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Peroneal Tendon Injury

What are Peroneal Tendon Injuries?

There are two peroneal tendons in your foot which run side-by-side behind the outer ankle bone. One peroneal tendon attaches to the base of the 5th metatarsal while the other tendon runs under the foot and attaches near the inside of the arch. Their main function is to stabilize the foot and ankle and protect them from sprains.

What Causes Peroneal Tendon Injuries?

Peroneal tendon injuries may be acute or chronic.  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.

Types of Peroneal Tendon Injuries

The three types of peroneal tendon injuries are tendonitis, tears, 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. 
  • Acute tears are caused by repetitive activity or trauma. Immediate symptoms of include pain behind the fibula following a fall, bad tackle or inversion injury, swelling, weakness or instability of the foot and ankle.
  • Chronic Degenerative tears (tendinosis) are usually due to overuse and occur over long periods of time.   The tendon gets overstretched over time and becomes thin and develops degenerative tears. Having high arches also puts the tendon at risk for developing a degenerative tear. The symptoms of degenerative tears may include occasional pain on the outside of the ankle, weakness or instability in the ankle, an increase in the height of the arch, with pain radiating up the leg on the outer side.
  • Subluxation is when one or both tendons have slipped out of their normal position.  This occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (retinaculum) lead to chronic tendon subluxation. The symptoms include a snapping feeling of the tendon around the ankle bone, sporadic pain behind the outside ankle bone, ankle instability or weakness.

How are Peroneal Tendon Injuries Diagnosed?

Prompt evaluation by a foot and ankle surgeon is advised. The surgeon will examine the foot and look for pain, instability, swelling, warmth, and weakness on the outer side of the ankle. 

In addition, an x-ray and an ultrasound or MRI scan may be needed to fully evaluate the injury. The foot and ankle surgeon will also look for signs of an ankle instability and other related injuries that sometimes accompany a peroneal tendon injury.

What are the Treatment Options?

Non-Surgical Treatment

Treatment depends on the type of Peroneal Tendon Injury. Options include Immobilisation in an aircast boot to reduce ankle movement and provide relative rest to the tendon. Medications like an oral anti-inflammatory can relieve pain and inflammation.  Ice, heat, or ultrasound therapy may be used to reduce swelling and pain. This is followed by targeted Physiotherapy for strengthening the tendons and finally Bracing for a short while or during activities requiring repetitive ankle motion. 

Surgical Treatment

In some cases, surgery may be needed to repair the tendon or tendons and perhaps the supporting structures of the foot. Your surgeon will recommend the most appropriate procedure for the patient’s condition and lifestyle. 

After surgery, physiotherapy is an important part of rehabilitation. There will be a period of immobilisation for 2 weeks in a plaster.  This will be followed by a period in an Aircast boot.  Physiotherapy and rehabilitation can take up to 3-6 months.  Return to sports is usually about 3-6 months.  80-90% will get back to similar level of sport.

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