Peroneal tendon injuries

Abstract

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.