Tendons are fibrous connective tissue composed of collagen, which is what makes them so strong. Often located around joints, tendons connect muscle to bone. It is the strength and flexibility of the tendons that facilitate the range of motion in joints.
The peroneal tendons, located on the outside of the lower leg and ankle, are the peroneus brevis and the peroneus longus tendons. The peroneus brevis tendon attaches to a bone on the outside of the foot and the peroneus longus tendon courses around the outer foot and attaches to the undersurface of the inner arch . Surrounded and protected by a fibrous tunnel, the peroneal tendons add stability to the ankle joint side to side and especially when on uneven surfaces.
Types of Peroneal Tendon Injuries
There are three basic types of peroneal tendon injuries: tendonitis, tears, and dislocation (subluxation). The most common causes of peroneal tendon injuries are overuse and trauma. Acute injuries are typically the result of trauma that occurs suddenly, while chronic issues develop over an extended period of time and tend to be caused by repetitive ankle movements.
Peroneal tendonitis, which causes pain and inflammation, is often due to sports that require repetitive motion side to side. Peroneal tendonitis usually resolves with rest and immobilization.
Peroneal tendon tears occur either due to a specific twist, or a more chronic repetitive activity. The tears are typically vertical, and a complete rupture is rare.
Peroneal tendon dislocation is the result of damage to the retinaculum ligament that keeps the tendons in the bony groove along the outer ankle. Usually, this is when the foot is forced up and to the side(for example, a caught ski tip.)
Causes of Peroneal Tendon Injuries
Individuals who participate in sports activities like running, basketball, baseball, soccer and gymnastics are especially susceptible to peroneal tendon injuries due to the constant and often high-stress ankle movements required. Some of the other common causes and risk factors for these types of injuries include:
- Trauma, such as a direct hit to the outside of the ankle or foot
- Overuse and/or repetitive movements of the ankle
- Sudden or forceful movements
- Improper training techniques or sudden increase in weight-bearing training or activities
- Footwear that is not properly fitted or supportive
- Excessive pressure on the peroneal tendons due to tight calf muscles
- High arches, which force the peroneal tendons to work harder
- Sprain or fracture in the ankle joint may cause tearing of the tendons
Whether due to trauma or chronic injury, some of the most common signs and symptoms associated with peroneal tendon injuries are:
- Pain in the ankle area
- Tenderness, particularly on the outside of the ankle
- Weakness or instability of the ankle or foot
- Warmth and redness
- Popping or snapping sensations at the outer edge of the ankle while walking
Peroneal tendon injuries are sometimes misdiagnosed, which can delay proper treatment and may cause the condition to worsen. Prompt consultation with a foot and ankle orthopedic surgeon is important. A physical examination to assess the level of pain, instability, swelling and weakness experienced by the patient will usually be followed by imaging tests, such as an X-ray or MRI scan, to fully evaluate the extent of the injury.
Treatment Options for Peroneal Tendon Repair
Treatment options for peroneal tendon injuries range from the conservative, nonsurgical methods designed to reduce pain and improve function while the tendon heals, to the surgical repair of the damaged tendon. Your surgeon’s recommendation for treatment will depend on the severity of the injury.
Anytime there is the potential for healing without surgery, your orthopedic specialist will first recommend more conservative treatment options. The goal will be to reduce pain and discomfort while restoring function and strength to the ankle. These recommendations will likely include some combination of:
- Nonsteroidal anti-inflammatory medications
- Immobilization of the ankle with a walking boot
- Physical therapy
When patients have experienced peroneal tendon tears or dislocations that are unresponsive to nonsurgical treatments, surgery may be necessary to repair or even reconstruct the tendon. Two surgical options for peroneal tendon tear or dislocation repair include retinaculum repair and groove reconstruction.
Retinaculum repair is a procedure designed to restore the retinaculum ligament, the bands of tissue that surround and stabilize the peroneal tendons. During this procedure, an incision is made near the back and outer edge of the fibula (ankle bone). The retinaculum ligament is then repaired and advanced back to the point of original attachment.
Groove reconstruction is a procedure performed to keep the peroneal tendons in place behind the bottom of the fibula. An incision is made near the back and lower edge of the fibula. A small flap is created toward the bottom of the fibula and then carefully folded back, resembling a hinge. A small amount of bone under the flap is removed to deepen the groove. The tendons are then returned to their normal place behind the fibula, and the incision is sutured closed. Groove reconstruction is occasionally performed when the fibula groove is shallow in combination with retinaculum repair.
Post-surgery recovery includes wearing a cast for two weeks, followed by a walking boot for another 4-6 weeks. Physical therapy will be necessary to help patients more quickly regain normal strength and range of movement.
Contact Dr. Hubbard Today For More Information on Peroneal Tendon Repair
If you are experiencing issues with a peroneal tendon, Dr. Christopher Hubbard has the experience and training to provide you with options, designed specifically for you, to give you the very best potential for complete recovery. Contact our office today to discuss your treatment options.