Peroneal Tendons
The peroneus longus and peroneus brevis are two very important muscles in the leg, which become tendons in the ankle and attach to the bones in the foot. They are located behind the fibula bone on the outside of the ankle and course along the lateral side of the foot. These tendons have functionally important roles in the biomechanics of the foot and ankle. Particularly, these tendons function to increase stability at the ankle joint, which is very important for exercise or even for standard walking in patients who have recurrent ankle sprains. An ankle sprain can cause damage to the peroneal tendons by overstretching them. Severe ankle sprains can lead to permanent damage by causing tears of the lateral ankle ligaments and peroneal tendons, which leads to even more sprains or chronic ankle instability.
In patients with cavus (high-arch) feet (see section on cavus feet) who don’t experience severe sprains or ankle instability, the peroneal tendons, which serve to stabilize the ankle, may still become injured or overworked. As a person with a high arch tends to walk on the outside border of the foot, the peroneal tendons stabilize the foot to keep it from rolling outward and preventing ankle sprains. This can lead to soreness or painful spasm of the tendons and sometimes even tears. Often times, in order to appropriately repair peroneal tendon damage, the cavus shape of the foot must be addressed as well with realignment.
Peroneal tendon pathology can cause symptoms of weakness at the ankle, feelings of instability, recurrent ankle sprains, swelling or popping behind the fibula bone, or pain on the side of the ankle and the foot.
The peroneal tendons can be seen popping in and out the their groove behind the fibula bone which can cause pain.
Conservative Treatment
Sometimes peroneal tendon issues will respond to conservative treatment. A brace or an insole to offload stress on the tendons can be beneficial. Some patients will find that the pain and swelling may respond to anti-inflammatory medications or ice therapy. Topical anti-inflammatories can also be used directly on the skin overlying the tendons to deliver a localized effect. Physical therapy may be useful to strengthen the tendons and decrease symptoms of ankle instability.
Tendon split tear into two halves followed by suture repair to restore shape and function
Surgical Intervention
If conservative treatment fails to offer relief, then surgery may be beneficial. There are several different procedures to address peroneal tendon problems. Most of the time, the tendons can be saved and can be repaired primarily. Occasionally, one of the tendons may be so severely damaged that it must be connected to or transferred to the other tendon. In cases with severe tissue degeneration of both tendons, then a tendon transfer from another part of your foot, or an allograft tendon (tendon from a donor) reconstruction may beneficial. Other contributing foot problems may be addressed simultaneously, such as deepening the groove where the tendons course behind the fibula bone to decrease pressure on the tendons or help the tendons track appropriately. Patients with excessively high arches may be more prone to ankle sprains and recurrent peroneal tendon tears. In these patients, it may be recommended to correct the high arch (see cavus foot) to keep the problem from recurring.
tendon with synovitis (inflammatory tissue)
brevis tendon split in half with longus tendon in the middle of the tear
swollen diseased tendon
tendon with synovitis (inflammatory tissue)
After Surgery
The timing of recovery will depend on the findings at the time of surgery. The operation is generally done on an outpatient basis. Many patients choose to have a nerve block performed to help with postoperative pain control. Much of the time immediately after surgery is spent resting and elevating the leg to decrease pain and swelling. We generally recommend you keep your leg elevated as much as possible during the first week after surgery. The ankle is usually immobilized for 2-6 weeks to promote healing. Sometimes, it is important not to put weight on the ankle, and using crutches or a rolling knee scooter can help with mobilization. You will be discharged home in a splint and then we will see you in office to check your incision around two weeks. Typically, at 4-6 weeks following surgery patients can start weigh-bearing in a walking boot. Patients wear the boot for about 4-6 weeks as they transition back to weight bearing and begin range of motion exercises. Physical therapy can be an important component of the recovery from peroneal tendon surgery, and is usually commenced at 3-6 weeks.
Peroneal Tendons with inflammation and synovitis