Peroneus Longus, Brevis and Tertius – Pain & Trigger Points

The peroneus longus, brevis and tertius are three muscles located at your ankle. They can cause pain in this area, as well as in the foot.

Especially if they are tense or carry trigger points.

However, you can free these muscles from tensions and trigger points with a self-massage.

On this page, you will learn how to do this. You will also learn …

  • which ailments these muscles can cause.
  • where they are located.
  • which functions they provide.
  • why they develop problems.
  • how you palpate them.
  • and, of course, how you massage them.

Read on and free yourself of your pain!

1. Pain Patterns, Symptoms & Differential Diagnoses

Tensions in these muscles usually lead to sensitivity of pressure and pain in the muscles.

Trigger points cause the same ailments, but they can also transmit the pain to other areas.

Below you will find the exact pain zones for each of the three muscles.

1.1 Pain patterns of trigger points in the peroneus longus

Trigger points in the peroneus longus can cause pain in the lateral area of the calf which radiates downwards.

1.2 Pain patterns of trigger points in the peroneus brevis

Trigger points in the peroneus brevis can result in pain in the inferior part of the lateral lower leg. It usually radiates downwards and can cause the following ailments:

  • Pain in the ankle joint, around the malleolar fork. These are often described as pain in the “lateral ankle”.
  • Pain in the lateral side of the back of the foot.

1.3 Pain patterns of trigger points in the peroneus tertius

Pain caused by trigger points in the peroneus tertius usually extends from the anterior ankle to the back of the foot.

In addition, the pain can radiate to the lateral side of the heel.

1.4 Symptoms and ailments

Trigger points in the peroneus often lead to a weakness of these muscles.

Weakness, in turn, can cause instability in your ankle joints, increasing the risk to twist the ankle.

2. Origin & Insertion

These three muscles lie on the lateral side of the lower leg, as well as on its front, passing down to the foot.

The peroneus longus and brevis lie on the lateral side, whereas the peroneus tertius is located at the front of the lower leg.

In the following sections, I describe the location of these muscles in more detail.

2.1 Origin, insertion & innervation of the peroneus longus

The peroneus longus is attached to the lateral compartment of the lower leg (more precisely: fibula), just below the knee.

Its head runs down the entire side of the lower leg, goes around your ankle, runs towards the lateral portion of your foot and then continues under the foot to its medial side.

Origin:

  • Caput fibulae (head of the fibula) and upper 2/3 of fibula and intermuscular septa.

Insertion:

  • Os cuneiforme mediale & Os metatarsale I

Innervation:

  • The muscle is innervated by the nervus fibularis superficialis.

2.2 Origin, insertion & innervation of the peroneus brevis

The peroneus brevis lies below the longus and is covered by it for the most part. It arises from the lower two-thirds of the lateral surface of the fibula, runs downward and snakes its way around the ankle.

However, it does not pass below your foot, but attaches to its lateral side.

Origin:

  • Lower two-thirds of lateral fibula and intermuscular septa

Insertion:

  • Os metatarsale V

Innervation:

  • The muscle is innervated by the nervus fibularis superficialis.

2.3 Origin, insertion & innervation of the peroneus tertius

The peroneus tertius also arises from the fibula, but lies further forward. It runs toward the lateral side of the foot, just like the peroneus brevis.

Origin:

  • Lower anterior third of fibula

Insertion:

  • Os metatarsale V

Innervation:

  • The muscle is innervated by the nervus peroneus profundus.

3. Function

These muscles provide stabilization and movement control, instead of literally moving a joint.

This stabilization work is carried out as long as the foot touches the ground and the ankle joint needs to be stabilized.

As soon as the foot leaves the ground, the muscles are able to move the ankle joint.

3.1 Motions of the peroneus longus and brevis (loose ankle joint)

  • Moving the sole of the foot downwards: Plantarflexion
  • Lateral lifting of the lateral edge of the foot: Pronation
1

Plantarflexion

2

Pronation & Eversion

3.2 Motions of the peroneus tertius (loose ankle joint)

  • Contraction of the back of the foot: Dorsiflexion
  • Lateral lifting of the lateral edge of the foot: Eversion
1

Dorsiflexion

2

Pronation & Eversion

4. Trigger Point Activation

Trigger points are activated by many different factors.

In this case, injuries come first, followed by immobilization and “unfavorable” habits such as wearing high-heeled shoes.

In the following, I will explain some of these points in more detail.

4.1 Origin of trigger points due to sprained ankle or supination trauma

In the case of a supination trauma, colloquially also known as a sprained or twisted ankle, the lateral ligaments of the ankle are injured.

These injuries range from overstretching to total ruptures.

Concerning the peroneus longus and brevis, the severity of the injury plays a subordinate role. They are always stretched to the extreme in a supination trauma, and this happens very easily.

These sudden stretches of the muscles often lead to the activation of trigger points.

But this is only the acute, immediate mechanism.

If you twist your ankle and injure yourself in the process, your peronei will always contract reflexively in order to protect the injured ligaments from more stretching.

Remember the function of these three muscles. They move the lateral edge of the foot upwards outwards, i.e. in the opposite direction of the “twist”.

This “reflex contraction” of the musculature is also called protective tension.

If this tension lasts for a long time, it can also overload the muscles and lead to activation of trigger points.

4.2 Activation of trigger points due to prolonged immobilization and weakness

If a muscle is held in one position for a longer period of time, this leads to reduced blood circulation, increased muscle tension and, in the end, to trigger points.

In addition, the maximum resilience of a muscle decreases rapidly during immobilization, and weak muscles are much more susceptible to trigger points than “well-trained” ones.

In point 4.1, we talked about “trauma caused by a twist”. If such an injury is very severe, the ankle joint is immobilized for a few weeks, for example with an aircast splint.

This splint severely restricts the mobility of the ankle joint in supination and pronation and thus protects the injured ligament structures.

However, this also decreases the strain on the peronei, which means that they become drastically weaker and are poorly supplied with blood. What is more, they wouldn’t be used any more in their entire functions. This provides a perfect precondition for the activation of trigger points.

This also shows the importance of adapted strengthening exercises and loosening after the injury is completely healed.

4.3 Sitting with crossed legs and high stockings

If you cross your legs while sitting, the peroneus longus is trapped between the crossed leg and the knee.

This compression can overload the muscle and create trigger points.

The same applies to high stockings, which have a very firm elastic tension. These also compress the muscle and can lead to problems.

4.4 High-heeled shoes

Wearing high heels puts your ankle in an unstable position. Now remember that the peronei primarily perform stabilization work in the ankle joint.

High heels can overload these muscles, especially if you wear them very often or for long periods of time.

4.5 Jogging or running and chronic tension in the tibialis anterior

This chapter may be harder for many of you to understand, but it is very important for those who walk a lot and are bothered by ankle, foot or heel pain.

So, let’s deal with functional anatomy …

Your tibialis anterior is the antagonist of your peroneus longus and brevis. It rises the back of the foot. This function is very important to ensure a controlled rolling movement during jogging.

This muscle is particularly strained when running downhill. You have certainly experienced this burning sensation in the area of your tibia when running downhill. That’s your overloaded tibialis anterior.

Many joggers overload this muscle when …

  • starting running after a long break.
  • running on uneven ground.
  • they do trail running.
  • they increase training intensity or volume too fast.

This overload is reflected in an increased muscle tension, and possibly in trigger points.

Increased muscle tension naturally results in the peroneus longus and brevis having to work harder to fulfil their function, because they work against it.

This heavy work can overload them and lead to trigger points.

5. Palpation

Palpation of these muscles works best during contraction.

In the following, I will show you how you can feel each of these three muscles.

5.1 Palpation of the peroneus longus

First palpate the head of the fibula, i.e. the origin of the muscle.

  • A sitting position is recommended.
  • The head of the fibula is the small bony knob on the lateral side of your knee, just below it.
  • Place two to three fingers on it.
  • Now move your foot in a way that your little toe is turned outwards and the lateral edge of the foot is lifted. Repeat this movement several times.
  • Feel the area under the head of the fibula and try to feel the peroneus longus contracting with each of these movements.
  • Follow its course downwards.

Note: The muscle head of the longus only reaches as far as about the middle of the lower leg.

Then it merges into the long tendon of the muscle. If you feel a contraction of the lower leg during this movement, it is the peroneus brevis or the tendon of the longus, which moves under your fingers.

5.2 Palpation of the peroneus brevis

The peroneus brevis is a little more difficult to feel, because it is covered by the longus. But with some patience and practice you will succeed.

If not, this is no problem, because you can massage the muscle without feeling it. You just need to know where to massage.

  • I recommend a sitting position.
  • Place two to three fingers on the outside of your lower leg, about halfway between the knee and ankle.
  • Now perform the same movement as in point 5.1 and try to feel the muscle.
  • Do you feel the difference between the tendon of the longus and the tension of the brevis under your fingers?

5.3 Palpation of the peroneus tertius

The peroneus tertius is relatively easy to palpate. Before you feel the muscle, however, you must first feel your malleolar fork.

  • The malleolar fork is what most call the “ankle”.
  • Place your hand on your ankle and feel its course upwards, downwards, forwards and backwards.

To feel the muscle, proceed as follows:

  • Grasp your lower leg and place your thumb in front of your ankle.
  • Raise your foot a few times and turn your little toe outwards. Leave your heel on the ground.
  • During these movements you move very slowly with your thumb upwards.
  • Try to feel a muscle contracting below your thumb.
  • This is your peroneus tertius. It is located in the lower quarter or third of your lower leg.

6. Self-massage of the Peroneus Longus, Brevis & Tertius

Many techniques, positions and devices are available for the self-massage of this muscle.

On this page, I will show you how to massage these muscles with your hands. As techniques, I apply the precise massage strokes as well as the pressure-motion technique.

6.1 Self-massage of the peroneus longus & brevis with the hands

  • Grasp your lower leg just below the knee.
  •  Place your thumbs side by side, right under the head of the fibula.
  • Press into the muscle and move your thumbs up and down.
  • Seek this way for painful and tense points.
  • Massage each of these points with a few massage strokes. In this case you only move the skin over the muscle, but do not slide over it.
  • Proceed this way for the entire lateral side of your lower leg.

6.2 Self-massage of the Peroneus tertius with the thumb

  • Grasp your lower leg, just above your ankle joint.
  • Place the thumb on the muscle.
  • Look for painful tensions by pushing into the muscle.
  • Massage each of these tensions by moving the muscle.
  • To do this, lift your heel and toes alternately.
  • Concentrate on the most painful parts of the movement without increasing the pain.

References

  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. The Lower Extremities. Baltimore, MD: Williams & Wilkins, 1993. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print