Peroneal Tendon Exercises: The Five Stretches, in Full

Each of these turns the sole of the foot inwards, which is the direction that lengthens the peroneal muscles and tendons on the outside of the leg. Work to a firm pull on the outer shin and ankle that eases while you hold it. Sharp pain, or pain right on the bone at the back of the ankle bone, means stop.

The first three take the whole foot into inversion. The last two add a pointed foot, which puts the tendons on more stretch where they curve behind the ankle bone, so they tend to be the two people feel most. If you can only manage two of the five, the towel version and the crossed-leg version between them cover most of what the full set is trying to achieve.

There are two of them. Peroneus longus and peroneus brevis start on the outer shin, run down together behind the lateral malleolus, the bony lump on the outside of your ankle, and turn sharply forwards under it to attach into the foot. That sharp turn is the point of the design and also its weak spot: it is where the tendons are compressed against bone, and where they most often become painful.

Their job is eversion, turning the sole outwards, and, more usefully, resisting the opposite. Every time you step on a kerb edge or a tree root and your ankle starts to roll inwards, the peroneals are the muscles that have to fire fast enough to catch it. That is why peroneal problems so often start after a rolled ankle, or after a run of walking on cambered roads or uneven ground.

Pain is usually felt behind or just below the outer ankle bone, sometimes tracking up the outer shin. It tends to be worse on uneven surfaces and better on a treadmill or a smooth pavement, which is a useful clue when you are working out whether the outside of your ankle is the tendon or the ligament.

Stretching a tendon that is already compressed against bone can make it more irritable rather than less. The peroneal tendons wrap round the back of the ankle bone, and deep inversion presses them harder into that groove. If a stretch reproduces your exact pain sharply, or leaves the ankle more sore for hours afterwards, that is the signal to back off it and load the tendon instead.

Three situations where the sheet above is not the right starting point:

• The first few weeks after a bad ankle sprain. Forcing inversion pulls directly on the healing lateral ligaments. Gentle movement inside comfort comes first.
• Pain that clicks or snaps behind the ankle bone. A tendon that subluxes, slipping forwards over the bone and back again, needs assessing rather than stretching.
• Pain that is worst first thing and warms up. That pattern points to a tendinopathy, and tendinopathy responds to progressive load far better than to length.

Our guide to foot pain covers how the outer ankle is separated from the other structures that refer pain into the same area.

Ankle sprains are one of the most repeat-prone injuries in musculoskeletal medicine. A systematic review of rehabilitation for chronic ankle instability reports that up to 70% of people who sustain a lateral ankle sprain go on to develop ongoing instability, and that the mechanism involves delayed activation of the very muscles the sheet above stretches. The peroneals are late to fire, so the ankle is already rolling before they arrive.

Length does not fix timing. What does is loading and balance work: heel raises turned out, resisted eversion with a band, and single-leg standing progressed onto softer or uneven surfaces. The same review found consistent improvements in dynamic balance, proprioception and muscle activation from supervised programmes, with the caveat that gains drift back once the programme stops, which is the argument for keeping one or two of the exercises going permanently rather than treating it as a six-week course.

The practical version: use the stretches for comfort and range, and add strength and balance work as the thing that changes your odds. Our round-up of injury prevention exercises puts the ankle work alongside the rest of the lower limb.

Ashdown Forest and the Cuckoo Trail account for a good share of the outer-ankle pain that arrives in the clinic through the summer. Forest tracks in August are rutted, dry and full of hidden roots, and the Cuckoo Trail has long stretches of camber that put one ankle in slight inversion for miles at a time.

What testing usually separates is a peroneal tendon problem from a ligament that never fully recovered. Both hurt on the outside of the ankle. The tendon is tender behind the bone rather than in front of it, it hurts when you turn the sole outwards against resistance, and it settles on flat ground. The ligament is tender at the front edge of the ankle bone and complains most when the foot is passively rolled in. In the Uckfield clinic, the people who have been stretching for weeks without progress are most often the ones whose tendon is being compressed by exactly that stretch, while the balance work that would retrain the catch reflex has never been started.

If outer ankle pain keeps returning after every walk on uneven ground, our page on tendinopathy in Uckfield explains how that pattern is assessed and loaded.

How long should I keep doing these stretches?
Give them three to four weeks at the frequency on the sheet before judging them. If the ankle is no easier by then, the limit is probably not tendon length.

Should peroneal stretches hurt?
A firm pull along the outer shin and ankle is what you want. Sharp pain behind the ankle bone, or pain that lingers for hours, means the tendon is being compressed rather than stretched.

Can I do these with a fresh ankle sprain?
Not in the first couple of weeks. Inversion pulls on the ligaments that are healing. Gentle pain-free movement comes first.

Do I need a scan for peroneal tendon pain?
Rarely at the start. Imaging becomes useful if the tendon clicks or gives way, or if pain persists despite a proper loading programme. Our article on whether you need a scan covers when it changes the plan.

Is there a printable version?
This page prints straight from your browser, figures and dosage included.