Peroneal Tendon Injuries

Commonly the result of repetitive sports injuries causes pain, instability, and weakness on the outer side of the ankle.

A tendon is a band of tissue that connects a muscle to a bone. The two peroneal tendons in the foot 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.

Three 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 – is an inflammation of one or both tendons
• Tears – there are two types of peroneal tears:
  • Acute tears – caused by repetitive activity or trauma. 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 – 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.
• Subluxation – means one or both tendons have slipped out of their normal position
  • 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. Dr. Marc Frankel at Frankel Foot & Ankle brings 20 years of expertise to  the treatment of complex peroneal injuries. Making an appointment to evaluate your injury is highly recommended.

To diagnose a peroneal tendon injury, Dr. Frankel 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 or other advanced imaging studies may be needed to fully evaluate the injury. He will also look for signs of an ankle sprain and other related injuries that sometimes accompany a peroneal tendon injury. Proper diagnosis is important because prolonged discomfort after a simple sprain may be a sign of additional problems.

Nonsurgical 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 anti-inflammatory drugs may help relieve 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.
  
  

When is surgery needed?

In some cases, surgery may be needed to repair the tendon or tendons and perhaps the supporting structures of the foot. Your 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.