Peroneal Tendonitis
Pain to the outside region of the foot and ankle following the course of the peroneal tendons. Usually associated with previous ankle sprain or a person with a high arch.
Symptoms
- Pain to the outside region of the foot and ankle with initial weight bearing activity
- Swelling oftentimes noted to the outside region of the heel bone
- Possible change in the heel position if tearing of the peroneal tendons has occurred related to previous ankle injury
Radiology
- Regular x-ray usually are not of benefit to the diagnosis unless the heel bone position is turned in related to tearing of the peroneus brevis tendon
- MRI will show suspected tearing to both of the peroneal tendons
Treatment
- Shoe with wide base of support with outsole wide to decrease the potential tendency to have the heel bone invert or turn in
- Possible use of over the counter or custom orthotic with additional padding to decrease the tendency of the heel bone invert or turn in
- Ice twice daily
- Non Steroidal anti-inflammatory medications
- Possible use of CAM boot to decrease the stress through the peroneal tendons
Peroneal Tendon Attenuation
Peroneal tendon tears are often times associated with a history of ankle sprain or noted in a person with a high arch.
Symptoms
- Pain to the outside region of the foot and ankle with initial weight bearing activity
- Swelling often times noted to the outside region of the heel bone
- Possible change in the heel position if tearing of the peroneal tendons has occurred related to previous ankle injury
Radiology
Regular x-rays are not usually of benefit unless the heel bone position is turned in related to tearing of the peroneal tendons.
MRI: will show suspected tearing to both of the peroneal tendons.
Treatment
- Shoe with wide base of support with outsole wide to decrease the potential tendency to have the heel bone invert or turn in.
- Possible use of over the counter or custom orthotic with additional padding to decrease the tendency for the heel bone invert or turn in.
- Lace up or Velcro closure ankle bracing to be worn with shoe
- Ice twice daily
- Non Steroidal anti-inflammatory medications
- Possible use of CAM boot to decrease the stress through the peroneal tendons.
Peroneal Tendon Subluxation
Peroneal Tendon Dislocation (Peroneal Tendon Subluxation)
Peroneal Tendon Dislocation is caused by the rupture of the peroneal retinacular ligament which acts to hold the peroneal tendons behind the ankle bone. This injury generally occurs following an ankle sprain
Symptoms
Intermittent pain above the ankle with or without swelling
“Popping” with dislocation of the peroneal tendons from behind the fibula bone
Pain to direct palpation to the peroneal tendons at the peroneal retinaculum
Diagnosis
Xrays three views of involved ankle of limited value
MRI standard of care but difficult to determine injury to ligament
Visible dislocation of the peroneal tendons with peroneal manual muscle testing
Treatment
Acute ankle sprain: Cast boot (CAM walker) / Aircast / Ice / anti inflammatory medications like ibuprofen and naproxen.
Peroneal Tendon dislocation: Ankle bracing within shoe gear / Ice / anti-inflammatory medications
Surgical Repair
