Foot / Ankle
Peroneal Tendinopathy
비골건병증
Overuse degeneration or tenosynovitis of the peroneus longus/brevis tendons behind the lateral malleolus
- How common
- Common cause of chronic lateral ankle pain
- Typical age
- Active adults, ages 30–50
What is it?
Repetitive eversion and chronic instability cause tendon wear and inflammation where the peroneals curve behind the lateral malleolus.
Commonly affected: Retromalleolar groove behind lateral malleolus
How it develops
- Repetitive EversionHiking and sports increase lateral load
- MicrotearsMicrotears within peroneal tendons
- TenosynovitisTenosynovitis behind lateral malleolus
- Chronic Tendinosis / Split TearLong-standing cases may develop split tears
Symptoms
- Posterolateral Ankle PainFocal pain behind lateral malleolus
- Resisted Eversion PainPain/weakness with resisted eversion
- Ankle InstabilitySense of giving way
- Local SwellingSwelling along tendon course
How it is examined
- Peroneal TendernessTenderness along tendon course
- Resisted EversionResisted eversion reproduces pain/weakness
- Subluxation TestPlantarflexion + eversion may demonstrate subluxation
- Lateral Ligament CheckAssess concurrent ankle instability
Imaging
X-ray to exclude bony causes.
- Often normal
- Rules out lateral malleolus fracture
- Fleck sign for tendon dislocation
MRI or US is standard — tendon signal, split tears, tenosynovitis.
- Increased intratendinous T2 signal
- Tenosynovial fluid
- Split tears
- Associated ligamentous injury
Non-surgical care
- Rest + Ankle BraceReduce load, use lateral ankle brace
- NSAIDs + IceFor acute inflammation
- Eccentric StrengtheningEccentric peroneal loading for tendon remodeling
- Lateral Wedge InsoleLateral wedge to offload peroneals
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
6-month conservative failure, >50% split tear, tendon dislocation
Procedures that may be discussed
- Tendon debridement
- Split tear repair
- Groove deepening for dislocation
Outlook
Over 80% improve with conservative care.