Peroneal Tendon Tearing ( Peroneal Tendon Attenuation)

Peroneal tendon tears are often times associated with a history of ankle sprain or noted in a person with a high arch.

Peroneal Tendon injuries:

Persistent pain to the outside portion of the ankle occurring after an ankle injury may indicate that there has been an injury to the peroneal tendons.

The peroneus brevis and peroneus longus are considered lateral compartment muscles of the leg that function to stabilize the foot during walking. The peroneus brevis muscle attaches to the fifth metatarsal bone and the peroneus longus attaches on the bottom of the foot on the first metatarsal bone. Both of these muscles work to stabilize the foot during different portions of the walking cycle. The peroneus brevis is the main tendon that helps maintain the heel bone in a straight position.

There are numerous ways that the peroneal tendons can become injured including chronic stress to the tendons in patients with high arches as well as acute trauma that is encountered in an ankle sprain. It appears that ankle sprains may be the most frequent way these tendons are injured. An ankle sprain is a dislocation force that is applied to the ankle that can lead to soft tissue or bone injury.

Suspicion for a peroneal tendon injury must be high in anyone having persistent pain following the course of the tendons beyond eight weeks after the injury. During an ankle sprain a tremendous amount of force and stretch is place on the peroneal tendons as they course along the outside of the ankle. The force generated by twisting the ankle and the subconscious firing of these muscles to help correct the foot at the time of injury can cause tearing to the tendons. When someone thinks of a “tendon tear” the natural tendency is to think of an acute total tear of the tendon like that of the Achilles tendon. Tears to the peroneal tendons however, typically occur along the length of the tendons. These longitudinal tears can cause persistent tendonitis symptoms and ultimately lead to weakness, tendon lengthening and an inability of these tendons to maintain the heel bone in a straight position. Injuries to these tendons can also be associated with ankle instability as well as peroneal tendon dislocation.

The clinical examination is consistent for pain to palpation along the course of the peroneal tendons and is often times associated with swelling to the outside ankle as well as possible weakness during manual muscle testing. X-rays are of limited benefit but MRI if indicated is highly accurate in indentifying any abnormality to the tendons.

Treatment for any significant ankle sprain is important with the use of CAM boot or ankle brace during its acute stage and then advancing to additional supportive ankle bracing as activities advance. When peroneal tendon injury is suspect it is important to stabilize the foot at the ankle region with the use of an ankle brace. For a patient with a high arch it is important not only to use an ankle brace but often times the use of an orthotic with appropriate padding to decrease the stress on the peroneal tendons is needed.

The pain associated with peroneal tendon tears is difficult to manage with conservative care measures. Surgical repair of the tendons may be required and can range from simple tendon repair with suture, deepening the bony groove along the fibula bone, osteotomies of the heel bone to correct for a high arch and even ankle stabilization procedures if ankle instability is experienced.

Successful outcomes in many foot and ankle related injuries are improved with early diagnosis and treatment. Although infrequent, pain to the outside portion of the ankle that is persistent must evaluated for peroneal tendon disorders.