Peroneal tendon injuries involve the two tendons (peroneus longus and peroneus brevis) that run behind the lateral malleolus on the outside of the ankle. These tendons evert and stabilize the ankle, and injuries to them cause lateral ankle pain that is often confused with chronic ankle sprain. Treatment depends on the specific injury pattern, which can include tendinosis, tears, subluxation, or dislocation.
What Are Peroneal Tendon Injuries?
The peroneus longus and peroneus brevis tendons share a common synovial sheath as they pass behind the lateral malleolus. They are restrained against subluxation by the superior peroneal retinaculum.
Common injury patterns include:
- Peroneal tendinosis: degenerative changes within the tendon from chronic overuse
- Peroneal tendon tears: longitudinal splits or partial-thickness tears, most commonly affecting the peroneus brevis
- Peroneal tendon subluxation: the tendons slip out of their groove behind the lateral malleolus during ankle motion, often due to a torn superior peroneal retinaculum after acute eversion injury
- Peroneal tendon dislocation: complete displacement of the tendons over the lateral malleolus, typically from acute trauma
Causes and Risk Factors
- Repetitive ankle eversion and inversion in sports
- Chronic ankle instability with secondary peroneal overuse
- Acute eversion injury for retinaculum tears
- High-arched feet (cavus foot) with hindfoot varus
- Sports requiring cutting and pivoting
- Prior ankle sprain that did not heal completely
Symptoms
- Pain and swelling along the lateral ankle behind the lateral malleolus
- Snapping or popping sensation with ankle motion (for subluxation)
- Tenderness along the tendons
- Pain with resisted ankle eversion
- Symptoms that persist after a typical ankle sprain has healed
- Catching or popping with cutting activities
Diagnosis
Dr. Chudik’s evaluation includes the prior injury history and the pattern of symptoms. Physical examination tests for peroneal subluxation by reproducing the snap with active ankle circumduction or eversion against resistance. Tenderness along the tendons localizes the pathology. MRI characterizes tendinosis, tears, and any retinaculum disruption. Dynamic ultrasound is particularly useful for visualizing subluxation. The Westmont office has on-site high-field MRI.
Treatment
Non-surgical treatment is appropriate for tendinosis and partial tears without significant mechanical symptoms:
- Activity modification and short-term immobilization
- Anti-inflammatory medication
- A targeted physical therapy program for peroneal strengthening, balance, and ankle proprioception
- Functional ankle bracing during sport
- Orthotics for cavus foot in selected cases
Surgical treatment is indicated for significant tears, recurrent peroneal subluxation, and failed non-surgical treatment. Dr. Chudik performs:
- Tendon repair or debridement for longitudinal splits
- Tendon transfer or tenodesis for irreparable tears
- Superior peroneal retinaculum repair or reconstruction for subluxation
- Groove deepening procedures for recurrent subluxation
Recovery and Outcomes
Non-surgical recovery typically takes six to 12 weeks for tendinosis and partial tears. Recovery after surgical repair typically includes four to six weeks of immobilization in a boot, progressive weight-bearing and motion, strengthening over three months, and return to sport at four to six months.
Outcomes are good when the specific pathology is identified and addressed.
When to See Dr. Chudik
Schedule an evaluation if you have lateral ankle pain that has not resolved with sprain treatment, snapping or popping behind the ankle, or persistent symptoms that fit a peroneal pattern. Call 630-324-0402 or request an appointment online.