There are three peroneal tendons: peroneus brevis, peroneus longus, and peroneus tertius. The lattermost is rarely injured. The other two tendons are more commonly injured during severe ankle sprain.
How does a peroneal tendon injury occur?
Peroneal tendon injuries can happen acutely or develop slowly over time. Sports that involve repetitive ankle motion, such as running, are prone to this type of injury. A strong force or chronic irritation can tear the peroneal tendons. The anatomy of each individual can contribute to damaging the peroneal tendons. For instance, a low-lying muscle belly can cause the tendons to pop out of the supporting ligaments that hold them in place.
What are the symptoms of a peroneal tendon injury?
Patients usually present with acute or chronic pain and swelling localized to the lateral ankle. The tendons are tender to palpation and there is pain with weightbearing activities. If there is damage to the peroneal retinaculum (band of tissue that holds the peroneal tendons against the ankle), the peroneal tendons can dislocate out of its normal anatomic position. This will cause ankle joint instability that can result in twisting injuries to the ankle.
What is the treatment?
Peroneal tendon tears or recurrent dislocations are challenging to manage without surgical intervention. Immobilization, braces, physical therapy and anti-inflammatory medications may temporarily relieve symptoms, but they routinely recur when the patient returns to pre-injury activity levels. In these cases, surgery is almost always necessary.
Surgical options include:
Tendon debridement. In this procedure, the surgeon divides the sheath around the tendon and clears away degenerated and irritated tissue.
Tendon repair. The surgeon divides the sheath around the tendons and, depending on the length of the tear, either removes the torn portion of the tendon or sutures the tear along the length of the tendon.
Recovery usually involves several weeks of immobilization, followed by therapy to restore strength and range of motion. Total recovery time is typically six to twelve weeks depending on the the surgery involved. As with all surgical procedures, recovery varies from to patient to patient.
