Ankle > Peroneal Tendon Disorders > Treatments

    Surgical Tendon Repair

Treatment Introduction

Surgery typically is prescribed to treat tears in your peroneal tendon. Your surgeon also can repair the tissues that hold your peroneal tendons in the tunnel behind the outside of your anklebone (lateral malleolus). If you continue to have ankle pain after four to six weeks of conservative treatment, you may become a candidate for surgery to treat your peroneal tendon disorder. Repairing your peroneal tendons usually requires open surgery, but many patients leave on the same day after surgery.

Preparing for Surgery

If you and your physician have decided on surgery to treat your peroneal tendon disorder, the decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Prior to your return home from the hospital, make sure that you have received any equipment you will need when you get home. This may include crutches or household items to make movement around the house easier. You should receive prescriptions for any of these from your doctor before you go home from the hospital.

   Any physical problems or changes in your overall health, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any new medications you are taking.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   If possible, practice walking with your crutches so you are ready to use them after surgery.

   Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your operation. There may be separate check-in areas for ambulatory outpatient (patients go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your doctor or one of his assistants about this. After you have checked in to the hospital, you will go to a holding area where the final preparations are made. The mandatory paperwork is completed, and your ankle may be shaved, though this is not always necessary. You will be asked to change into a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or one of his assistants and meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). An IV (intravenous) line may be inserted into your arm at this time. You will then walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important things to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general or regional anesthesia.

   Since you will most likely be able to go home within a few hours of surgery, arrange for someone to drive you home when you are released.

   Wear a loose pair of shorts, sweatpants, or other clothing that will fit comfortably over your short leg cast or splint when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Surgery Procedure

Surgically repairing your peroneal tendons usually takes 1-1 1/2 hours to perform. Spinal anesthesia is given to numb you from the waist down, and you are sedated so that you sleep through the procedure.

   An incision approximately 12 centimeters long is made along the outside of your ankle, along your peroneal tendons.

   Surgeons open up the sheath surrounding your peroneal tendons and inspect the tendons for any longitudinal tears.

   If less than 50 percent of the tendon has tears running through it, the tendon tissue usually can be sewn back together with sutures.

   If more than 50 percent of the tendon is torn or frayed, then your surgeon generally performs a procedure called tenodesis. The damaged portion of your tendon is cut away and the remaining portion is sutured to the other peroneal tendon next to it. Because the peroneus brevis is more commonly torn, the most common tenodesis procedure for peroneal tendon disorders involves sewing the end of the peroneus brevis to the intact peroneus longus.

   In some cases when your tendon has dislocated, the tissue that typically holds your peroneal tendons in the tunnel behind your small lower leg bone is loose. Suturing this tissue, called retinaculum, back to itself can tighten the tendon tunnel. A tighter tunnel helps prevent future tendon dislocations.

   The tendon sheath and skin incisions are closed with stitches and your ankle is put into a splint to immobilize it. You are then taken to the recovery room.

After surgical repair of your peroneal tendon disorder, you will be transported to the recovery room, where you will be closely observed for one to two hours while the immediate effects of anesthesia wear off. Your ankle will be immobilized in a splint when you wake up, and your ankle will be elevated. After surgery, you will experience some pain. Adequate pain medications will be prescribed for you. You may be given intravenous (IV), oral, or intramuscular pain medications as needed. Your surgeon will prescribe crutches, and you are usually instructed to keep all weight off your ankle for the first few weeks. Your temperature, blood pressure, and heartbeat will be monitored by a nurse who, with the help of the doctor, will determine when you can prepare to go home. You normally leave the hospital or clinic the same day after surgery, sometimes within four hours. If you experience a lot of pain, you may be admitted for an overnight stay after surgical repair of your peroneal tendons. Make sure to have someone available to drive you home, as you will be unable to drive a car.

Home Recovery

After surgical repair of your peroneal tendon, you may need to be on crutches for about six weeks. Rest as much as possible with your ankle elevated above the level of your heart. This helps blood drain away from your ankle and controls swelling. It is essential to keep as much weight as possible off your ankle. The more weight you put on your ankle, the greater your chances of further damaging the tendon. Household tasks that require you to be on your feet may be difficult for six to eight weeks. It can be helpful to have someone around the house who can help with any physical chores. You will most likely return to your physician’s office within 10 to 14 days to have your sutures taken out and the post-surgery ankle splint replaced by either a short leg cast or a splint called a cam walker.
To keep the cast dry, wrap a plastic garbage bag around the cast while showering, or bathe with your leg out of the tub. You usually can bear some weight while wearing the cast or cam walker for about six to eight weeks. Typically, you will return to your physician for check-up visits every two weeks until your tendon has healed. If your ankle was immobilized in a cast, your ankle may be put into a removable cam walker when the cast is removed. In general, you should continue using your crutches and wearing your cam walker as instructed by your doctor until symptoms resolve. Many patients, especially those who had extensive tendon damage, begin weight bearing in a cam walker for an additional three to four weeks. As you go back to normal shoe wear, sometime between eight and 12 weeks after surgery, you may need to wear an air cast in your shoe to help support your ankle. Your physician may suggest physical therapy that can be done at home, or refer you to a physical therapist when your cast comes off.

Recovery from surgical repair of your peroneal tendon typically takes about four months. Your ankle will feel weak when it comes out of the cast and it is important to perform gentle range of motion exercises three or four times a day for three or four weeks after your cast is removed. Physical therapy to strengthen your ankle generally is prescribed sometime after eight to 12 weeks, when your physician has put your ankle into an air cast or you can bear your own weight without much discomfort. If you experience episodes of pain or discomfort while exercising, have your physician examine your ankle. By following a physical therapist’s routine, many patients can return to sports and activities within six months. Physical therapy usually involves learning an ankle stretching routine and performing ankle and lower leg strengthening exercises.

   Ankle stretching exercises

   Ankle strengthening exercises

Prevention

To prevent reinjury to your ankle, you should strengthen your peroneal tendons. Physicians often recommend proprioceptive training, which includes training with a special balance board (BAPS board) that rolls on top of a ball. Increasing your ankle strength and balance can help you better withstand strain on your ankle during activities. The peroneal tendons prevent inward turning of your ankle (inversion) and are responsible for the stability of your ankle. It is difficult to know who may be prone to future peroneal tendon injuries, but people with weak tendons may have a tendency to invert their ankle and suffer an ankle sprain or reinjure their peroneal tendons. Though you usually do not have any restrictions on your activities after surgery, you should be cautious when running on uneven surfaces or engaging in high-velocity sports that may cause twists or falls.