to get any relief, get in touch with your podiatrist or physical therapist for further recommendations.


Peroneal Tendonitis Products


Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT

JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.

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