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Peroneal Tendon Tears and Instability

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If there are tears in the tendons, non-operative treatment is limited and surgery is usually recommended to repair the injuries and prevent progressive tendon degeneration.

There are two peroneal tendons, the brevis and longus. The muscle bellies of these tendons are located on the lateral (outside) side of the calf. The tendons travel along the lateral ankle and insert into the bones of the foot. These muscles help stabilize the ankle and function to pull the foot towards the outer or lateral side (eversion). Ankle sprains or similar injuries can often damage the tendons. The strong tissue that keeps them in the proper position behind the fibula may also be torn or stretched (peroneal retinacular tear). This can lead to the tendons slipping out from behind the tip of the fibula (lateral ankle bone). This is termed peroneal tendon instability. Often, no specific injury can be associated with the symptoms and it is more of a chronic problem. The injury to the tendons can vary from mild strains to tears. Over time, tears in the tendons can propagate and become more severe.

Symptoms

Pain and swelling occurs on the lateral side of the ankle around the tip of the fibula. This pain often radiates up the leg and can be associated with a popping or clicking sensation if instability of the tendons is present. Walking on uneven ground or side to side cutting movements often exacerbate the symptoms.

Treatment

Non-operative treatment includes rest, activity modification, immobilization (boot or cast), anti-inflammatory medications, bracing and physical therapy. Commonly, a MRI is obtained to evaluate the injury. If there are tears in the tendons and/or retinaculum, non-operative treatment is limited and surgery is usually recommended to repair the injuries and prevent the progressive degeneration of the tendons. There are many different surgical options depending on the individual pathology. During the surgery, the severity of the tears often dictates which procedure is performed. Post-operatively, a cast is usually worn for several weeks, but weight bearing is allowed. Physical therapy is also required to improve tendon gliding, strength, and range of motion.