The peroneal tendons, located along the outer edge of the lower leg, provide stability and function to the ankle joint. Injuries to the peroneal tendons are typically due to repetitive stress. Peroneal tears may be caused by long-term overuse or trauma, and can either occur suddenly or develop over time. These tears are usually characterized by pain, swelling, and weakness or instability of the ankle. Peroneal tendon dislocations, also known as subluxation, can occur when the tissue holding the tendon in place becomes torn either by injuring or spraining the ankle.

The treatment of peroneal tendon injuries may be surgical or non-surgical. When surgical repair or restoration of the tendon is required, a direct repair of the tendon is usually possible. If there are significant tears of one of the peroneal tendons, then that part of the tendon can be excised and a tenodesis can be performed. When surgical repair or restoration of dislocating peroneal tendons is required, there are two surgical options: retinaculum repair or grooved reconstruction.

Causes

Peroneal tendon injuries usually develop in individuals who participate in sports that require constant movement of the ankles, such as running, baseball, soccer and gymnastics. Peroneal tendon tears occur when the retinaculum, the tissue band that surrounds tendons and keeps them in place, becomes weakened or torn. Peroneal tendon dislocations occur when the retinaculum has become so damaged that the tendons cannot be held in place at all. Peroneal tendon dislocations commonly follow an ankle sprain.

Symptoms

• Ankle pain
• Swelling
• Recurrent popping sensations at the outer edge of the ankle
• Tenderness around the outside of the ankle
• Weakness or instability of the ankle or foot

Diagnosis

In order to accurately diagnose a peroneal tear or dislocation, imaging tests such as an X-ray and MRI scan may be conducted to evaluate the injury. A physical examination of the foot is also performed to assess the extent of pain, instability, swelling and weakness.

Non-Surgical Treatment

• Non-steroidal anti-inflammatory medications
• Immobilization in a splint, brace, or walking boot
• Rest and activity modification
• Physical therapy

Surgical Treatment

• Tenosynovectomy: removing the inflamed and degenerative portion of the tendon to remove pathologic tissue and reduce pain, which can sometimes be performed via a minimally-invasive technique
• Direct tendon repair with sutures: any tears or pathology within the tendon is identified, removed, and sutured directly under visualization
• Tenodesis: suturing the tendon to an adjacent healthy tendon to augment the strength of the injured tendon
• Peroneal retinaculum repair: repairing the soft tissue bands that hold the tendons in place
• Groove deepening: creating a deeper tunnel for the tendon to glide in to prevent tendon dislocations

Surgical procedures are chosen based on a thorough history and physical examination, x-rays, and often an MRI or CT scan. These imaging modalities help to evaluate the integrity of the peroneal tendons and any associated pathology, as well as the morphology of the bone that the tendons glide behind. Therefore, recovery from surgery varies. Post-operative protocol will include ambulation in a walking boot at one of the spectrum to a period of immobilization and non-weight bearing of the affected extremity on the other end of the spectrum. Recovery will also include directed physical therapy to regain strength, balance, and range of motion.