Peroneal Tendon injuries

What Are the

Peroneal Tendons?

A tendon is a band of tissue that

connects a muscle to a bone. In

the foot, there are two peroneal tendons.

They run side-by-side behind

the outer ankle bone. One peroneal

tendon attaches to the outer part of

the midfoot, while the other tendon

runs under the foot and attaches

near the inside of the arch. The main

function of the peroneal tendons is

to stabilize the foot and ankle and

protect them from sprains.

Types of Peroneal

Tendon Injuries

Peroneal tendon injuries may be

acute (occurring suddenly) or chronic

(developing over a period of time).

They most commonly occur in

individuals who participate in sports

that involve repetitive ankle motion.

In addition, people with higher arches

are at risk for developing peroneal

tendon injuries. Basic types of peroneal

tendon injuries are tendonitis, tears,

and subluxation.

Tendonitis is an inflammation of one

or both tendons. The inflammation

is caused by activities involving

repetitive use of the tendon, overuse

of the tendon, or trauma (such as

an ankle sprain).

Symptoms of tendonitis include:

• Pain

• Swelling

• Warmth to the touch

Acute tears are caused by repetitive

activity or trauma. Immediate

symptoms of acute tears include:

• Pain

• Swelling

• Weakness or instability of the foot

and ankle

As time goes on, these tears

may lead to a change in the shape

of the foot, in which the arch may

become higher.

Degenerative tears (tendonosis) are

usually due to overuse and occur

over long periods of time—often

years. In degenerative tears, the

tendon is like taffy that has been

overstretched until it becomes thin

and eventually frays. Having high

arches also puts you at risk for

developing a degenerative tear. The

signs and symptoms of degenerative

tears may include:

• Sporadic pain (occurring from

time to time) on the outside of

the ankle

• Weakness or instability in the ankle

• An increase in the height of

the arch

Subluxation – one or both tendons

have slipped out of their normal

position. In some cases, subluxation is

due to a condition in which a person

is born with a variation in the shape

of the bone or muscle. In other cases,

subluxation occurs following trauma,

such as an ankle sprain. Damage or

injury to the tissues that stabilize the

tendons (retinaculum) can lead to

chronic tendon subluxation. The

symptoms of subluxation may include:

• A snapping feeling of the tendon

around the ankle bone

• Sporadic pain behind the outside

ankle bone

• Ankle instability or weakness

Early treatment of a subluxation is

critical, since a tendon that continues

to sublux (move out of position)

is more likely to tear or rupture.

Therefore, if you feel the characteristic

snapping, see a foot and ankle

surgeon immediately.

Diagnosis

Because peroneal tendon injuries are

sometimes misdiagnosed and may

worsen without proper treatment,

prompt evaluation by a foot and

ankle surgeon is advised. To diagnose

a peroneal tendon injury, the surgeon

will examine the foot and look for

pain, instability, swelling, warmth,

and weakness on the outer side of the

ankle. In addition, imaging studies

such as an MRI or ultrasound may be

needed to fully evaluate the injury.

An ankle sprain may sometimes

accompany a peroneal tendon injury.

The surgeon is trained to look for

signs of this and other related

injuries. Proper diagnosis is important

because prolonged discomfort after

a simple sprain may be a sign of

additional problems.

Treatment

Treatment depends on the type of

peroneal tendon injury. Options include:

• Immobilization. A cast or splint

may be used to keep the foot and

ankle from moving and allow the

injury to heal.

• Medications. Oral or injected antiinflammatory

drugs may help

relieve the pain and inflammation.

• Physical therapy. Ice, heat, or ultrasound

therapy may be used to reduce

swelling and pain.As symptoms

improve, exercises can be added to

strengthen the muscles and improve

range of motion and balance.

• Bracing. The surgeon may

provide a brace to use for

a short while or during

activities requiring repetitive

ankle motion. Bracing may

also be an option when

a patient is not a candidate

for surgery.

• Surgery. In some cases, surgery

may be needed to repair the

tendon or tendons and perhaps

the supporting structures of

the foot. The foot and ankle

surgeon will determine the

most appropriate procedure

for the patient’s condition and

lifestyle.After surgery, physical

therapy is an important part

of rehabilitation.