Unlike a sprain that refers to damaged ligaments, a strain refers to damage to muscles and tendons as a result of being pulled or stretched too far.

In the ankle, there are two tendons that are often strained. These are the peroneal tendons, and they stabilize and protect the ankle.

Symptoms

Pain and swelling on the outside of the ankle just below the bony protrusion.

Pain is often worse during activity, but symptoms improve with rest.

You may have pain when pressing the outside of the ankle.

Pain may be recreated by stretching the peroneal muscles.

Causes

Factors which can increase your risk of injury include;

If you run on along slopes which cause excessive inversion (rolling out) of your foot then you are more susceptible.

Tight calves will increase the tension in the peroneal tendon.

Overtraining is also a contributory factor.

Biomechanical factors such as overpronation, or oversupination are factors, increasing friction between your tendon and ankle bone

Anatomy

The two peroneal tendons in the foot run side by side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sprains.

Acute tendon tears result from a sudden trauma or force.

The inflammation of a tendon is called Tendinitis.

Microscopic tendon tears that accumulate over time, because of being repeatedly over stretched, can lead to a condition called Tendinosis.

Tendons can also rupture when completely torn.

Subluxation refers to a tendon that slips out of place.

Treatment

Treatment for peroneal tendonitis includes a program of

Stretching
Strengthening
Mobilisation and manipulation
Proprioceptive and balancing exercises
Icing
Ankle bracing or taping during contact sports.

If symptoms are severe, a cast or ROM boot immobilisation is prescribed for 10 days.

After symptoms resolve, the patient begins a progressive rehabilitation programme along with a gradual increase to full activity

In some cases, surgery may be needed to repair the tendon or tendons and perhaps the supporting structures of the foot

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