Peroneal tendonitis treatment in Manchester
Find out why the outside of your ankle hurts, calm the tendon down and build an ankle that copes with running, sport and uneven ground.
Peroneal tendonitis physio in Manchester city centre
Reviewed by Nick Chatziviltsos, PgDip, HCPC-registered physiotherapist (PH114351), November 2026
At a glance
Who gets it: Runners, walkers and court or field sport players, especially after an ankle sprain or a jump in training.
Main symptom: Pain and sometimes swelling behind and below the outer ankle bone, worse on uneven ground or pushing off.
Typical recovery: Most people improve over 6 to 12 weeks. Long-standing cases can take 3 to 6 months.
Sessions: Most people need 4 to 6 over 2 to 3 months.
Avoid: Complete rest, or running through sharp pain on cambered roads and trails.
Get checked: You heard a crack, can't take weight, or your foot looks a different shape: contact NHS 111 or go to A&E.
Peroneal tendonitis is pain in the two tendons that run behind the bony bump on the outside of your ankle. These tendons steady your foot when you land, turn or stand on one leg. When they're overloaded, they get sore and can thicken.
You might know it as peroneal tendinopathy. That's the term most clinicians now use, because the problem is usually overload rather than true inflammation. NHS guidance links it closely to ankle sprains, a weak or unstable ankle, worn footwear and running on uneven surfaces.
The good news is that most cases settle without surgery. What a good physio adds is a clear answer to three questions. Is it really the tendon? What overloaded it this time? And what needs to get stronger so it doesn't keep coming back?
🛠️ How we treat peroneal tendonitis
Every peroneal tendonitis plan at Athos Physio follows the same three steps. What changes is what we find at each one.
Step 1. Find the root cause
Outer ankle pain has several possible sources. In your first 60-minute session we work out three things:
What's sore: the tendons themselves, the ligaments from an old sprain, the joint, or a bone that needs ruling out
What's overloading it: a recent sprain, an ankle that still rolls, a high-arched foot, a jump in mileage, or cambered roads and trails
What's keeping it going: weak calf and hip muscles, poor balance on one leg, worn trainers, or running through pain
We show you on a 3D anatomy model how the tendons wrap behind the ankle bone. Once you see why they're working so hard, your plan makes sense.
Step 2. Treat what's driving it
Ease the pain. Soft tissue work, IASTM and joint mobilisation for a stiff ankle or foot, plus simple ways to take the strain off at home.
Change the load, don't stop it. For a few weeks, we cut back on the runs, surfaces or drills that flare it. You keep what you can do comfortably.
Start loading the tendon early. Tendons respond to the right amount of load. Gentle holds and banded work usually start in week one.
Sort the footwear. We check your trainers for wear and how they suit your foot. Sometimes a simple change helps a lot.
Step 3. Build it to last
This is the part that stops it coming back.
Tendon strength. Banded eversion, single-leg heel raises and loaded calf work, built up week by week.
Balance and control. Single-leg balance, reaching drills and landing work, so your ankle reacts fast on uneven ground.
Hip and leg strength. A strong hip helps control how your foot lands. Weak hips often show up in runners with ankle pain.
Rehab on the gym floor. Being inside F45 NQ means we can rebuild hopping, landing, cutting and running drills in a real training space.
We finish when you're back running, training or playing with confidence, not just when the pain has gone.
Want to know whether it's your peroneal tendons or something else? Your first 60-minute session finds out and starts treatment the same day. Book your assessment →
🔍 What is peroneal tendonitis?
You have two peroneal muscles on the outside of your lower leg: peroneus longus and peroneus brevis. Their tendons run down behind the outer ankle bone, held in a groove by a band of tissue. Brevis attaches to the base of your fifth metatarsal, the bone on the outside of your foot. Longus runs under your foot to the big toe side.
Together they turn your foot outwards and stop your ankle rolling in. They work hard every time you land, push off, change direction or run on a slope.
Peroneal tendinopathy happens when the load on these tendons is more than they're ready for. The tendon becomes sore and can thicken. It is often linked to an ankle sprain that didn't fully recover.
Types of peroneal tendon problem we see
Reactive tendinopathy: a tendon that's sore after a sudden rise in load, such as a long race or a new trail route; runners and walkers after a jump in training.
Long-standing tendinopathy: pain that has come and gone for months, often with a thicker tendon; people who've had repeated sprains or kept training through it.
Tendon tear: a split in the tendon, usually peroneus brevis, often after repeated sprains; mostly adults with long-standing pain or ankle instability. May need a scan.
Tendon subluxation: the tendons slip out of their groove, often with a click or snap; usually after a forceful sprain in sport. Needs a specialist opinion.
Working out which type you have changes how hard we load the tendon and how fast you progress.
⚠️ Peroneal tendonitis symptoms
Most people notice pain that builds gradually. You might have:
Pain behind or just below the bony bump on the outside of your ankle
Pain along the outside of your foot towards the fifth metatarsal
Swelling along the line of the tendons
Pain that's worse on uneven ground, cambered roads, slopes or when turning
Pain or weakness pushing your foot outwards, or rising onto your toes
Stiffness or pain first thing in the morning, or when you start moving after rest
A feeling that your ankle is weak or rolls easily
A click or snap behind the ankle bone, if the tendons are slipping
Is it peroneal tendonitis, a sprain or a stress fracture?
Pain at the front of the outer ankle after a recent roll points more to a ligament sprain. See our sprained ankle page.
Pain at one spot on the outside of the foot that's worse with every step may be a fifth metatarsal stress fracture. Stop running and get assessed. See our stress fracture page.
Pain at the back of the heel or above it is more likely the Achilles. See our Achilles tendinopathy page.
Pain under the ball of the foot suggests metatarsalgia rather than the tendons.
A deep ache at the small hollow in front of the ankle bone can come from the joint rather than the tendon.
We test each of these at your first session rather than guessing from the symptoms alone.
🔍 What causes peroneal tendonitis?
It's rarely one thing. Usually the tendons are asked to do more than they're ready for, often while they're already working overtime to protect an unstable ankle.
Common triggers we see in Manchester
An old ankle sprain. NHS guidance notes that about 40% of ankle sprains go on to cause long-term ankle pain. Peroneal tendinopathy is one of the causes.
A sudden jump in training. Marathon and half marathon blocks, or a new run streak, add load fast.
Cambered surfaces. Canal towpaths, sloping pavements and trail runs in the Peak District load the outer ankle.
Worn or unsuitable trainers. Shoes that have collapsed to one side make the tendons work harder.
High arches. A high-arched foot that tips outwards puts extra strain on the tendons.
Court and field sport. Five-a-side, netball, tennis and padel involve lots of cutting and quick turns.
Extra body weight, which NHS guidance lists as a risk factor.
Myths about peroneal tendonitis
"Rest will fix it." Rest eases pain, but tendons get weaker without load. The pain often returns when you restart.
"It's inflamed, so anti-inflammatories will cure it." They can ease pain for a while, but they don't rebuild the tendon.
"A strapping or brace is the answer." Support can help in the short term. Strength and balance are what last.
"You need a scan straight away." Most cases are diagnosed from your story and an examination. A scan helps when a tear or bone injury is suspected.
🧪 How we assess peroneal tendonitis
Your first session lasts 60 minutes, so there's time to assess properly and start treatment the same day.
Your story (10 to 15 minutes). When it started, any sprains, your training and surfaces, your trainers, and what you want to get back to.
Safety screen. We check for the warning signs listed on this page, including signs of a bone injury.
Tendon tests. We press along the tendons and test how they respond to resisted eversion, where you push your foot outwards against our hand. We also use the peroneal compression test to load the tendons in their groove.
Stability and slipping checks. The anterior drawer and talar tilt tests check the ankle ligaments. Resisted eversion with the foot pulled up checks whether the tendons slip out of their groove.
Foot shape. We look at your arch and use the Coleman block test if your foot tips outwards, as a high arch can overload the tendons.
Strength and balance tests. How many single-leg heel raises you can do on each side, single-leg balance with eyes open and closed, and a hop test if it's comfortable.
Your diagnosis and plan. In plain English: what's sore, why now, what to change this week, whether a scan would help, and how many sessions we expect.
You'll leave with treatment started and the first two or three exercises of your custom rehab plan. If we suspect a tear, a fracture or slipping tendons, we'll explain why and write to your GP about a scan or a specialist opinion.
🛠️ Peroneal tendonitis treatment at Athos Physio
Every plan moves through four phases. How fast you move depends on how your tendon responds, not on the calendar.
Settle (weeks 0 to 2). Bring pain down and keep you active. Soft tissue work, IASTM and ankle mobilisation; load changes; easy cycling or swimming; holds against a band or wall to ease pain.
Load (weeks 2 to 6). Start strengthening the tendon. Banded eversion, double then single-leg heel raises on flat ground, single-leg balance, hip strength.
Strengthen (weeks 6 to 12). Build strength for running and sport. Heavier heel raises, step-downs, balance on unstable surfaces, hopping and landing drills, a walk-run plan.
Return to sport (week 12 onwards). Get you back to full running and sport. Running volume then speed, hills and trails, cutting and change of direction, a long-term strength plan.
Your home programme is usually 3 to 5 exercises taking about 15 minutes a day. We use a simple pain rule. Some discomfort during exercise is fine if it settles by the next morning.
Most people need 4 to 6 sessions over 2 to 3 months. Long-standing pain, a tear or an unstable ankle can take longer.
What actually works for peroneal tendonitis?
NHS guidance recommends changing activity to control symptoms, suitable footwear and ankle rehabilitation. It suggests further advice if pain hasn't improved after 6 weeks, or sooner after repeated sprains. NHS leaflets also say most cases settle without surgery.
Recommended: changing, not stopping, the activities that flare it; progressive strengthening of the peroneal tendons and calf; balance and ankle stability training, especially after a sprain; supportive footwear, and insoles or bracing for some people; pain relief from a pharmacist or GP to help you stay active, if you need it.
Less useful: long periods of complete rest; stretching alone, without strengthening; early exercises on the edge of a step before the tendon has settled; routine scans for typical tendon pain; surgery before a proper course of rehab. It's kept for tears or slipping tendons that don't settle.
Our approach is built around exercise because that's where the guidance points. Hands-on treatment helps you move comfortably while the tendon gets stronger.
⏱️ How long does peroneal tendonitis take to heal?
Recent flare-up after a jump in training: feeling much better: 2 to 4 weeks; back to full training: 6 to 8 weeks.
Long-standing tendinopathy: feeling much better: 6 to 8 weeks; back to full training: 3 to 6 months.
With ankle instability after sprains: feeling much better: 6 to 12 weeks; back to full training: 3 to 6 months.
Tendon tear or slipping tendons: feeling much better: depends on specialist advice; back to full training: often 4 to 6 months, sometimes longer.
"Back to full training" means your normal running or sport, not just walking without pain.
✅ Running, gym and sport with peroneal tendonitis
If you run
You may not need to stop completely. Pain up to 3 out of 10 during a run is usually fine if it settles by the next morning.
Pick flat, even routes for now. Swap the canal towpath and trails for a track or flat park loop.
Cut back on hills and fast sessions first, as these load the tendon most.
Check your trainers. If they're worn on the outside or more than 500 to 800 km old, it may be time for new ones.
Build back slowly. Add roughly 10% a week if your ankle stays settled.
If you train in the gym or play sport
Keep training your upper body, hips and the other leg
Swap jumping, skipping and sideways drills for cycling or rowing for now
Bring cutting and change of direction back last, once hopping is pain-free
Use strapping or a brace for sport if it helps you feel confident, while you build strength
Self-help
Use ice wrapped in a damp towel for up to 20 minutes after activity if it eases pain
Wear supportive shoes day to day, and avoid flat, flimsy shoes for long walks
Do your strength exercises on flat ground, not on the edge of a step, until we say so
Practise standing on one leg while brushing your teeth
Related conditions
Sprained ankle: pain and swelling after rolling your ankle
Achilles tendinopathy: pain and stiffness at the back of the heel or above it
Stress fracture: pain at one spot on a bone that builds with every run
Plantar fasciitis: sharp heel pain with your first steps in the morning
❓ Peroneal tendonitis FAQs
🚨 Physio, GP or A&E?
Most outer ankle pain is safe to manage with a physio. A few symptoms need a doctor first.
Book a physio (no GP referral needed): pain behind or below the outer ankle bone that builds with running, walking or sport; ankle pain that hasn't improved after 2 weeks of home treatment, or keeps returning (book a physio or see your GP); pain at one spot on the outside of the foot that's worse with each step (stop running and book an assessment; you may need a scan to rule out a stress fracture); repeated ankle rolling, or a snap and slipping feeling behind the ankle bone (book a physio; we may advise a scan or a specialist opinion).
Call your GP urgently or 111: severe pain, you can't take weight, or the area is very swollen or bruised (contact NHS 111 or an urgent treatment centre); a hot, red, swollen ankle with a high temperature (contact NHS 111 or your GP the same day).
Call 999 or go to A&E: you heard a crack, your foot or ankle looks a different shape, or it's numb, cold or blue (call 999 or go to A&E now).
The urgent and emergency signs can point to a fracture or infection, which need medical care first. If you're ever unsure, ring us on 07475 433300 and we'll tell you honestly whether you should see us or someone else first.
Not sure if it's a tendon, a sprain or something more serious? Book a free 15-minute call and we'll tell you honestly what to do next. Book a free call →
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Yes. Strengthening the tendons, improving balance and changing your training load are the main treatments, and most people improve without surgery.
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A recent flare-up often settles in 6 to 8 weeks. Long-standing pain can take 3 to 6 months of steady rehab.
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Often, yes. Mild pain that settles by the next morning is usually fine. Sharp pain, limping or pain that builds through a run means you should stop and get assessed.
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Yes, in practice. Tendinopathy is the term most clinicians now use, because the problem is usually overload rather than inflammation.
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The peroneal tendons work harder to protect an ankle that's still weak or unstable. That extra work can make them sore weeks or months later.
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Usually not. A scan helps if we suspect a tear, slipping tendons or a stress fracture, or if you're not improving with good rehab.
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A brace or strapping can help you feel secure for sport in the short term. Strength and balance work is what stops it coming back.
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Sometimes. They can help if your foot shape is adding to the strain. We'll check your feet and trainers and tell you honestly if they're worth trying.
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Most people need 4 to 6 over 2 to 3 months. We'll give you an estimate at your first appointment.
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No. You can book directly with us. If you're claiming on health insurance, check with your insurer first.
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Your first 60-minute assessment and treatment is £95. Follow-up sessions are £55 for 30 minutes, £95 for 60 minutes or £135 for 90 minutes. See our price list for all fees.
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Yes. Book a free 15-minute consultation and we'll tell you honestly whether physio is the right next step.
📍 Book peroneal tendonitis physio in Manchester city centre
Athos Physio is inside F45 NQ, 77 Piccadilly, Manchester M1 2BU, a two-minute walk from Piccadilly station and Piccadilly Gardens. We're open 7am to 8pm, Monday to Friday, so you can come in before or after work.
Your first appointment is a 60-minute assessment and treatment (£95). Follow-ups are £55 for 30 minutes, £95 for 60 minutes or £135 for 90 minutes. We work with Bupa, WPA, Vitality and Aviva, and you can see all our fees on the price list.
Can't get into town? We also offer home physio visits and online physiotherapy. Not sure physio is right for you? Book a free 15-minute call and we'll talk it through.
Call or WhatsApp 07475 433300, or book online.
Other services: Physiotherapy and active rehab · Sports massage · Pregnancy and postnatal physio · Home visits · Online physio
Written by Nick Chatziviltsos, physiotherapist and founder of Athos Physio, BSc (Hons) Physiotherapy, HCPC registered. Last reviewed: November 2026.
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