What Athletes Should Know about Peroneal Tendon Injuries

Ankle pain. Tenderness and swelling. Recurrent popping sensations. Weakness and instability.

These ailments might seem common among athletes—and you might feel inclined to “toughen up” and push through the pain when they occur. But if you play a sport that requires constant motion (think running, football, soccer, baseball or basketball) and are experiencing these symptoms, you might have an injury that’s commonly misdiagnosed: a peroneal tendon tear or dislocation.

Peroneal tendon injuries might occur alone or, as with the case of Dallas Cowboys’ LB Jaylon Smith, be the result of a host of damages caused by athletic play. Regardless, tears and dislocations can require surgery and physical therapy—putting you on the sidelines for weeks or months. Here’s what you need to know:

What are peroneal tendons?

Peroneal tendons are important. They run along the outer edge of the lower leg—just behind the ankle bone—and work to keep the ankle joint stable. The tendons are housed by a liagamnet  called the retinaculum, which keeps them protected and in place.

How do the tendons get damaged?

There are two common peroneal tendon injuries: tears and dislocations. Tears can happen suddenly or develop over time, usually as the result of lengthy overuse or trauma. If the protective retinaculum becomes weak, the tendons are not reduced as well as they should be, and  can tear. Sometimes the retinaculum becomes so damaged that it can’t function at all—which can eventually lead to a dislocation. This type of injury usually follows a severe ankle sprain.

How do I know if I have a peroneal tendon injury?

It will definitely hurt—but the symptoms are similar to that of other injuries. Since it can be difficult to diagnose peroneal tendon damage, it is important to seek a professional opinion. In our clinic, we couple imaging such as X-rays and MRI scans, with physical examinations to evaluate levels or pain, instability, swelling and weakness.

What are my options after a tear or dislocation?

In the event of an injury, there are two surgical options: tendon repair for tears, and retinaculum repair and groove reconstruction for dislocations. Tendon repair involves suturing the longitudinal tear. Retinaculum repair involves advancing and suturing the torn retinaculum firmly back in place. This can be combined with groove reconstruction which involves moving the tendons so that they are reduced behind the fibula. In some instances, all three procedures take place. Following surgery, you will be in a cast for 2 weeks. After that, a walking boot will be needed for up to 4-6 additional weeks. You will also require physical therapy to completely recover.

Surgery is not the only option, however. Conservative methods, including nonsteroidal medications, physical therapy, and the help of splints, braces, or casts have proven effective in some cases.

The bottom line is that some athletes are more susceptible to peroneal tendon injuries than others. Understand the symptoms, and don’t hesitate to reach out if you feel your tendons have torn or dislocated.