Peroneus Brevis Trigger Points

Introduction

The peroneus brevis is a key lower leg muscle responsible for foot eversion, ankle stability, and lateral balance. When trigger points develop in this muscle, they can cause outer ankle pain, foot weakness, and instability, often mimicking ankle sprains, peroneal tendinitis, or nerve compression.

Name and Area

  • Name: Peroneus Brevis (Fibularis Brevis)

  • Area: Located on the outer lower leg, running from the fibula to the base of the fifth metatarsal (outer foot bone).

Indications

Peroneus brevis trigger points may contribute to:

  • Pain on the Outer Ankle and Foot (Mistaken for Ankle Sprain or Peroneal Tendinitis)

  • Pain That Extends to the Outer Edge of the Foot (Can Mimic Stress Fractures or Nerve Compression)

  • Weakness in Foot Eversion (Difficulty Keeping the Foot Stable While Walking or Running)

  • Pain When Walking on Uneven Surfaces (Common in Runners, Hikers, and Athletes)

  • Instability in the Ankle (Feels Like the Ankle "Wobbles" or Is Prone to Rolling Inward)

  • Pain That Worsens with Prolonged Standing, Running, or Wearing Unsupportive Shoes

Pain from this muscle is often mistaken for ankle ligament sprains, peroneal tendinitis, or nerve compression syndromes.

Muscle Action

  • Everts the Foot: Moves the foot outward, essential for maintaining lateral stability.

  • Assists in Plantarflexion: Works with calf muscles to point the foot downward.

  • Supports the Lateral Ankle: Helps prevent ankle rolling and instability.

The peroneus brevis is crucial for ankle strength, balance, and injury prevention.

Signs and Symptoms

Individuals with peroneus brevis trigger points often report:

  • Pain Along the Outer Ankle That Feels Like a Dull Ache or Sharp Twinge

  • Pain That Radiates to the Outer Foot (Common in Runners, Hikers, and Athletes)

  • Weakness in Foot Eversion (Difficulty Walking on Uneven Terrain or Side Slopes)

  • Pain When Wearing High Heels or Minimalist Shoes (Lack of Lateral Support Increases Strain on the Peroneals)

  • Pain or Fatigue in the Foot and Ankle After Long Walks or Runs

  • Frequent Ankle Rolling or Feeling of Instability

Pain worsens with lateral foot movements, excessive pronation, or prolonged standing.

Perpetuating Factors

Common causes of peroneus brevis trigger points include:

  • Ankle Sprains or Instability (Leads to Chronic Overuse of the Peroneal Muscles for Stability)

  • Running on Uneven Surfaces (Increases Strain on the Outer Ankle and Foot)

  • Wearing Unsupportive Shoes (High Heels, Flip-Flops, or Minimalist Running Shoes)

  • Excessive Pronation or Supination (Can Overload the Peroneal Muscles)

  • Weak Hip and Glute Muscles (Leads to Increased Stress on the Lower Leg and Foot Stabilizers)

Trigger Point Referral Pattern

Trigger points in the peroneus brevis refer pain to:

  • The outer ankle and lateral foot (Mistaken for Peroneal Tendinitis or Ankle Ligament Sprains)

  • The base of the fifth metatarsal (Can Mimic Stress Fractures or Cuboid Syndrome)

  • The outer calf (Mistaken for Nerve Compression or Shin Splints)

Pain from this muscle is often confused with ankle injuries, foot stress fractures, or lateral foot instability.

Differential Diagnosis

Peroneus brevis trigger points may be mistaken for:

  • Peroneal Tendinitis (Pain and Swelling Along the Outer Ankle and Foot, Common in Runners and Walkers)

  • Ankle Ligament Sprain (Pain and Swelling After a Twisting Injury, Often Due to Ankle Rolling)

  • Cuboid Syndrome (Pain in the Outer Midfoot, Worse with Weight-Bearing Activities)

  • Stress Fractures in the Fifth Metatarsal (Pain on the Outer Foot, Worsens with Running and Jumping Movements)

  • Tarsal Tunnel Syndrome (Nerve Compression That Causes Burning or Tingling in the Foot and Ankle)

A thorough ankle, foot, and lower leg examination is necessary to rule out these conditions.

Associated Trigger Points

Peroneus brevis trigger points often co-exist with:

  • Peroneus Longus (Outer Foot and Ankle Pain, Affects Lateral Foot Stability and Gait Mechanics)

  • Tibialis Posterior (Inner Ankle and Foot Pain, Affects Arch Support and Stability)

  • Gastrocnemius and Soleus (Calf Tightness and Ankle Instability, Contributes to Foot Fatigue)

  • Quadratus Plantae (Foot Arch Pain, Can Resemble Plantar Fasciitis or Foot Cramps)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Peroneus Brevis Lower two-thirds of the lateral fibula Base of the fifth metatarsal Superficial fibular nerve (L5–S2)

The peroneus brevis is innervated by the superficial fibular nerve, which also controls foot eversion and lateral ankle stability.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the outer lower leg and base of the fifth metatarsal.

  • Resisted Foot Eversion Testing: Assess pain and weakness when pushing the foot outward against resistance.

  • Gait Analysis: Look for ankle instability, excessive pronation, or difficulty maintaining balance on uneven surfaces.

  • Ankle Stability Testing: Rule out ligament sprains, stress fractures, or nerve compression.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the peroneus brevis, reducing ankle tightness and improving foot stability.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots along the outer calf and ankle.

  • Massage Therapy: Helps improve circulation and reduce muscle tension in the peroneals.

Stretching

  • Peroneal Stretch: Sit with the leg extended and gently pull the foot inward to stretch the outer calf.

  • Calf Stretch Against a Wall: Helps reduce tension in the peroneals and surrounding muscles.

Strengthening Exercises

  • Resistance Band Foot Eversion: Strengthens the peroneus brevis and improves ankle stability.

  • Single-Leg Balance Drills: Enhances proprioception and reduces ankle instability.

  • Calf Raises on an Uneven Surface: Engages the peroneals for better lateral foot control.

Postural and Footwear Adjustments

  • Avoid Wearing Unsupportive Shoes (Opt for Footwear with Proper Lateral Stability and Arch Support)

  • Use Custom Orthotics If Needed (Prevents Excessive Pronation or Supination That Can Strain the Peroneals)

  • Gradually Increase Running or Activity Intensity (Prevents Sudden Overuse of the Peroneus Brevis)

Conclusion

The peroneus brevis plays a crucial role in foot eversion, ankle stability, and lateral foot support, but trigger points in this muscle can cause significant outer ankle, foot, and calf pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent chronic ankle instability.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.