Ankle > Peroneal Tendon Disorders

What are the Peroneal Tendons?

Your have two peroneal tendons, the peroneus longus and peroneus brevis. Both travel down the outside of your lower leg and are held in place in a groove behind your small lower leg bone (fibula) on the outside of your ankle. If you touch the area behind the bony knob on the outside of your ankle (lateral malleolus), you can feel your peroneal tendons. The peroneal tendons attach the muscles on the outside of your calf (peroneal muscles) to your foot bones. The peroneus brevis attaches on the outside part of your foot to a bone called the fifth metatarsal. The peroneus longus travels under the foot and attaches on the base of a bone on the inside of your foot called the first metatarsal.

The three most common types of peroneal tendon disorders that affect athletes and active people are:

   Tendinitis – Though chronic tendinitis is relatively rare in the peroneal tendons, some patients have microtears or inflammation in the sheath surrounding the tendons or in the tendon itself.

   Tendon dislocation – Your peroneal tendons may pop out of their groove on the outside of your ankle. The tunnel that holds the tendons in their groove, called the retinaculum, can become loose or tear off the bone, and the tendons can dislocate. As the dislocated tendons pop over your anklebone, the tendon can become damaged.

   Tears – A strong enough force or chronic irritation can actually tear your peroneal tendons. Tears also can occur as a result of a tendon dislocation if the tendon rubs too hard against your anklebone surface.

Your peroneal tendons typically suffer tendinitis or tears when your ankle bends too far inward (inversion). The peroneal tendons can pop out of the groove on the outside of your ankle, when your foot is bent too far upward (dorsiflexion) and tilted outward (eversion). If the tendons return to position, it is known as subluxation. If the tendons remain out of the groove, it is a dislocation. Cutting sideways, stepping on uneven ground, and falling forward over the ball of your foot may cause your ankle to twist inward, damaging your peroneal tendons. Sports such as soccer and football that are played on uneven fields can cause peroneal tendon disorders. Running on trails or uneven streets, or falling forward while skiing, can also put you at risk. You may be predisposed to injuring your peroneal tendon if you have an abnormal foot alignment called a hindfoot varus. This means that the natural alignment of your heel (hindfoot) and ankle is slightly inverted. People with a hindfoot varus are at a higher risk of inverting their ankles during activities.

Considerations

Most dislocated or torn peroneal tendons do not heal if left untreated, and you may continue to have pain while activities become increasingly difficult. Though there is no definite risk of bone deformity, the longer you wait to visit your physician after the injury, the more damage you could do to your tendon and the harder it may be to properly treat your peroneal tendon disorder. If you have tendinitis and minor pain in your ankle, you usually can treat your tendon disorder with relative rest and ice. As the severity of your injury increases, you may need to wear a cast. Torn tendons or tendons that do not heal in a cast may require surgery to repair the tendon. If your peroneal tendon is dislocated, you may need surgery to repair the retinaculum tissue that holds your tendon in the proper groove. The links to the left explain standard peroneal tendon treatments in detail.

Though many people with mild or moderate ankle pain feel they can treat themselves at home, you should have your ankle evaluated by a physician, who can check for complications and decide on a specific treatment program for your ankle. There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

MEDICAL HISTORY

Your physician likely will ask about your activities, which may have caused your peroneal tendon disorder. You will probably be asked when the soreness or pain began. If you have had any prior ankle injuries, your physician will ask about the treatments you have tried in the past. You should reveal any relevant ankle surgery information at this time. Your physician may suspect a peroneal tendon disorder if you have a history of ankle sprains, or if you suffered an ankle sprain a few months ago but still feel pain in the outside or back of your ankle. Inform your physician of any persistent snapping sensations or pain in the outside of your ankle. You also may be asked about other conditions, such as diabetes and allergies, and medications currently being taken, and about your physical and athletic goals – information that will help decide what treatment might be best for you in achieving those goals.

During the physical exam, your physician typically looks for swelling and tenderness along the peroneal tendons on the outside and back of your ankle. Your physician may ask you to turn your ankle outward against resistance to check your strength. Your ankle usually is moved while your physician touches the back of it, between your Achilles tendon and the outer bony knob. The damaged peroneal tendon usually can be felt popping over your outer anklebone.

TESTS

Physicians ordinarily have X-rays taken of your ankle, and if they suspect a peroneal tendon disorder, they may order MRI (magnetic resonance imaging). MRI gives your physician a better look at the tendon itself to see if there are any tears. It can also help determine if your peroneal tendons are in the proper groove, or if they are slightly dislocated.