How Runners Get Peroneal Tendon Injury

A peroneal tendon injury is an ankle injury that is temporary in forefoot running, but can become chronic in heel strike running. For instance, a newbie forefoot runner may be at risk for peroneal tendon injury because the ankles need more time to develop strength to stabilize a forefoot strike landing.

Causes of Peroneal Tendon Injury in Runners

How Runners Get Peroneal Tendon Injury

Peroneal Tendon Injury in Forefoot Running

Runners who learn forefoot running may experience peroneal tendon pain because ankle plantarflexion at touchdown increases tensile loads on the passive stabilizing ligaments and tendons surrounding the ankle [1, 2].

  • Ankle plantarflexion at touchdown in forefoot running affords better energy load distribution and cushioning [3].

Put another way, the ankles have a functional role in forefoot running that includes shielding the body from impact. On average, peroneal tendonitis is a function of adapting to forefoot running, and the probability of the condition turning chronic is very low.

Peroneal Tendon Injury in Heel Strike Running

Peroneal tendon injury is prevalent in heel strike running, and heel strike runners may have more difficulty than forefoot runners in circumventing the condition.

  • Christina et al. [1] found that the traits that caused peroneal tendonitis included mostly high impact forces and weakening of the anterior tibial muscle  —these traits are more associated with heel strike running.

What is more, impact and workload at touchdown is also higher in heel strike running, which increases load response on the peroneal tendon and could engender peroneal tendinopathy [4], a more chronic version of peroneal tendonitis.

The Take Home Message

The main difference between heel strike and forefoot strike running in contributing to peroneal tendon pain or injury is forefoot running naturally increases impact absorption with minimum amount of impact exposure on the peroneal tendon.

The moral of the story is, forefoot running is a better prescription for the peroneal tendon because it inhibits the tendency of overload induced-ankle weakness.

If you’ve never heard of forefoot running, click here to find out more about the injury-free style of running.


More From Run Forefoot:

Barefoot Running – Running barefoot makes it easier to learn forefoot running.

Knee Pain – Risk factors for knee pain in runners.

The Arch in Forefoot Running – Why forefoot running is better for the arch.

Plantar Fasciitis – Find out why heel strike runners are more at risk for plantar fasciitis.

Forefoot Running Shoes – Reviews of barefoot running shoes that are best for forefoot running.

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[1]. Christina KA, White SC, Gilchrist LA (2001) Effect of localized muscle fatigue on vertical ground reaction forces and ankle joint motion during running. Hum Mov Sci 20(3):257–276.

[2]. Philbin TM, Landis GS, Smith B (2009) Peroneal tendon injuries. J Am Acad Orthop Surg 17(5):306–317.

[3]. Divert C, Mornieux G, Baur H, Mayer F, Belli A (2005) Mechanical comparison of barefoot and shod running. Int J Sports Med 26(7):593–598

[4]. Ziai et al. Peroneal tendonosis as a predisposing factor for acute lateral ankle sprains in runners. Knee Surg Sports traumatol Arthrosc, 2015; DOI 10.1007/s00167-015-3562-3.

Bretta Riches

"I believe the forefoot strike is the engine of endurance running..."

BSc Neurobiology; MSc Biomechanics candidate, ultra minimalist runner & founder of RunForefoot. I was a heel striker, always injured. I was inspired by the great Tirunesh Dibaba to try forefoot running. Now, I'm injury free. This is why I launched Run Forefoot, to advocate the health & performance benefits of forefoot running and to raise awareness on the dangers of heel striking, because the world needs to know.
Bretta Riches

P.S. Don't forget to check out the Run Forefoot Facebook Page, it's a terrific place to ask questions about forefoot running, barefoot running and injury. I'm always happy to help!

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