Peroneal Tendon Injuries

Understanding Peroneal Tendon Injuries

The peroneal tendons run behind the outer ankle bone (fibula) and attach to bones on the outer edge and bottom of the foot. There are two peroneal tendons: the peroneus brevis and peroneus longus. These tendons help stabilize the ankle, prevent it from rolling inward, and assist with pushing off when walking.

Peroneal tendon injuries are often associated with ankle sprains and can be overlooked, leading to chronic ankle problems if not properly diagnosed and treated.

Types of Peroneal Tendon Injuries

Tendinitis: Inflammation of one or both tendons from overuse or repetitive stress
Acute Tears: Partial or complete tearing of the tendon from sudden injury
Degenerative Tears: Gradual breakdown and thinning of the tendon over time
Subluxation: Tendons slipping out of their normal position behind the ankle bone
Dislocation: Complete displacement of the tendons from their groove

Symptoms

Pain along the outer side of the ankle
Swelling behind the outer ankle bone
Pain that worsens with activity
Ankle instability or weakness
A snapping sensation around the ankle (with subluxation)
Warmth to the touch
Pain when turning the foot outward against resistance

Causes and Risk Factors

Ankle Sprains: Especially repeated inversion sprains
Overuse: Repetitive ankle motion in sports or work
High Arches: Creates more strain on peroneal tendons
Improper Training: Sudden increase in activity
Tight Calf Muscles: Increases tendon stress
Improper Footwear: Inadequate support

Diagnosis

Physical Examination: Palpating the tendons, testing strength and stability
Provocative Tests: Specific maneuvers to reproduce symptoms or subluxation
X-rays: Rule out fractures and assess bone structure
MRI: Detailed imaging of tendons to assess tears and inflammation
Ultrasound: Dynamic imaging to see tendon subluxation in real-time

Treatment Options

Non-Surgical Treatment

Many peroneal tendon injuries respond to conservative care:

Immobilization: Walking boot or cast to allow healing
Rest: Avoiding activities that aggravate symptoms
Ice: Reducing pain and swelling
Anti-inflammatory Medications: Controlling inflammation
Physical Therapy: Strengthening and stretching exercises
Bracing: Ankle support during activities
Custom Orthotics: Correcting biomechanical issues

Surgical Treatment

Surgery may be needed for severe tears, chronic tendinitis that doesn't respond to conservative care, or recurrent subluxation:

Tendon Repair: Suturing tears back together
Debridement: Removing damaged tissue
Groove Deepening: Creating a deeper channel to hold the tendons
Retinaculum Repair: Fixing the structure that holds tendons in place
Tendon Transfer: For severe damage, using another tendon to restore function

Recovery and Prevention

Full recovery can take several weeks to months
Physical therapy is important for restoring strength and flexibility
Strengthening the peroneal muscles helps prevent re-injury
Proper ankle support during high-risk activities
Addressing underlying issues like high arches with orthotics