The peroneal tendons connect the muscles outside the lower leg with the outside of the foot. These tendons can cause ankle problems through tendonitis, tears, and instability. How do peroneal tendons cause ankle problems? Learn about these tendons and associated conditions, such as peroneal tendonitis and tear, and what you should do about them.
What are the peroneal tendons?
The peroneal tendons arise from the muscles contained on the outside of the lower leg. The tendons form into two just above the ankle: the peroneus longus and the peroneus brevis. The tendons course on the outside of the ankle and insert into the foot. In general, the action of these muscles and tendons is to evert the foot – i.e., moving the foot in an outward motion.
The peroneal tendons are closely related and sit on top of each other behind the fibula bone. This close relationship is why we often encounter problems with these tendons. The tendons can rub against each other, causing inflammation.
How does a peroneal tendon cause ankle problems?
An acute injury, such as an ankle sprain, or a gradual repetitive injury can damage these tendons. The tendons can be inflamed, torn, or unstable. It is essential to undergo an assessment to determine the exact cause of the peroneal problem, as treatments often vary.
Peroneal tendonitis
This is the most common problem when the tendons are inflamed just behind the fibula bone at the ankle joint. Most cases of tendonitis are caused by overuse. Typical symptoms of peroneal tendonitis include pain and swelling behind the ankle bone. Generally, the tendons are tender to the touch, and stretching them by rolling the foot inward causes pain.
Imaging such as ultrasound and MRI can diagnose swelling of the tendons.
Simple treatments, such as ice, compression, and anti-inflammatory medications, can help reduce swelling. Physiotherapy to strengthen the tendons, calf muscles, and small muscles of the foot will help. Shoe selection and orthotics can help reduce forces on the tendons and alleviate pain. Finally, a cortisone shot into the tendon sheath is helpful for more complicated cases. We must administer this injection with ultrasound guidance to ensure the cortisone is injected into the tendon sheath, rather than the tendon itself.
Peroneal tendon tears
While less common than tendonitis, peroneal tendon tears can occur. Moreover, they are more likely to happen in the peroneus brevis tendon.
Peroneal tendon tears occur for two reasons. First, the blood supply to the peroneus brevis differs throughout the tendon. The blood supply is the poorest in the area near the fibula bone, which reduces the tendon’s healing potential. Second, the peroneus brevis tendon wedges between the peroneus longus and the bone as it wraps around the fibula. This leads to rubbing, friction, and potential tearing.
Overall, we treat peroneal tendon tears the same as peroneal tendonitis. Physical therapy for a peroneal tendon tear is essential. However, we tend to avoid cortisone injections due to the risk of worsening a tear. Instead, we would consider other injections, such as platelet-rich plasma (PRP in these cases. Finally, peroneal tendon tear surgery is an option to repair the tear or suture the tendon to a normal adjacent tendon.
Peroneal tendon subluxation and dislocation
Usually, peroneal tendon subluxation and dislocation occur after an ankle sprain. In most cases, the peroneal sheath, which keeps the tendons in place behind the fibula bone, is torn. This results in the tendons being torn out of their groove, causing severe pain, clicking, or locking. Sometimes, the tendons remain outside their track.
Most doctors use ultrasound to visualise the peroneal tendons moving out of the groove. However, the video below shows a rarer type of dislocation where the tendons switch positions in the track.
Generally, cases of peroneal tendon subluxation or dislocation require surgery to repair the sheath and increase the depth of the groove.
Final word from Sportdoctorlondon
The peroneal tendons hug the outside of the ankle. They can swell, tear or dislocate. It is essential to diagnose a tendon problem and treat it quickly.
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