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In this video, Dr. Bob discusses peroneal tendon injuries and their treatment options.
Peroneal Tendon Tear and Dysfunction
Distinguishing between ankle injuries can be challenging. Fortunately, Dr. Bob Baravarian is a trained trauma expert with decades of extensive experience in treating ankle tendon injuries, including peroneal tendon injuries.
Dr. Bob Baravarian has even taught his peroneal tendon repair techniques to other doctors and clinics.
A peroneal tendon tear occurs when one or both of the bands of tissue in your ankle—the peroneal brevis and peroneal longus—are torn due to injury or overuse. There are several types of tears, each varying in severity, making it crucial to receive an accurate diagnosis and appropriate treatment.
What is peroneal tendon dysfunction?
A peroneal tendon tear is just one of three types of peroneal dysfunction.
- Peroneal tendonitis refers to inflammation of the tendons in the lower leg and ankle.
- Peroneal tendon subluxation (or a strained peroneal tendon) occurs when the tendons are elongated (overstretched) or pulled away from their normal structures.
- Peroneal tendon tears occur when the tendons are partially or completely separated.
All three are predominant causes of ankle instability and pain and can occur from a traumatic ankle injury or chronic stress on the joint.
What is a peroneal tendon tear?
Two tendons in your ankle connect the muscles of your lower leg to your foot, providing stability and strength. They originate from the peroneus longus and brevis muscles near the knee and then run down the outside of the leg, becoming tendons.
The tendons run through the lateral ankle joint to the outer edge of your foot. Along with the fibularis tertius, they create the peroneal muscles. Most injuries occur behind the lateral malleolus, the prominent bone on the outside of your ankle joint, where the tendons form a pulley-like system.
Peroneal tendon tears can result from a traumatic injury, such as an ankle sprain that overstretches the tendons and ligaments. However, they can also arise from overuse, particularly through repetitive activities involving side-to-side movements, like basketball, which consistently place stress on the tendons.
Typically, a chronic use injury arises alongside poor mechanics of the ankle and foot. For instance, if loose tendons rub against the edge of the fibula instead of resting in their usual position behind the bone, they may fray and gradually tear, leading to tendinosis. Moreover, specific foot conditions like high arches can increase your risk for peroneal tendon injury.
Both acute and chronic conditions can result in one or both tendons being torn. It is more common to pull the peroneus brevis tendon than the peroneus longus tendon.
What are the types of peroneal tendon tears?
The cause of a tendon tear is related to its type. There are two types of peroneal tendon tears:
- Acute peroneal tendon tears result from an injury, such as a dislocation, that causes the band of tissue to tear. In most cases of acute tears, you can pinpoint exactly when the ankle pain began.
- Chronic peroneal tears develop gradually over a prolonged period due to ongoing stress on the tendons. Your pain may vary in intensity and can flare up from time to time.
In addition, you can have a mild to severe tear of the tendon, usually classified as grades.
- Grade I is mild; the tendon is usually overstretched with minimal to no tearing.
- Grade II is moderate, in which the tendon shows a partial tear.
- Grade III is severe and presents with a complete tear of the tendon, sometimes referred to as a tendon rupture.
What does a peroneal tendon injury feel like?
Peroneal tendon tears can present with common symptoms focused on the ankle and foot.
Symptoms of a torn peroneal tendon or injury include:
- Pain in the outer ankle
- Increased pain during inversion or eversion of the foot (turning and stretching it outward or inward, side to side)
- Warm to the touch where the tendon is injured
- Ankle swelling
- Reduced range of motion
- Ankle instability, especially around the outside of the ankle
- Ankle and foot weakness
Degenerative tears from overuse can lead to symptoms that appear intermittently or develop gradually. Acute tears resulting from injury cause sudden and easily recognizable pain.
How are peroneal tendon conditions diagnosed?
Almost all foot and ankle diagnoses begin with an examination. Our doctors will ask you about your medical history and then assess for pain and limited ankle movement. If pain is observed along the peroneal tendons, imaging, such as an X-ray, may be necessary to evaluate foot alignment and check for any fractures.
We also have access to ultrasound to examine tendon gliding, looseness (laxity), and to check for any small tears or scar tissue within the tendons.
If a tear is suspected, magnetic resonance imaging (MRI) may be necessary to examine the area and determine the size or extent of the tear. MRIs can also diagnose ankle issues such as ligament tears, arthritis, or cartilage damage.
What are the options for peroneal tendon tear treatment?
Dr. Baravarian always opts for conservative treatment options when possible. However, if nonsurgical treatment is insufficient, our foot and ankle surgeons are highly trained in surgical techniques for peroneal tendon tears.
Conservative care options for a peroneal tendon injury
Conservative treatment options include:
- Immobilization with a cast, splint, boot, or brace allows the area to rest and heal.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce inflammation and pain associated with tendinitis.
- Rest, ice, compression, and elevation (RICE).
- Physical therapy aims to enhance strength and mobility once the soft tissues have healed.
If the tendon does not respond to treatment after six weeks, surgery may be necessary.
How is a peroneal tendon tear treated with surgery?
If surgery is needed to repair your peroneal tendon, our doctor will assess the best procedure for your condition and lifestyle.
One option is tendon debridement, in which we create a small opening in the back of the ankle to clean out the damaged and inflamed tissue within the sheath that covers the tendon. Once cleaned, scar tissue is expected to fill in the sheath without any surgical repairs required.
Tendon repair can occur in several ways. We will access the tendon sheath to suture the tear or anchor the loose tendon to it. During tenodesis, a ruptured, unattached peroneal tendon can be reattached to a healthy tendon or bone.
If the tendon needs to be removed, Dr. Baravarian may use a tendon graft to repair the damaged structure by placing connective tissue from elsewhere in your body (autograft) or donor tissue (allograft) in place of the damaged tendon. If there is cartilage damage or loose or torn ligaments, these will be repaired simultaneously.
Peroneal tear surgeries are conducted at one of our outpatient surgery centers, using general anesthesia. Typically, peroneal tendon surgeries last about one and a half hours.
What should you expect after peroneal tendon repair surgery?
After orthopedic surgical repair of your torn peroneal tendon, the best remedy is rest and elevating your foot. It’s crucial to avoid putting weight on the foot.
We may provide you with an ankle splint for added support and immobilization. You will return to our office in about two weeks to have your sutures removed. At that time, your ankle splint will be replaced by either a short cast or a device known as a cam walker. You may begin weight-bearing activities with the cam walker in about a month.
You can start wearing normal footwear three to four months after surgery.
Why physical therapy is essential for your recovery
Working with his carefully selected physical therapists to strengthen your ankle will be crucial for your recovery and will be prescribed 8 to 12 weeks after the procedure. Physical therapy generally involves learning an ankle stretching routine and performing exercises to enhance the strength of the ankle and lower leg.
By adhering to a physical therapist’s routine, many patients can return to sports and activities within six months.
Dr. Baravarian is among the most experienced in treating peroneal tendon tears in California
Dr. Bob Baravarian has decades of experience treating various adult foot and ankle injuries. His expertise in sports medicine utilizes the latest technologies to successfully diagnose and treat peroneal strains and tears.
Dr. Baravarian is conveniently located for patients across Southern California and the Los Angeles area. Our foot and ankle surgeons are available at locations in and around Santa Monica, Beverly Hills, West Los Angeles, Sherman Oaks, the San Fernando Valley, El Segundo, the South Bay, LAX, Calabasas, Agoura Hills, Westlake Village, Valencia, Santa Clarita, and Santa Barbara.
Peroneal Tendon Tear FAQs
Can a peroneal tendon tear heal on its own?
A peroneal tendon injury typically does not resolve on its own. Mild tears require conservative treatment, such as rest and ice, for healing, while more severe tears may necessitate surgical repair.
Can you walk with a peroneal tendon tear?
Minor tears in the peroneal tendons usually won’t prevent you from walking, though you might experience pain and instability. A complete rupture of the peroneal tendon can lead to such instability in the ankle joint that you may be unable to walk properly, especially without significant pain.
How is a peroneal tendon tear different from an Achilles tendon tear?
You can typically distinguish between a peroneal tendon injury and an Achilles tendon injury by the pain’s location. Peroneal tendon injuries usually cause pain on the outside of the ankle and the outer part of the foot. In contrast, Achilles tendon issues tend to cause pain at the back of the heel, which can sometimes radiate upward to the calf.
