Peroneal Tendon Injuries
The peroneal tendons run on the outside of the ankle just behind the bone called the fibula. Tendons connect muscle to bone and allow them to exert their force across the joints that separate bones. Tendinitis implies that there is inflammation in the tendon. Tendinosis means there is enlargement and thickening with swelling of the tendon. This usually occurs in the setting of overuse, meaning a patient or athlete does a repetitive activity that irritates the tendon over long periods of time.
What Causes A Peroneal Tendon Injury
The history is very important in the setting of peroneal tendinosis. As noted above, these are overuse injuries. People with peroneal tendinosis typically have either tried a new exercise or have markedly increased their activities. Characteristic activities include marathon running or others which require repetitive use of the ankle. Patients will usually present with pain right around the back of the ankle. There is usually no history of a specific injury.
As discussed above, improper training or rapid increases in training and poor shoe wear can lead to peroneal tendinosis. Also, patients who have a hindfoot varus posture, or high arch, may be more susceptible. This is because in those patients, the heel is slightly turned inwards which requires that the peroneal tendons work harder. Their main job is to evert or turn the ankle to the outside, which fights against the varus position. The harder the tendons work, the more likely they are to develop tendinosis.
There are two peroneal tendons that run along the back of the fibula (Figures 1 and 2). The first is called the peroneus brevis. The term “brevis” implies short. It is called this because it has a shorter muscle and starts lower in the leg. It then runs down around the back of the bone called the fibula on the outside of the leg and inserts (i.e. connects) to the fifth metatarsal.. The peroneus longus takes its name because it has a longer course. It starts higher on the leg and runs all the way underneath the foot to insert on the bottom of the first metatarsal. Both tendons, however, share the major job of everting or turning the ankle to the outside. The tendons are held in a groove behind the back of the fibula and have a roof made of ligamentous-type tissue over the top of them called a “retinaculum.”
Symptoms of peroneal tears and peroneal tendinitis include pain along the lateral part of the foot and ankle up to the 5th metatarsal bone, as well as pain with eversion of the foot.
A thorough subjective and objective examination from a can be sufficient to diagnose peroneal tendonitis.
X-rays do not reveal soft tissue abnormalities; however, they are useful for excluding arthritis, bone abnormalities such as pes cavus, or fractures.
In cases where other injuries may need to be ruled out, or conservative treatment is failing, an MRI scan or ultrasound investigation can e used for detecting all types of peroneal lesions.
For the majority of patients, an injury to the peroneal tendon can be treated using non-surgical treatments. Recomended treatments can include:
- RICE (Rest, Ice, Compression, Elevation)
- Activity Modification
- Custom Orthotics
- Physical Therapy
If these modalities fail to help after several weeks an MRI or ultrasound may be ordered to better evaluate the extent of tendon inflammation and tearing.
Peroneal Tendon Surgery
Some injuries to the peroneal tendon can not heal on their own.
A tear in the tendon, depending on how thick and long may need to be surgically fixed.
This is done by making an incision over the area of the tendon that is torn and using sutures to repair the tendon.
An injured peroneal tendon can also be be dislocated or the tendon membrane can be inflamed and damaged. If a tendon has been so badly damaged that it can not be repaired surgically, it will need to be replaced (allograft or autograft).
Surgery can also include repair to other supporting structures of the foot.
The surgical approach will depend on the severity and type of injury. A foot and ankle surgeon will determine the most appropriate surgical approach based on your condition and activity level. Surgery for a peroneal tendons is done under general anesthesia.
At Brooklyn Premier Orthopedics, we also make use of amniotic membrane wraps that help promote healing and decrease adhesions and scar tissue that may form around the tendon.
After surgery you would be placed in a splint with no weight bearing for about 2 weeks. After 2 weeks you can advance to range of motion and ambulating with a boot. At 4 weeks you would begin aggressive physical therapy to get you back to full strength and range of motion.
See A Foot And Ankle Specialist
At Brooklyn Premier Orthopedics, our podiatrist and orthopedic doctors frequently diagnose, evaluate and treat foot and ankle conditions and disorders.
If you have are experienced foot or ankle pain, instability, swelling, warmth or weakness, you should schedule an appointment with a doctor right away. An injured foot or ankle can worsen over time without proper treatment.