Peroneus Longus Trigger Points

Introduction

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

Name and Area

  • Name: Peroneus Longus (Fibularis Longus)

  • Area: Located on the outer lower leg, running from the fibula to the base of the first metatarsal and medial cuneiform.

Indications

Peroneus longus trigger points may contribute to:

  • Pain Along the Outer Ankle and Foot (Mistaken for Ankle Sprains or Peroneal Tendinitis)

  • Pain That Extends to the Arch of the Foot (Can Mimic Plantar Fasciitis or Nerve Compression)

  • Weakness in Foot Eversion (Difficulty Walking on Uneven Surfaces or Maintaining Ankle Stability)

  • Pain When Standing for Long Periods or Wearing Unsupportive Shoes

  • Frequent Ankle Rolling or Feeling of Instability (Common in Runners and Athletes)

  • Pain That Worsens with Running, Jumping, or Side-to-Side Movements

Pain from this muscle is often mistaken for peroneal tendinitis, ankle ligament sprains, or arch strain.

Muscle Action

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

  • Plantarflexes the Foot: Works with calf muscles to point the foot downward.

  • Supports the Foot Arch: Assists in maintaining proper foot mechanics and preventing excessive pronation.

The peroneus longus is crucial for ankle control, foot stability, and gait mechanics.

Signs and Symptoms

Individuals with peroneus longus trigger points often report:

  • Pain on the Outer Side of the Lower Leg and Ankle (Can Mimic an Ankle Sprain or Tendinitis)

  • Pain That Extends to the Arch and Inner Foot (Can Feel Like a Pulling or Burning Sensation)

  • Weakness in Foot Eversion (Difficulty Maintaining Balance on Uneven Ground)

  • Pain When Wearing High Heels, Flip-Flops, or Minimalist Shoes (Lack of Lateral Support Increases Peroneal Strain)

  • Pain or Fatigue in the Foot and Ankle After Walking or Running for Extended Periods

  • Frequent Ankle Rolling or Feeling of Instability in the Foot

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

Perpetuating Factors

Common causes of peroneus longus trigger points include:

  • Ankle Sprains or Chronic Instability (Forces the Peroneals to Overwork for Stability)

  • Running on Uneven Terrain (Can Lead to Overuse and Lateral Foot Strain)

  • Wearing Unsupportive Shoes (High Heels, Flip-Flops, or Minimalist Footwear That Lack Arch and Ankle Support)

  • Excessive Foot Pronation or Supination (Increases Stress on the Peroneals and Contributes to Instability)

  • Weak Glutes and Hip Muscles (Forces the Lower Leg Muscles to Compensate for Stability and Balance)

Trigger Point Referral Pattern

Trigger points in the peroneus longus refer pain to:

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

  • The arch and medial foot (Can Mimic Plantar Fasciitis or Posterior Tibial Dysfunction)

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

Pain from this muscle is often confused with ankle instability, plantar fasciitis, or foot arch strain.

Differential Diagnosis

Peroneus longus 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)

  • Plantar Fasciitis (Sharp Pain in the Heel and Arch, Worse in the Morning or After Activity)

  • Cuboid Syndrome (Pain on the Outer Midfoot, Worsens with Weight-Bearing Activities)

  • Tarsal Tunnel Syndrome (Burning Pain and Numbness in the Foot and Ankle, Similar to Nerve Compression)

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

Associated Trigger Points

Peroneus longus trigger points often co-exist with:

  • Peroneus Brevis (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 and Heel Pain)

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

Anatomy and Innervation

Muscle Origin Insertion Innervation
Peroneus Longus Upper two-thirds of the lateral fibula Base of the first metatarsal and medial cuneiform Superficial fibular nerve (L5–S2)

The peroneus longus is innervated by the superficial fibular nerve, which also controls foot eversion and lateral foot stabilization.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the outer lower leg and base of the first 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 longus, reducing ankle tightness and improving foot stability.

Manual Therapy

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

  • 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 longus 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

  • Wear Shoes with Proper Arch Support (Prevents Excessive Pronation and Ankle Instability)

  • Use Custom Orthotics If Needed (Provides Better Lateral Foot Stability)

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

Conclusion

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

➡️ 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.