Peroneal tendon pathologies are frequently overlooked yet important causes of lateral ankle and hindfoot pain. Trauma, chronic lateral ankle instability, malalignment, accessory muscles and tendons, os peroneum, systemic diseases, and medications constitute the major risk factors. The clinical spectrum ranges from tendinitis, tendinosis, and tenosynovitis to longitudinal tears, subluxation/dislocation, painful os peroneum syndrome, and full-thickness ruptures. Careful history-taking and physical examination, along with magnetic resonance imaging (MRI) and dynamic ultrasonography (USG), play key roles in diagnosis. While conservative treatment may be effective in the early phase, chronic cases frequently require surgical intervention. In recent years, endoscopic/ tendoscopic techniques, minimally invasive groove-deepening procedures, and biological therapies such as platelet-rich plasma (PRP) have gained prominence. This review provides a comprehensive overview of the anatomy and biomechanics, clinical presentation, diagnostic approach, conservative and surgical treatment options, as well as recent advancements from 2020 to 2025 in the management of peroneal tendon pathologies.