Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

The Peroneal Tendons: Unsung Ankle Stabilizers

The peroneal tendons — the peroneus longus and peroneus brevis — run behind the lateral malleolus (outer ankle bone) in a shared groove, secured by the superior peroneal retinaculum. These tendons evert the foot and provide dynamic lateral ankle stability. Peroneal tendon injuries are significantly underdiagnosed because their symptoms — outer ankle pain, swelling, and instability — are easily attributed to ankle sprains. At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, we evaluate lateral ankle pain comprehensively to distinguish peroneal pathology from ligamentous injury.

Peroneal Tendinopathy vs. Tears

Peroneal tendinopathy (overuse-related degeneration without structural tear) produces chronic outer ankle pain with activity, tenderness directly over the tendons, and pain with resisted eversion. It is common in runners, soccer players, and basketball players who perform repetitive ankle eversion. Peroneal tears — most commonly longitudinal splits in the peroneus brevis where it wraps around the fibula — cause more acute pain, swelling, and potentially a palpable defect or snapping sensation. MRI or diagnostic ultrasound distinguishes tendinopathy from partial or complete tears and determines the extent of damage.

Peroneal Tendon Subluxation

The superior peroneal retinaculum that holds the peroneal tendons in their fibular groove can be torn during acute ankle dorsiflexion injuries (common in skiing), allowing the tendons to snap over or around the fibula — peroneal subluxation. Patients feel a snapping or clicking on the outer ankle with movement. MRI may show retinaculum disruption; dynamic ultrasound can directly visualize tendon subluxation during provoked movement. Surgical repair of the retinaculum is typically required for athletes with symptomatic subluxation.

Treatment Approaches

Conservative management for tendinopathy: activity modification, immobilization in a boot for acute flares, physical therapy with progressive eccentric strengthening of the peroneals, addressing biomechanical factors (lateral heel instability contributing to peroneal overload with orthotics). Ultrasound-guided tendon sheath injection reduces inflammation in the acute phase. Surgical treatment for significant tears or failed conservative management: tendon debridement, tubularization repair of longitudinal splits, tenodesis (suturing peroneus brevis to peroneus longus), or reconstruction with tendon graft for severe tears. Contact Balance Foot & Ankle at (810) 206-1402 for evaluation of lateral ankle pain that may involve peroneal tendon pathology.

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Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist for Peroneal Tendon Problems

Peroneal tendon tears and tendinopathy cause chronic outer ankle pain and instability that is often misdiagnosed as a recurring ankle sprain. At Balance Foot & Ankle, Dr. Tom Biernacki uses ultrasound to evaluate peroneal tendons in real-time and provides both conservative and surgical treatment options.

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Clinical References

1. Dombek MF, Lamm BM, Saltrick K, et al. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg. 2003;42(5):250-258.
2. Heckman DS, Reddy S, Pedowitz D, et al. Operative treatment for peroneal tendon disorders. J Bone Joint Surg Am. 2008;90(2):404-418.
3. Redfern D, Myerson M. The management of concomitant tears of the peroneus longus and brevis tendons. Foot Ankle Int. 2004;25(10):695-707.

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Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.