Peroneal tendon tears: a retrospective review

doi:10.1016/S1067-2516(03)00314-4

The Journal of Foot and Ankle Surgery

Volume 42, Issue 5, September–October 2003, Pages 250-258

https://doi.org/10.1016/S1067-2516(03)00314-4 Get rights and content

Abstract

Tears of the peroneal tendons are not uncommon but remain an underappreciated source of chronic lateral ankle pain. The purpose of this study was to identify the typical patient profile and nature of the injury, to analyze the course of treatment, and to determine the prevalence of complications seen with surgical repair. Forty patients with chronic pain over the peroneal tendons from the Foot and Ankle Institute at the Western Pennsylvania Hospital underwent peroneal tendon repair. During a 3-year period, a retrospective review was performed by evaluating medical records, surgical reports, and radiographs. The average patient age was 42 years (range, 13 to 64 years). The most common cause was an ankle sprain or other traumatic injury (58%). Peroneus brevis tears (35 patients; 88%), peroneus longus tears (5 patients; 13%), combined peroneus brevis and longus tears (15 patients; 37%), low-lying peroneus muscle belly (13 patients; 33%), lateral ankle ligamentous disruptions (13 patients; 33%), and peroneal subluxation (8 patients; 20%) were identified during surgery. The average follow-up was 13 months (range, 9 to 40 months). Ninety-eight percent of the patients were able to return to full activities without pain at final follow-up. The minor complication rate (transient symptoms) was 20%. Clinically significant (major) complications (continued symptoms or revisionary surgery) occurred in 10% of patients. This study indicates that lateral ankle ligamentous incompetence, combined peroneal brevis and longus tears, and low-lying peroneus muscle belly commonly coexist in patients with peroneal tendon injuries. Appropriate surgical intervention of peroneal tendon tears and their coexisting pathology yields successful and predictable results with few clinically significant complications.

Section snippets

Materials and methods

Forty patients from the Foot and Ankle Institute of Western Pennsylvania at the Western Pennsylvania Hospital (Pittsburgh, PA) who underwent a surgical repair of a peroneal tendon tear were reviewed. All of these patients underwent surgical repair because of longstanding symptoms associated with a peroneus brevis and/or longus tendon injury. Four individual surgeons performed the surgeries during a 3-year period. A retrospective review was performed to obtain objective data from patient

Clinical results

Peroneal (peroneus brevis and/or longus) tendon repair was performed on 30 female and 10 male patients, with an average age of 42 years (range, 13 to 64 years). Twenty-three (58%) patients recalled a history of a traumatic injury, whereas 17 patients (42%) could not recall any specific event. Various mechanisms of injury were reported, all of which had an insidious onset of lateral ankle symptoms: ankle sprains (14 patients; 61%), ankle fractures (2 patients), work-related injuries (2

Discussion

In the largest retrospective study of its kind, this study evaluated 40 patients with a surgically confirmed peroneus brevis and/or longus tendon tear. Fifty-eight percent of patients with a peroneal tendon tear had a history of injury, whereas 42% of the patients denied any traumatic history. The most common precipitating traumatic event was an ankle sprain (61%). Krause et al (3) found similar results: 55% of their patient population had a traumatic event and 45% had an unknown cause of the

Conclusion

Physical signs such as tenderness on palpation in the fibular groove, edema along the tendon sheath, and subluxation are diagnostic of peroneal tendon pathology. These injuries are frequently overlooked and misdiagnosed because of the vague nature of symptoms. In addition, lateral ankle ligamentous injuries commonly coexist in these patients. The mechanisms of these injuries are not completely understood. However, the authors believe that peroneal tendon injuries are not independent of each

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Cited by (162)

The tendon of the fibularis brevis muscle – Systematic overview and new classification system
2024, Annals of Anatomy
The fibularis brevis muscle belongs to the lateral compartment of the leg. It originates from the lower two-thirds of the lateral surface of the fibula bone and it also is attached to the anterior intermuscular septum. Its insertion is normally located on the tuberosity at the base of the fifth metatarsal bone, on its lateral side. However, distal attachment of this muscle is morphologically variable. Different variations have been identified and some classification systems have been created for both adults and foetuses. Based on various literature references, we have created a new classification system and compared the frequency of each type. The main aim of this review is to present morphological variations of the fibularis brevis tendon with their clinical significance, especially in autografting in case of surgical treatment of fibularis brevis tendon rupture. The clinical aspect of this pathology and some medical cases will also be presented.
Peroneal tendon injuries
2024, Orthopaedics and Trauma
The peroneal tendons work to both evert the foot and stabilize the hindfoot on plantarflexion and push off. The tendons are frequently injured as part of sprains and soft tissue injuries to the ankle joint, but diagnosis and treatment are often delayed. Athletes participating in activities with repetitive ankle motion, particularly those involving cutting and twisting movements, as well as those with certain anatomical features, are prone to peroneal tendon injury. Often synovitis and low-grade tendinopathy of the peroneal tendons can be managed with physiotherapy and bracing. Large longitudinal tears, rupture, and subluxation or dislocation of the tendons from the retromalleolar groove are more likely to be treated operatively, although pre-surgical rehabilitation will still be useful in chronic cases. Other surgical procedures can be combined as part of an effective treatment plan such as ankle arthroscopy, ligament stabilization and realignment procedures such as a lateralizing calcaneal osteotomy and Barouk–Rippstein–Toullec first metatarsal elevation osteotomy for non-neurogenic cavus. Persistent weakness in the peroneal tendons post injury may contribute to worsening hindfoot varus deformity: in turn, this leads to further stress on peroneus brevis which can lead to its rupture and consequently further deformity if untreated.
Is Subtle Cavovarus a Problem for Athletes?
2023, Foot and Ankle Clinics
[Translated article] Relationship between low lying peroneus brevis muscle belly and peroneal tendons dislocation
2023, Revista Espanola de Cirugia Ortopedica y Traumatologia
Peroneal tendon pathologies are an important cause of pain in the lateral aspect of the ankle. It has been proposed in the literature that low lying peroneus brevis muscle belly occupies more space in the retromalleolar groove and could cause laxity of the superior retinaculum which would promote tendon dislocation, tenosynovitis or ruptures. The objective of the study is to characterise the population with low lying peroneus brevis muscle belly and determine the association between the low lying peroneus brevis muscle belly found on magnetic resonance imaging and clinical peroneal tendon dislocation.
A case–control study was developed with a sample of 103 patients. The cases were patients with low lying peroneus brevis muscle belly and peroneal dislocation and the controls were patients with normal implantation of the peroneus brevis muscle and peroneal tendon dislocation.
The prevalence of clinical peroneal dislocation in patients with low implantation of the peroneal brevis muscle belly was 7.64%, and the prevalence of clinical peroneal dislocation in patients with normal implantation of the peroneus brevis muscle belly was 8.88%. The OR was 0.85 (CI 0.09–7.44, p = 0.88).
Our findings indicate that there is no statistically significant relationship between low lying peroneus brevis muscle belly and clinical dislocation of the peroneal tendons.
Las patologías de los tendones peroneos son una causa importante de dolor en la región lateral del tobillo. Se ha propuesto en la literatura que la implantación baja del vientre muscular del peroneo corto ocupa más espacio en el surco retromaleolar y podría causar laxitud del retináculo superior asociándose a luxación de los tendones, tenosinovitis y/o roturas. El objetivo del estudio es caracterizar la población con implantación baja del vientre muscular del peroneo corto y estudiar la asociación entre la implantación baja del vientre muscular del peroneo corto visualizado en la resonancia magnética y la luxación de los tendones peroneos.
Se desarrolló un estudio de casos y controles con una muestra de 103 pacientes. Los casos fueron pacientes con luxación de los tendones peroneos e implantación baja del vientre muscular del peroneo corto y los controles pacientes con luxación de los tendones peroneos e implantación normal del vientre muscular del peroneo corto.
La prevalencia de luxación clínica de los tendones peroneos en pacientes con implantación baja del vientre muscular del peroneo corto fue de 7,64%, y la prevalencia de luxación clínica de los tendones peroneos en pacientes con implantación normal del vientre muscular del peroneo corto fue de 8,88%. El OR fue de 0,85 (IC 0,09-7,44, p = 0,88).
Nuestros hallazgos sugieren que no existe una relación estadísticamente significativa entre la implantación baja del vientre muscular del peroneo corto y la luxación clínica de los tendones peroneos.
Diagnosis and treatment of peroneal tendon disorders
2023, Orthopaedics and Trauma
Peroneal tendon disorders are a common cause of lateral hindfoot pain and dysfunction that are often overlooked and misdiagnosed. Disorders can be divided into instability, inflammation and tears but often occur concurrently or as a result of each other. A detailed history and examination is required with an early level of suspicion as there are several differential diagnoses with similar presentations. Investigations such as ultrasound and MRI are useful to confirm diagnosis. Understanding of the pathophysiology and evidence-based management of peroneal disorders is mostly backed by opinion-based medical literature. The majority of acute disorders can be managed non-operatively with rest and physiotherapy but in many cases arthroscopic or open surgery is needed. If not managed appropriately the problem can become chronic and very challenging to treat. Early recognition of the characteristic clinical findings and the appropriate use of investigations and treatments is therefore essential to prevent this. This review article focuses on current understanding of common peroneal tendon pathologies, their diagnosis and treatment.
Peroneal Pathology in the Athlete
2023, Clinics in Podiatric Medicine and Surgery

View all citing articles on Scopus

¹: Surgical Resident, Division of Foot and Ankle Surgery.

²: Surgical Resident, Division of Foot and Ankle Surgery.

³: Member, Residency Training Committee.

⁴: Chief, Division of Foot and Ankle Surgery.

⁵: Director of Residency Training Programs, Division of Foot and Ankle Surgery.

View full text

Original researchPeroneal tendon tears: a retrospective review

Abstract

Section snippets

Materials and methods

Clinical results

Discussion

Conclusion

J Foot Ankle Surg

J Foot Ankle Surg

Further evidence of attrition in the human body

Am J Anat

Peroneus brevis tendon tearspathophysiology, surgical reconstruction, and clinical results

Foot Ankle Int

Characterization of patients with primary peroneus longus tendinopathya review of twenty-two cases

Foot Ankle Int

Lateral ankle instability associated with dislocation of the peroneal tendons treated by the Chrisman-Snook procedure. A case report and literature review

Am J Sports Med

Peroneus longus and brevis tendon tearsMR imaging evaluation

Radiology

MR features of longitudinal tears of the peroneus brevis tendon

Am J Roentgenol

MR imaging of peroneal tendon disorders

Am J Roentgenol

Peroneus quartus muscleMR imaging features

Radiology

Chronic peroneus brevis tendon lesions

Foot Ankle

Original research
Peroneal tendon tears: a retrospective review